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COVID-19: Medical Considerations and Recommendations for Independent Schools

 

The following medical considerations and recommendations for independent schools regarding operations within the COVID-19 pandemic environment represent the professional knowledge and expertise of Dr. Benjamin Estrada and Dr. Nancy Wood.  Initially created for St. Paul’s Episcopal School in Mobile, Alabama, they have applicability for any independent school.  Drs. Estrada and Wood have graciously agreed to allow broad distribution of this document to the greater independent school community.  Their considerations and recommendations have been edited for clarity and adapted for independent school benefit by N. Blair Fisher, Head of School at St. Paul’s Episcopal School.

 

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Authors

Dr. Benjamin Estrada is a Pediatric Infectious Disease specialist in Mobile, Alabama and is affiliated with multiple hospitals in the area. He has been in practice for more than 20 years.

Dr. Nancy Wood works in Mobile, Alabama, specializing in Adolescent Medicine and Pediatrics.         Dr. Wood is affiliated with Mobile Infirmary Medical Center and Springhill Memorial Hospital.

N. Blair Fisher is the Head of School for St. Paul’s Episcopal School in Mobile, Alabama.  His 25-year career also includes service at The Walker School and Charlotte Preparatory School.

 

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COVID-19 Planning Considerations for Independent Schools

 

  1. Mitigation and social distance strategies seem to be working in reducing the number of expected deaths and limiting the burden on the health care system.  The effect of the mitigation strategies is now visible, with actual deaths far below initial mortality projections.  This is extremely positive news and points to the efficacy of the approach.
  1. At some point the economy and the country will have to re-start. Unfortunately, despite our desire for a return to normalcy, the full materialization of this goal is unlikely soon; the COVID-19 virus is now widely present across the country and it is likely that immunity may only be present in a small percentage of the population. Given the virus infectivity, which has now been corrected to an average of 5 individuals infected per infected index case, the percentage of the population that needs to be immune before the epidemic stops is 81%. This can only be achieved by the development of “herd immunity” through natural infection and recovery, or by broad vaccination efforts.
  1. Until an effective vaccine is developed and widely administered, this disease will continue to affect communities across the country; the number of cases and deaths will be directly dependent on the strength of the mitigation measures in place.
  1. It should be fully anticipated that several additional waves of infection are likely to affect any given community until a vaccine is available. The disruption caused by these waves could be significant, especially during the fall when COVID combines with influenza and other respiratory infections.
  1. Given this likelihood, schools will have to develop innovative plans for continuation of activities over the next 18-24 months.
  1. It is impossible at this time to determine exactly when it will be safe to re-start school activities. In order to prepare for an eventual return, institutions where mass or group gatherings are expected (including schools) need to have sound onboarding plans to protect students, faculty, and families. These plans should include:
    1. Screening for recent signs of infection and recent diagnosis
    2. Screening for recent contact with diagnosed individuals and persons under investigation
    3. Institutional ability to provide social distance physical barrier measures
    4. Well-delineated processes for communication with public health authorities in charge of contact tracing.
  1. Schools would be wise to delay physical instruction activities until provided assurance by state and local officials that the rate of transmission has decreased significantly in their region, to levels that are equal to or less than those present at the time the decision was made to cease physical instruction.
  1. Once some form of physical instruction re-starts, a “new normal” including social distance, significant sport limitations, and a hybrid of on-line and physical instruction should be considered.
  1. A potential strategy to deal with the reality of the epidemic could be to provide physical instruction during the periods of the year when the epidemic curve reaches bottom and to re-start online instruction when additional waves develop.
  1. During the times when physical instruction is available, strategies such as wearing face masks, mandatory exclusion from school for symptomatic students, and mandatory negative COVID test results for infected students or faculty/staff members before returning to school should be considered. Students with sick contacts at home who have been diagnosed or evaluated for COVID should remain in mandated quarantine at home for recommended periods before they are able to return to normal activities. Such protocols are important given that individuals can continue to shed the virus for 7-21 days after initial infection.
  1. The demographic group less affected by death and severe disease requiring hospitalization is children younger than 19 years of age. However, children younger than 19 and adults younger than 30 are also the group most likely to be asymptomatic when they are infected. This implies a significant potential of exposure to older faculty who are at risk of developing more severe disease if appropriate measures such as mandatory use of face masks and physical distance are not in place.
  1. A close and trusting partnership between the school administration and community must be created and in order to ensure understanding, cooperation, and support in COVID prevention and mitigation strategies.  Clear and open communication is vital to overall success.
  1. It should be emphasized to the school community that such stringent mitigation strategies are designed not only to protect the students but also to protect the more vulnerable members of the school community and staff.
  1. Maintaining social distancing requirements or other protective measures (gloves, masks, etc) would be particularly difficult with very young students, who developmentally aren’t able to continually hold those requirements in their mind.  Schools will have to think very carefully about how to serve these young children in a physical environment.
  1. Schools should have plans in place for students who would be considered at elevated risk for severe COVID complications (asthmatics, diabetics, immunosuppressed, etc).
  1. To minimize the burden of a combined flu and COVID season during the fall/winter, influenza immunization should be mandatory.
  1. Strict environmental cleaning strategies should be in place around the clock for any gathering areas such as classrooms, cafeteria, gymnasia, and restrooms.
  1. Environmental service personnel should be provided with appropriate personal protective equipment to limit their exposure to potentially contaminated environments.
  1. It should be anticipated that athletics pose a significant risk of transmission if infected participants are involved, even if asymptomatic.  It is unlikely that traditional sports seasons at all levels will occur during the 2020-2021 season.  There should be in-depth discussion about the risks involved in sports participation for the school, athletes, and their families.  
  1. A specific program for school athletes, including regular screening and continuous surveillance, should be in place. This implies the ability to perform tests with rapid turnaround time and the ability to provide on-line instruction for athletes in case they need to be isolated or quarantined.
  1. When athletics are eventually re-started, these should be played without live, densely clustered audiences in order to enforce social distance requirements.
  1. Even if a school’s area is not currently experiencing an infection wave, playing sports in locations where the epidemic curve may be concerning should be avoided (i.e. “away” games in areas of active epidemic outbreak)
  1. Cafeteria gatherings should involve student separation and pre-made lunch boxes for pick-up. Given that the virus is transmitted by contact, the use of communal food or drink stations of any kind should be discouraged.
  1. School chapel activities should avoid the implementation of physical communion and ideally be held online to prevent mass gatherings.
  1. Activities which enhance the dispersion of airborne particles, such as instrument playing, chorus, or drama productions should be limited and monitored for physical separation.
  1. Schools must weigh the benefits and risks entailed in auxiliary activities such as after-school programs, summer programs, and the like.
  1. A potential alternative to enhance safety between epidemic waves could be a rethinking of instructional periods; i.e. to re-start physical instruction during the summer months of June/July/August once the epidemic curve has decreased, and to minimize physical instruction during the predicted peak COVID winter months.

 

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