State agencies offer advice on public school openings

The Department of Health and Senior Services (DHSS) and the Department of Elementary and Secondary Education (DESE) released a document recently that answers frequently asked questions about K-12 school reopening health-related guidance.

The document aims to provide additional clarity and consistency for Missouri school leaders and public health officials as they make decisions about school reopening strategies at the local level. There are no statewide health mandates related to K-12 school reopening being issued at this time, and it is important to note that local school boards and local jurisdictions have the authority to implement more stringent or less restrictive preventative measures than those listed in this document.

Across the country, the majority of health officials, educators and families seem to agree: they want to reopen schools this fall, but in a way that continues to protect public health.

“While closing school buildings in March was necessary, there are a number of serious consequences that can come from our students not attending school in-person,” Commissioner of Education Margie Vandeven said. “These implications are being considered along with the continued risk of COVID-19. Therefore, school leaders and local health officials are working thoughtfully to reopen our schools – knowing that school operations must take place differently to better protect public health and combat the spread of the virus.”

How should K-12 schools screen students for COVID-19?

K-12 schools should implement a process for daily screening for symptoms of and exposure to COVID-19. Parents and caregivers should be empowered to screen children for symptoms at home, prior to coming to school, and should be provided with a checklist that includes the following symptoms and exposure:

• Fever or chills

• Cough

• Headache

• Muscle aches

• Nausea, vomiting or diarrhea

• New loss of taste or smell

• New runny nose or congestion

• Shortness of breath or difficulty breathing

• Sore throat

• Close contact with a person with COVID-19 in the last 14 days

Screening

This list is subject to change as new symptoms of COVID-19 are identified and schools should be prepared to educate families regarding additional symptoms of concern. Parents should assess their children for fever. It is important to note, however, that temperature screenings are of low sensitivity and performing those checks in-person at school has the potential to create lines/groups of students.

Students with symptoms should not attend school and parents should consult their healthcare provider and follow CDC considerations regarding their return to school. For students who are diagnosed with COVID-19, either by a laboratory test or based on their symptoms, return to school is permissible when the student is at least 10 days from symptom onset, has had three days with no fever and has improving symptoms. Return to school for children with an alternate diagnosis is at the discretion of their healthcare provider and/or the school nurse. Children with a known close contact with COVID-19 or an adult with symptoms compatible with COVID-19 should stay home for 14 days from their last contact and until return to school is approved by the local health department in accordance with the CDC guidance.

Schools should broadly communicate the importance of keeping students home when they feel sick. At-home screening reinforces that decision and reminds families how important that choice is, as it helps to further protect other students, school staff members, and communities as a whole. Performing a daily screening before a student arrives at school also reduces the likelihood that a student will have to be isolated at school and sent home after experiencing COVID-19 symptoms.

Should schools screen students for COVID-19 onsite?

Children should be visually inspected for signs and symptoms of illness as they enter the school and/or classroom. School leaders may also elect to perform additional symptom or temperature screening at school, but should ensure those procedures do not force bottlenecks at building entry points, creating unnecessary situations where students cannot maintain adequate physical distance from one another.

How should K-12 schools screen staff members for COVID-19?

Health data continues to reveal that adults are much more likely to spread the novel coronavirus than children, unlike other viruses (e.g. influenza) where children are more likely to transmit the virus to others. Therefore, school staff members should self-screen at home, following the same protocol listed above for families screening students at home. Schools should also screen staff members upon entry to the building each day, and that screening may include a temperature check.

How should K-12 schools screen visitors for COVID-19?

Schools should limit visitors inside the building during the upcoming school year. Schools should identify options to conduct meetings with families remotely via conference call or videoconference so parents can continue to engage with teachers such as parent-teacher conferences and participate in necessary discussions such as  Individualized Education Program (IEP) and 504 plan meetings; discipline conversations.

If visitors are unable to join a remote meeting or conduct their business without entering the building, schools should screen the visitor for COVID-19 by asking questions about symptoms and performing a temperature check, and then limit the visitor’s movement throughout the school building. Schools may consider a designated visitor space/room where physical distancing measures are enforced. A record of visitors inside the school should also be kept, and it should include areas of the school that were visited and the time the visitor entered and exited the building.

Why is physical distancing important?

Physical distancing is one measure that has been demonstrated to reduce the spread of the novel coronavirus. Distances of three to six feet may be effective in reducing viral transmission. However, a person is considered a “close contact” of a case of COVID-19 if they are within six feet of the case for more than 15 minutes. Close contacts of cases require quarantine for 14 days from the last exposure. By observing physical distancing in schools and reducing contacts, we can limit the number of children (and staff members) who will need to quarantine if a positive case occurs in school.

What physical distancing measures should K-12 schools have in place to protect against the spread of COVID-19?

Schools should assign students to cohorts and limit their exposure to other cohorts within the building. This means that students should stay with the same group of students and adults throughout the day. If classes must rotate, schools should consider rotating teachers, rather than moving groups of students throughout the school building. Strict adherence to a specific size of student groups should be discouraged, as this may limit the ability to provide in-person education. Schools should also implement and enforce assigned seating, and keep records of those seating charts to assist with identifying close contacts in the event a member of the school community is diagnosed with COVID-19.

