Coronavirus

Operating schools during COVID-19: CDC’s Considerations

Updates have been made to align with the new school resources and tools that were released on July 23rd and 24th and the latest COVID-19 information. Changes to the considerations as of August 21, 2020: Expanded considerations on planning and preparing schools before opening Updated considerations on ventilation Updated considerations on food service Updated considerations for…

Updates have been made to align with the new school resources and tools that were released on July 23rd and 24th and the latest COVID-19 information.

Changes to the considerations as of August 21, 2020:

  • Expanded considerations on planning and preparing schools before opening
  • Updated considerations on ventilation
  • Updated considerations on food service
  • Updated considerations for students who may be unable to wear masks
  • Updated considerations for students with special healthcare needs and disabilities
  • Updated considerations on cohorting, staggering, and alternating strategies
  • Updated considerations on recognizing signs and symptoms of COVID-19 and screening
  • Updated considerations on coping and support
  • Updated considerations on making plans for accommodations
  • Updated considerations for Direct Service Providers (DSPs)

Considerations for schools

As communities in the United States consider how to safely re-open K-12 school buildings and in-person services, CDC offers updated considerations for mitigation strategies that K-12 school administrators can use to help protect students, teachers, and staff and slow the spread of COVID-19.  These updated Considerations for Schools are intended to aid school administrators as they consider how to protect the health, safety, and wellbeing of students, teachers, staff, their families, and communities:

  1. Promoting behaviors that reduce COVID-19’s spread
  2. Maintaining healthy environments
  3. Maintaining healthy operations
  4. Preparing for when someone gets sick

Schools should determine, in collaboration with state and local health officials to the extent possible, whether and how to implement each of these considerations while adjusting to meet the unique needs and circumstances of the local community. Implementation should be guided by what is feasible, practical, acceptable, and tailored to the needs of each community. It is also critically important to develop strategies that can be revised and adapted depending on the level of viral transmission in the school and throughout the community and done with close communication with state and/or local public health authorities and recognizing the differences between school districts, including urban, suburban, and rural districts. These considerations are meant to supplement—not replace—any Federal, state, local, territorial, or tribal health and safety laws, rules, and regulations with which schools must comply (e.g., Individuals with Disabilities Education Actexternal icon).

School-based health facilities may refer to CDC’s Guidance for U.S. Healthcare Facilities and may find it helpful to reference the Ten Ways Healthcare Systems Can Operate Effectively During the COVID-19 Pandemic.

Guiding principles to keep in mind

Everyone’s goal is to prioritize the reopening of schools as safely and as quickly as possible given the many known and established benefits of in-person learning. In order to enable this and assist schools with their day-to-day operations, it is important to adopt and diligently implement actions to slow the spread of COVID-19 inside the school and out in the community. Vigilance to these actions will moderate the risk of in-school transmission regardless of the underlying community burden – with risk being the lowest if community transmission is low and there is fidelity to implementing proven mitigation strategies.

The statement The Importance of Reopening America’s Schools this Fall highlights that parents and school leaders are very eager for schools to reopen, but understandably concerned about the health and safety of their children during the COVID-19 pandemic.

Children and COVID-19

In general, children with COVID-19 are less likely to have severe symptoms than adults or experience an asymptomatic infection – meaning they do not have any signs or symptoms of disease (1-7).

Analysis of pediatric COVID-19 hospitalization data from 14 states from early March to late July 2020 found the cumulative rate of COVID-19–associated hospitalization among children was over 20 times lower compared to adults (8.0 versus 164.5 per 100,000 population) (8). Although the cumulative rate is low, one in three children hospitalized with COVID-19 was admitted to an intensive care unit so the risk is not negligible (8). Similarly, the death rate among school-aged children is much lower than the rate among adults (9, 10). Also, the comparatively low risk for hospitalization and death among children themselves must be contextualized to the risk posed to teachers, school administrators, and other staff in the school environment. The risk of teachers, school administrators, and other staff in the school is expected to mirror that of other adults in the community if they contract COVID-19.

To be sure, the best available evidence from countries that have reopened schools indicates that COVID-19 poses low risks to school-aged children – at least in areas with low community transmission. That said, the body of evidence is growing that children of all ages are susceptible to SARS-CoV-2 infection (3-7) and, contrary to early reports (11, 12), might play a role in transmission (7, 13, 14).

The many benefits of in-person schooling should be weighed against the risks posed by COVID-19 spread. Of key significance, in-person learning is in the best interest of students, when compared to virtual learning. Application and adherence to mitigation measures provided in this document and similar to those implemented at essential workplaces can help schools reopen and stay open safely for in-person learning.

