As an educator and a parent, as well as a physiologist, I am concerned for the path we are on with school closures. I am well aware of and respect the concerns teachers. I am also well aware of and respect the needs of parents, as well as students. The challenge that is before us—and one that I don’t believe we are addressing—is the long-term effect of the decisions that are being made regarding the reopening of schools in light of COVID-19.
In an e-mail from our Superintendent, we were told: “In a recent meeting with health and state officials, we were told that even with the required safety protocols, physical distancing, cohorting requirements, and contact tracing, under these conditions with the infection rate as high as it is in our county, we WILL have virus outbreaks in our schools. These outbreaks would require the quarantine of students and staff for several weeks and the shutdown of in-person learning. Repeated opening and closing of classrooms and schools would continue until the virus is better contained.”
I whole-heartedly understand the predicament, but there is a rabbit hole in the information school officials are receiving. COVID-19—more specifically, 2019-nCoV—is a virus. It is virus that has its origin in a non-human host. As such, it is not going to disappear, even with a successful vaccine. We have had 2 similar viruses (i.e., beta-coronavirus), as well as the H1N1 influenza (swine flu), reach pandemic levels in the last 20 years. The likelihood of other novel coronaviruses surfacing in the near future is great. As such, it is easy—albeit unpopular—to see that virus outbreaks in our schools are inevitable. Closing schools with each outbreak is unfeasible. We have to look beyond the present virus.
Personally, I am fine with sending my children back to school in September. (I am personally fine with returning to my in-person college classroom.) I do, however, understand the apprehension among teachers/staff and parents. As such, we have to address these concerns for the long-term. We have to consider the likelihood of viral spread of any virus. (Viruses, after all, do seriously affect long-term health and may kill people.)
This particular virus (2019-nCoV) does not affect children in the same way it affects older adults and persons with certain pre-existing conditions (e.g., hypertension , heart disease, diabetes, obesity, etc.). The next nCoV, however, may not be a kind to children. 2019-CoV severity has been linked to the effects of what is referred to as the “cytokine storm”—a hyper-immune response to which certain populations are more vulnerable. In the case of COVID-19, it is imperative that the most vulnerable be protected. Herein is the challenge. There is uncertainty remaining as to how the virus spreads and, more specifically, how to identify who might be a carrier. Much of this confusion and uncertainty is driven by partial and misinformation shared via social media. Thus, we have to be careful not to make decision based on fear and hysteria. Instead, we have to make decisions that will make the education environment safe—not only amidst the COVID-19 pandemic, but when the next flu season or other outbreaks arrive.
Statistically, our children are quite safe from the current virus. Most teachers, given that the median age of teachers is rather young, are safe, too. While some teachers and school staff are at greater risk, there are precautionary measures that can be taken. (Frankly, these same precautionary measures should be taken without the threat of 2019-nCoV. Afterall, these same individuals are likely at greater risk of any viral infection.) So, long-term school closure may not be warranted. It is also worth noting that school is one of the best places for children to develop the adaptive immune system. I, personally, fear that the negative implications on the immune system from prolonged quarantine far outweigh the risk of 2019-nCoV infection for most children.
The most effective protective measures against viral spread are well-known: proper hand-hygiene, social distancing, and mask wearing (albeit the latter two of these is subject to debate over the specifics, as I will discuss). Below, I offer my suggestions—for what it might be worth.
Proper hand-hygiene. I would hope that proper hand-washing is a skill that all kindergarteners bring with them on the first day of school. If not, they certainly should be “graduating” from kindergarten with this skill. Now is a great time to be emphasizing the importance of hand-washing with our children (and some adults may stand a refresher, as well). Expecting a child to not touch things is unrealistic. For many kinesthetic learners, hands-on learning is quite literal. Excessive hand-washing or sanitizing, however, can be detrimental to the development of a healthy adaptive immune system. Nevertheless, it is possible to expect kids to wash frequently at school and for frequently touched surfaces to be kept clean. Activities like wiping desks clean can be a regular part of the daily school activities. Sharing of items can be kept to a minimum.