Cohorting may not be feasible for middle and high school students and thus, assigned seating can help to reduce contacts among older students.

Other physical distancing measures to consider:

• Schools should limit the mixing of cohorts of students to the extent possible.

• Students should be spaced as far apart as possible. Six feet apart is best; when that’s not possible, schools should make efforts to ensure a minimum of three feet of space between students.

• Desks should be placed facing forward in the same direction so students do not sit face-to-face.

• Schools should place physical distancing markers and cues throughout the building, which will remind and prompt students to remain six feet apart in areas where they are not stationary, such as hallways, cafeterias, restrooms and other locations where lines assemble.

• Schools should require hand hygiene before and after students move from one space to another within the building. Proper hand hygiene information can be found here and should be shared with students of all ages.

How should physical distancing take place on a school bus?

School bus transportation may not readily allow for physical distancing. However, strategies to reduce contact on buses and risk of infection can include:

• Screening of COVID-19 symptoms at home prior to getting on the bus.

• Encouraging hand hygiene upon boarding the bus.

• Assigning students to seats so contacts are stable.

• Seating siblings together.

• Loading the bus from back to front.

• Encouraging the use of face masks during transport.

• Having windows open when safe and weather-permitting.

• Providing bus drivers and monitors onboard with personal protective equipment, such as face masks and face shields and/or eye protection, as long as these do not impair driving.

• Installing physical barriers such as plexiglass between the driver and students, if feasible.

Schools may also ask families that are able to transport their students to and from school or arrange for carpools, when possible, to reduce the number of students riding buses in the upcoming school year.

How should physical distancing take place during meal times?

Keep students in cohorts during meal times and, when possible, have students eat in their classrooms rather than moving through the school building. Schools may consider bringing meals directly to classrooms but should make efforts to ensure nutritional value and appealing menu choices are not sacrificed. For older students, multiple separate lunch periods may be created and alternate locations, such as an outdoor environment or large indoor spaces such as the gymnasium, may be used for lunches with proper supervision.

How should physical distancing take place during recess and physical education?

Physical activity during recess and physical education class is important for a child’s physical, mental and emotional health. Students should engage in these activities with their primary cohorts to the extent possible to reduce the number of contacts. Multiple cohorts could have recess at the same time, as long as they are playing in separate areas of the playground.

If possible, individual equipment used during recess and physical education such as balls, jump ropes could be separated by cohort to reduce the need for disinfecting between uses. If that is not possible, individual equipment should be cleaned between uses. Stationary playground equipment does not need to be cleaned, with the exception of handrails and other high touch surfaces, which should be cleaned in accordance with CDC guidelines. Schools should require hand hygiene before and after recess and physical education.

Are there other creative ways schools can arrange for physical distancing?

School leaders should consider leveraging space in innovative ways. Large spaces, such as multi-purpose rooms and auditoriums could be marked and utilized to account for appropriate physical distancing. The risk of transmitting the virus outdoors is much lower, so schools may also consider using outdoor learning spaces more often.

How should physical distancing take place during music class, given the conversation around the higher rate of COVID-19 transmission during singing?

In local areas with ongoing community transmission, chorus and band classes should be controlled. School leaders should be advised that the risk of transmission during music and band classes increases in older grades. When considering music classes, ensure that students remain in cohorts and are appropriately physically distanced. Holding these classes outdoors would be a safe alternative. When cohorting and/or physical distancing cannot occur, consider alternative music classes such as virtual instruction, music technology, music theory, and music appreciation.

Should K-12 students and staff wear face coverings?

Face coverings are an important strategy to reduce transmission of the novel coronavirus, primarily by reducing the spread of infection from the wearer to those around. Young children may have difficulty complying with the proper use of face coverings and may have increased face touching, mask chewing, mask trading, and other behavior that could increase risk of infection. For this reason, continuous usage of face coverings is not recommended for young children.

Older children, such as those in middle and high school, are likely to be able to follow guidance regarding proper mask usage. Additionally, these students are less easily cohorted. Thus, the use of face coverings can provide an additional layer of protection against the spread of infection.

Face coverings should be considered for all age groups during periods when students are not cohorted or cannot physically distance such as in hallways or during entry and dismissal periods. As noted above, it is also appropriate for all students to wear masks or face coverings while riding the bus.

Schools should consider how to best deliver training to students on the safe and proper use of masks, accounting for the training most appropriate for the age group. Local leaders are encouraged to stay informed about CDC guidance and recommendations on face coverings.

Should K-12 staff members wear face coverings?

It is recommended that school leaders require school staff members to wear face coverings, as the data indicates COVID-19 transmission is more likely from adult to student, than from student to adult. Face coverings should be worn by staff members at all times when they are in close proximity to students or other staff members. In lecture formats, where the teacher is stationary and appropriately physically distanced from students, face coverings may not be necessary. In some circumstances, such as when working with young children or deaf or hard of hearing students, the need to convey facial expressions and mouth movements is important; in these circumstances, the use of a clear face shield is preferred to no face covering at all. As noted above, bus drivers and monitors onboard a school bus should wear personal protective equipment.

Any teacher or staff member who is working closely with symptomatic children must wear medical grade masks and eye protections to ensure that staff are protected.