Deciding how to reopen

School officials should make decisions about school reopening based on available data including levels of community transmission and their capacity to implement appropriate mitigation measures in schools to protect students, teachers, administrators, and other staff. Schools should also consider other aspects of students’ risk and wellbeing that arise when schools do not reopen for in-person classes. This includes the potential adverse impacts on students’ social-emotional, behavioral, and mental health, as well as the critical services provided to students to help mitigate health disparities and serve children in need, such as school lunch programs, special education services, after-school programs and mental health services.

The unique and critical role that schools play makes them a priority for reopening and remaining open, enabling students to receive both academic instruction and enable the provision of other critical services and supports. By strictly implementing mitigation strategies, schools will be able to meet the needs of their students and community, while reducing the risk of COVID-19 spread.

Taking actions to lower the risk of COVID-19 spread

COVID-19 is mostly spread by respiratory droplets released when people talk, cough, or sneeze. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own eyes, nose, or mouth. Therefore, personal prevention practices (such as handwashing, staying home when sick) and environmental cleaning and disinfection are important principles that are discussed below. Fortunately, there are a number of actions school administrators can take to help lower the risk of COVID-19 exposure and spread during school sessions and activities.

In order to reach the goal of reopening schools as safely and as quickly as possible for in-person learning, and help schools remain open, it is important to adopt and diligently implement actions to slow the spread of COVID-19 inside the school and out in the community.  This means that students, families, teachers, school staff, and all community members take actions to protect themselves and others where they live, work, learn, and play.

Continuum of risk

By model of learning and implementation of proven mitigation strategies

In general, the risk of COVID-19 spread in schools increases across the continuum of virtual, hybrid, to in-person learning with the risk moderated for hybrid and in-person learning based upon the range of mitigation strategies put in place and the extent they are conscientiously followed.

While not exhaustive, this stratification attempts to characterize the risks of spread among students, teachers, and staff across this continuum:

Lowest risk:

  • Students and teachers engage in virtual-only classes, activities, and events

Some risk:

  • Hybrid Learning Model: Some students participate in virtual learning and other students participate in in-person learning
  • Small, in-person classes, activities, and events
  • Cohorting, alternating schedules, and staggered schedules are applied rigorously
  • No mixing of groups of students and teachers throughout/across school days
  • Students and teachers do not share objects
  • Students, teachers, and staff follow all steps to protect themselves and others at all times including proper use of face masks, social distancing, hand hygiene
  • Regularly scheduled (i.e., at least daily or between uses) cleaning and disinfection of frequently touched areas implemented with fidelity

Medium risk:

  • Hybrid Learning Model: Most students participate in in-person learning, some students participate in virtual learning
  • Larger in-person classes, activities, and events
  • Cohorting, alternating schedules, and staggered schedules are applied with some exceptions
  • Some mixing of groups of students and teachers throughout/across school days
  • Students and teachers minimally share objects
  • Students, teachers, and staff follow all steps to protect themselves and others such as proper use of face masks, social distancing, hand hygiene
  • Regularly scheduled cleaning and disinfection of frequently touched areas largely implemented with fidelity

Higher risk:

  • Students and teachers engage in in-person only learning, activities, and events
  • Students minimally mix between classes and activities
  • Students and teachers share some objects
  • Students, teachers, and staff follow some steps to protect themselves and others at all times such as proper use of face masks, social distancing, hand hygiene
  • Irregular cleaning and disinfection of frequently touched areas

Highest risk:

  • Students and teachers engage in in-person only learning, activities, and events
  • Students mix freely between classes and activities
  • Students and teachers freely share objects
  • Students, teachers, and staff do not/are not required to follow steps to protect themselves and others such as proper use of face masks, social distancing, hand hygiene
  • Irregular cleaning and disinfection of frequently touched areas

Plan and prepare

Emergency operations plans: review, update, and implement EOPs

The most important actions for school administrators to take before reopening in-person services and facilities are planning and preparing. To best prepare, schools should expect that students, teachers, or staff may contract symptoms consistent with COVID-19, and schools must know what to do when this happens. Regardless of the number of cases in a community, every school should have a plan in place to protect staff, children, and their families from the spread of COVID-19 and a response plan in place for if/when a student, teacher, or staff member tests positive for COVID-19. This plan should be developed in collaboration with state and local public health departments; school nurses, parents, caregivers, and guardians; student leaders; community members; and other relevant partners. Schools should prioritize EOP components that address infectious disease outbreaks and their consequences.

  • Reference key resources on emergency preparedness while reviewing, updating, and implementing the EOP.