Social distancing. Six-feet is actually a rather arbitrary number. The literature actually supports 1-meter (approximately 3 feet) as a safe distance for limiting viral spread. Of course, greater distance provides greater protection. Social distancing is relative to risk. The greater the risk of infection (i.e., being a high-risk carrier or a high-risk recipient) the greater the distance that is warranted. In the case of COVID-19, children are at a rather low risk. As we look at social distancing in the classroom, it is obvious that the current schools are not designed for 6-ft social distancing and current (often excessive) class sizes. Three feet, however, is a bit more reasonable and manageable. (It should also be expected that what can regulated in the classroom will not be the likely scenario when children are free to play outside of school. I have rarely seen children observing “social distancing” while playing outside.) At best, we can mitigate the possible spread by managing classroom arrangement and making the most safe and effective use of the classroom.
Masks. Masks are effective, but not always necessary. Moreover, masks are effective only when used properly. I have rarely seen a child use a mask properly. It also merits consideration whether we will demand students, teachers, and staff wear masks with all subsequent outbreaks. Ideally, masks will become common place when children, staff, and teachers are potentially contagious—no matter the virus.
For children, the challenge is wearing the mask—properly or otherwise. The options are numerous and what is most comfortable should be considered best for the individual child. We also have to allow leeway for children who might find wearing a mask physiologically and/or psychologically uncomfortable.
For teachers/staff, the challenge is finding facial coverage that protects them and their colleagues, as well as allows them to teach effectively. The standard N95/KN95 or surgical masks are effective, but can muffle the teacher’s voice and hides facial expression. For many students—particularly those with hearing impairment or other special needs—being able to see the teacher’s face and mouth is imperative. As such, masks are far less than ideal. As an alternative, many are considering face shields. Something to consider, however, is that most shields are intended to protect the eyes and supplement traditional masks. Without covering the mouth/nose, traditional face shields offer little protection against viral aerosols. In the event that the wearer might cough or sneeze, the viral-infected droplets and aerosols will be directed down and out through the open base of the shield. While the shield defends against the forward projection of droplets, those which escape the shield will land on any surface or person below and in near proximity. Several teachers have found the ZVerse Flex1 to be an ideal alternative. (They offer youth sizes, as well.) This option provides coverage from the bottom up and allows a safe and unobstructed view of the teacher’s face.
Studies have shown that even health care workers are as likely as any of us to let their social distancing and masking habits to slip when they are on break from direct patient care. It is not unlikely that teachers and staff will let their guards down in the faculty lounge where the risk of transmission is greatest. Here is where social distancing and mask protection are most warranted—and least likely to be followed. As such, we need strict standard operating procedures. Procedures that won’t end when COVID-19 is in our rearview mirrors.
COVID-19 might be here for years to come. Certainly is not the last virus of pandemic scale. There will be cases of this and other viruses to appear at varying scales in our schools. Ideally, we will keep the cases to zero, however, this is probably not reasonable. We cannot open and close schools with every outbreak. Our best route is to take a proactive and preventative approach. As such, we must invest in the future (re)design of schools to provide optimal air circulation and classroom health. Proper HVAC design and air filtration are necessary. Windows should be able to be opened without sacrificing student safety. Large scale disinfection should be possible—and done on daily basis (e.g., UV-C, disinfectant fog, etc.). Now is the time to be creative and forward-thinking. Now is not the time for knee-jerk reaction and panic.
Parents and teachers have valid fears, and such fears need to be addressed. In the process, however, we cannot lose focus on the physiology of viral infection and immunity. We also cannot impose our selfish will on others. Now is a time to come together and act in community. The challenge is not insurmountable.
Be your best today; be better tomorrow.
Carpe momento!
1 https://zshields.zverse.com/collections/available-products/products