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Schools face outbreaks and quarantines as challenges of reopening emerge

In this Aug. 5, 2020, file photo, wearing masks to prevent the spread of COVID19, elementary school students use hand sanitizer before entering school for classes in Godley, Texas. (AP Photo/LM Otero, File)
In this Aug. 5, 2020, file photo, wearing masks to prevent the spread of COVID19, elementary school students use hand sanitizer before entering school for classes in Godley, Texas. (AP Photo/LM Otero, File)
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As schools across the United States begin to reopen under pressure to resume in-person classes, new data suggests school districts might face greater difficulties than some officials expected as they attempt to keep students and staff safe from the coronavirus pandemic.

A report published by the American Academy of Pediatrics and the Children's Hospital Association found at least 97,000 children tested positive for the virus in the last two weeks of July, amounting to a 40% increase in confirmed cases involving children. The report was based on incomplete data from 49 states, New York City, Washington, D.C., Puerto Rico, and Guam, so total child cases nationwide were likely even higher.

Nearly 9% of all known U.S. coronavirus cases involved children, as of July 30, but child fatalities remained rare, with children accounting for less than 1% of all COVID-19 deaths. As with adult cases, the South and the West saw the biggest surges in child coronavirus infections in July.

The rise in child cases came as schools in many states were preparing to reopen with students in classrooms for at least part of the week for the first time since March. Other school districts have opted to remain entirely virtual for at least the start of the school year, despite the hardships remote learning creates for children and parents, because officials do not believe in-person classes can be held safely.

Some districts that have required students to return to classrooms are already encountering complications. A Georgia school that was widely criticized last week after students shared photos of crowded hallways filled with mask-less teens online has revealed nine students and staff members tested positive for the coronavirus and the school building will close for cleaning temporarily.

Elsewhere in Georgia, Atlanta officials reported 12 students and two staff members across a dozen schools tested positive during the first week of classes. In Cherokee County, more than 250 students who were potentially exposed to the coronavirus were sent home to quarantine. Local officials in Cobb County have opted to keep classes virtual for the foreseeable future after more than 100 suspected cases involving students or staff were reported.

At least five schools in the Indianapolis area reported positive tests in the first week after they reopened, and nine cases have been linked to Corinth High School in Mississippi. More than 80 students in Putnam County, Tennessee were quarantined after a student there tested positive. Thales Academy in North Carolina announced last week an entire fourth-grade class would need to quarantine for two weeks because a student tested positive days after Vice President Mike Pence visited one of its locations and praised its reopening plan.

The Centers for Disease Control and Prevention has provided limited guidance on what to do once coronavirus cases have been identified in a school. It does not recommend closing schools over a single positive test, but if the virus spreads, administrators are advised to consult with local health officials on whether to shut down the building.

State and local officials in many areas where the school year is set to begin in late August or early September are still weighing options. Some are planning full or partial reopening of classrooms, while others are proceeding with full-time virtual learning.

In New York, Gov. Andrew Cuomo said Friday schools could reopen for in-person education this fall if coronavirus test positivity rates in the community are below 5%, but he left the choice in the hands of local officials. New York City, the largest school district in the country, is planning for a hybrid schedule where students can be in class a few days a week, but a final decision has not been made.

“If anyone can open schools, we can open schools,” Cuomo said.

After becoming the epicenter of the nation’s coronavirus outbreak this spring, New York has been more successful than most states at driving down transmission. Even with the virus spreading less rapidly than at its peak in July in much of the country, experts say many U.S. communities are not yet at a point where they can reopen schools without risking a surge in infections.

“If schools open, I think transmission of the virus in those schools is nearly certainly going to happen,” said Shira Shafir, an epidemiology professor at the UCLA Fielding School of Public Health.

According to Sarah Connolly, a microbiologist at DePaul University, eliminating that risk before schools open in the weeks ahead is likely impossible, but greatly increasing access to rapid testing technology and committing to aggressive social distancing measures could make returning to classrooms safer for students and teachers.

“We don't know when a vaccine will be available and how effective it will be,” Connolly said. “In the meantime, rapid testing could help open schools. The other thing that could get us back to school is very low rates of community spread. This will only happen if people continue to stay 6 feet apart, wear masks, wash hands, and stay home when sick.”

Meghan May, a professor of microbiology and infectious disease at the University of New England College of Medicine, also pointed to the lack of rapid testing as a significant impediment. Delays in obtaining test results could allow the virus to spread widely before students know they are infected.

“If an infected student does not receive results for five to 10 days, they will be spreading the virus to their peers, teachers, school staff, and families in the meantime,” May said. “If they receive results in less than one day, they will know to isolate and inform their presumably smaller number of contacts.”

The reopening of schools has become a politically volatile subject, with Democrats urging caution and President Donald Trump accusing those who want to continue remote learning of trying to damage his reelection bid and threatening federal funding of school districts that do not resume in-person classes. Some Republican governors have sought to force schools in their states to open, prompting anger and lawsuits from educators.