School nurses, teachers, staff, parents, student leaders, and other community stakeholders (e.g., youth service organizations, health centers, etc.) should be involved in the development of the Emergency Operations Plans (EOP). Some of the strategies school administrators should consider while developing their EOP:

  • Develop a protocol for monitoring local COVID-19 data in your community to keep track of the level of community transmission, to make decisions about changes to mitigation strategies, and to help determine whether school closures may be necessary. This should include daily review of official public health data for the community surrounding the school. Contact the state, local, tribal, or territorial Public Health Department for references to local COVID-19 data.
  • Develop and test information-sharing systems (e.g., school-to-parent email or texting protocols, periodic virtual meetings with parent/teachers, etc.) with school and community partners and key stakeholders. Use institutional information systems for day-to-day reporting on information that can help to detect and respond to an outbreak, such as number of cases and absenteeism or changes in the number of visits to the health center by students, teachers, and other staff.
  • Adopt mitigation strategies to promote healthy behaviors that reduce the spread of COVID-19, maintain healthy school environments and operations, and plan what to do if a student, teacher, or staff member gets sick.
  • Examine the accessibility of information and resources to reduce the spread of COVID-19 and maintain healthy environments and determine whether they are culturally relevant, in plain language, and available in appropriate languages and accessible formats.
  • In consultation with local officials, establish transparent criteria for when the school will suspend in-person learning to stop or slow the spread of COVID-19, as well as transparent criteria for when to resume in-person learning.
  • Assess students’ special needs (such as continuing education, meal programs, and other services) and develop strategies to address these needs if in-person learning is suspended or if a student needs to self-isolate as a result of a diagnosis of or exposure to COVID-19.
  • Ensure the EOP takes into consideration students with disabilities, students with special healthcare needs, students experiencing homelessness, migrant students and those with English learners, etc.

Promote behaviors that reduce spread of COVID-19

Schools may consider implementing several strategies to encourage behaviors that reduce the spread of COVID-19.

Staying home when appropriate

Educate staff and families about when they/their child(ren) should stay home and when they can return to school.

  • Actively encourage employees and students who are sick or who have recently had close contact (less than 6 feet for fifteen minutes or more) with a person with COVID-19 to stay home. Develop policies that encourage sick employees and students to stay at home without fear of reprisal, and ensure employees, students, and students’ families are aware of these policies. Consider not assessing schools based on absenteeism, and offering virtual learning and telework options, if feasible.
  • Staff and students should stay home if they have tested positive for or are showing COVID-19 symptoms.
  • Staff and students who have recently had close contact with a person with COVID-19 should also stay home and monitor their health.
  • CDC’s criteria can help inform when employees should return to work:

Hand hygiene and respiratory etiquette

  • Teach and reinforce handwashing with soap and water for at least 20 seconds and increase monitoring to ensure adherence among students and staff.
  • Encourage staff and students to cover coughs and sneezes with a tissue. Used tissues should be thrown in the trash and hands washed immediately with soap and water for at least 20 seconds.
  • If soap and water are not readily available, hand sanitizer that contains at least 60% alcohol should be used (for staff and older children who can safely use hand sanitizer).

Masks

  • Teach and reinforce use of masks. The use of masks is one of many important mitigation strategies to help prevent the spread of COVID-19. Masks are meant to protect other people in case the wearer is unknowingly infected but does not have symptoms. Masks are not Personal Protective Equipment (PPE) (e.g., surgical masks, respirators).
  • Appropriate and consistent use of masks is most important when students, teachers, and staff are indoors and when social distancing is difficult to implement or maintain. Individuals should be frequently reminded not to touch the face covering or mask and to wash their hands or use hand sanitizer frequently. Information should be provided to staff, students, and students’ families on proper use, removal, and washing of masks.
  • Masks should not be placed on:
    • Children younger than 2 years old
    • Anyone who has trouble breathing or is unconscious
    • Anyone who is incapacitated or otherwise unable to remove the mask without assistance
    • Younger students, such as those in early elementary school (Pre-K through 3rd grade).
    • Students, teachers, and staff with severe asthma or other breathing difficulties.
    • Students, teachers, and staff with special educational or healthcare needs, including intellectual and developmental disabilities, mental health conditions, and sensory concerns or tactile sensitivity.
  • While masks are strongly encouraged to reduce the spread of COVID-19, CDC recognizes there are specific instances when wearing a mask may not be feasible. In these instances, parents, guardians, caregivers, teachers, staff, and school administrators should consider adaptations and alternatives whenever possible. They may need to consult with healthcare providers for advice about wearing masks.
  • People who are deaf or hard of hearing—or those who care for or interact with a person who is hearing impaired—may be unable to wear masks if they rely on lipreading to communicate. This may be particularly relevant for faculty or staff teaching or working with students who may be deaf or hard of hearing. In this situation, consider using a clear mask that covers the nose and wraps securely around the face. If a clear mask isn’t available, consider whether faculty and staff can use written communication (including closed captioning) and decrease background noise to improve communication while wearing a mask that blocks your lips.
  • Masks are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the mask coughs, sneezes, talks, or raises their voice. This is called source control.
  • In addition to those who interact with people who are deaf or hard of hearing, the following groups of teachers and staff may also consider using clear masks:
    • Teachers of young students (e.g., teaching young students to read).
    • Teachers of students who are English language learners
    • Teachers of students with disabilities
  • Clear masks should be determined not to cause any breathing difficulties or over heating for the wearer. Clear masks are not face shields. CDC does not recommend use of face shields for normal everyday activities or as a substitute for masks because of a lack of evidence of their effectiveness to control the spread of the virus from the source for source control.