“We need to at least try to get to ‘yes,’ to the safest possible ‘yes,’ because the virus isn’t just going to magically go away. It’s going to be with us for some time,” Sen. Marco Rubio, R-Fla., said in a video posted to Twitter Monday, insisting the harm done by keeping schools closed might be graver than the threat of infection if they open.

Facebook and Twitter removed videos posted by President Trump and his campaign last week after he falsely claimed children were “almost immune” to the virus. While coronavirus cases in children are typically much less severe than in adults, there have been nearly 100 child deaths in the U.S. and recent research suggests children may spread the virus more easily than previously thought.

Last month, a broad study of thousands of coronavirus patients in South Korea found children between 10 and 19 can transmit the virus as much as adults, but younger children appear to transmit it far less. The authors acknowledged limited data on testing of children makes it difficult to draw definitive conclusions, though.

A study published in JAMA Pediatrics in late July found infected children younger than 5 carry a much higher viral load in their noses than older children. However, that research did not address the likelihood of transmission.

The CDC released a report last Friday indicating Black and Hispanic children are five to eight times more likely than White children to suffer symptoms that require hospitalization if they contract the coronavirus. The study also found nearly three-quarters of reported cases of multisystem inflammatory syndrome, a rare complication believed to be associated with COVID-19 in children, have been in Black and Hispanic children.

A CDC case study on an overnight youth camp in Georgia found at least 260 people tested positive for the coronavirus in the two weeks after a teenage staff member became infected in June. Researchers were unable to determine if all of the transmissions occurred at the camp and whether those who became ill followed social distancing rules, but they concluded the virus spread effectively in a “youth-centric overnight setting.”

Other countries have already reopened schools with varying degrees of success. In parts of Europe, schools opened with social distancing protocols in place after community transmission of the virus was reduced, but schools became a major source of infections in Israel after classes resumed there with fewer restrictions.

“We know that young children can spread the virus,” Connolly said. “Whether they spread it as well as adults may be less important.”

Uncertainty about how children transmit the virus and how sick they are likely to get if they catch it complicates the calculation of whether it is safe for a community to reopen schools, but experts say children are not the only consideration.

“We also know children are not the only people in schools,” Shafir said. “We need to think about teachers and custodians, the parents and grandparents.”

Still, proponents of resuming in-person education stress there are social, emotional, and academic dangers inherent in keeping children at home, as well. The CDC and the American Academy of Pediatrics have recommended reopening classrooms where possible, but officials have also acknowledged high rates of transmission could prevent that in many communities.

"The primary consideration should always be the safety, the health of the welfare of the children, as well as the teachers and the secondary effects for spreading to the parents and other family members," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last week.

There are steps school districts can take to mitigate the risks, such as mandating masks, establishing one-way passage in communal areas, distancing desks in classrooms, erecting Plexiglas barriers between students and teachers, and regularly disinfecting rooms. Schools that have experienced infections have sometimes failed to comply with these practices, either by not requiring masks or allowing students to congregate in larger groups.

“If districts do not follow them, or if schools are not properly resourced and supported to follow them, it is entirely predictable that these cases and the resultant recurring shutdowns and quarantines will continue,” May said.

Even if schools attempt to implement best practices, there is no guarantee children will adhere to them. Ensuring students keep their faces covered and stay six feet away from each other would present challenges for school administrators.

“Children under the age of 10 may not be as mask-complaint because they’re under the age of 10,” Shafir said. “They may not abide by social distancing, as well.”

Efforts to provide schools with additional federal funds to prepare for reopening have stalled in Washington, along with other stimulus measures. Executive action signed by President Trump over the weekend addressed some economic concerns—unemployment benefits, student loans, evictions—but any money to help schools will need to be appropriated by Congress.

Elementary and high school administrators had sought at least $175 billion in federal funding to help ensure classrooms could reopen safely. Senate Republicans had proposed $70 billion for K-12 education, with more than half of that reserved for schools that resumed in-person learning for at least half the week.

The American Federation of Teachers launched a half-million-dollar national ad campaign Monday targeting President Trump and Senate Majority Leader Mitch McConnell for failing to support a comprehensive stimulus package that includes more funding for schools.

“For more than two months, Mitch McConnell and the White House have been shouting that they want schools and the economy to reopen, while shamefully sitting on their hands and refusing to act on an actual relief package...,” said AFT President Randi Weingarten. “Signing executive orders that don’t address our real needs, including support for schools and child care, while effectively cutting unemployment and threatening Social Security, is a cynical and cruel political ploy.”

As the political jockeying continues, public health experts say the bottom line remains the same: if the coronavirus is spreading in the community, it will probably spread in the schools, and not enough has been done to slow the spread of the virus in many communities.

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“What we need to accept is that there is no shortcut back to normal,” May said. “I can say unequivocally that if communities want children back in school safely and consistently, the fastest way to do that is to knock down the spread of the virus by implementing and stringently sticking to the recommended guidelines, not just for schools, but for workplaces and public spaces as well.”

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