Adequate supplies

Ensure you have accessible sinks and enough supplies for people to clean their hands and cover their coughs and sneezes. Supplies include soap, a way to dry hands (e.g., paper towels, hand dryer), tissues, hand sanitizer with at least 60 percent alcohol (for staff and older children who can safely use hand sanitizer), disinfectant wipes, masks (as feasible) and no-touch /foot-pedal trash cans (preferably covered).

Signs and messages

  • Post signs in highly visible locations (e.g., school entrances, restrooms) that promote everyday protective measurespdf icon and describe how to stop the spreadpdf icon of germs (such as by properly washing hands and properly wearing a maskimage icon). Signs should include visual cues (such as clear, easy-to-understand pictures demonstrating the healthy behaviors) at the appropriate reading and literacy level.
  • Broadcast regular announcements on reducing the spread of COVID-19 on PA systems.
  • Use simple, clear, and effective language about behaviors that prevent spread of COVID-19 when communicating with staff and families (such as on school websites, in emails, and through school social media accounts). If feasible, provide communication in multiple languages.
  • Use communication methods that are accessible for all students, faculty, and staff, including those with disabilities.
  • Translate materials into common languages spoken by students, faculty, and staff and people in the school community.
  • Find freely available CDC print and digital resources on CDC’s communications resources main page. CDC also has American Sign Language videos related to COVID-19 and other communication tools.

Maintaining healthy environments

School administrators may consider implementing several strategies to maintain healthy environments.

Cleaning and disinfection

  • Clean and disinfect frequently touched surfaces (e.g., playground equipment, door handles, sink handles, drinking fountains) within the school and on school buses at least daily or between use as much as possible. Use of shared objects (e.g., gym or physical education equipment, art supplies, toys, games) should be limited when possible, or cleaned between use.
  • Develop a schedule for increased frequency of routine cleaning and disinfection.
  • If transport vehicles (e.g., buses) are used by the school, drivers should practice all safety actions and protocols as indicated for other staff (e.g., hand hygiene, masks). To clean and disinfect school buses or other transport vehicles, see guidance for bus transit operators.

Shared objects

  • Discourage sharing of items that are difficult to clean or disinfect.
  • Keep each child’s belongings separated from others’ and in individually labeled containers, cubbies, or areas.
  • Ensure adequate supplies to minimize sharing of high touch materials to the extent possible (e.g., assigning each student their own art supplies, equipment) or limit use of supplies and equipment by one group of children at a time and clean and disinfect between use.
  • Avoid sharing electronic devices, toys, books, and other games or learning aids.

Ventilation

Consider ventilation system upgrades or improvements and other steps to increase the delivery of clean air and dilute potential contaminants in the school. Obtain consultation from experienced Heating, Ventilation and Air Conditioning (HVAC) professionals when considering changes to HVAC systems and equipment.  Some of the recommendations below are based on the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Guidance for Building Operations During the COVID-19 Pandemicexternal icon. Review additional ASHRAE guidelines for schools and universitiespdf iconexternal icon for further information on ventilation recommendations for different types of buildings and building readiness for occupancy. Not all steps are applicable for all scenarios.

Improvement steps may include some or all of the following activities:

  • Increase outdoor air ventilation, using caution in highly polluted areas.
    • When weather conditions allow, increase fresh outdoor air by opening windows and doors. Do not open windows and doors if doing so poses a safety or health risk (e.g., risk of falling, triggering asthma symptoms) to children using the facility.
    • Use fans to increase the effectiveness of open windows.  Position fans securely and carefully in or near windows so as not to induce potentially contaminated airflow directly from one person over another (strategic window fan placement in exhaust mode can help draw fresh air into room via other open windows and doors without generating strong room air currents).
    • Decrease occupancy in areas where outdoor ventilation cannot be increased.
  • Ensure ventilation systems operate properly and provide acceptable indoor air quality for the current occupancy level for each space.
  • Increase total airflow supply to occupied spaces, when possible.
  • Disable demand-controlled ventilation (DCV) controls that reduce air supply based on occupancy or temperature during occupied hours.
  • Further open minimum outdoor air dampers to reduce or eliminate HVAC air recirculation. In mild weather, this will not affect thermal comfort or humidity. However, this may be difficult to do in cold, hot, or humid weather.
  • Improve central air filtration:
    • Increase air filtrationexternal icon to as high as possible without significantly diminishing design airflow.
    • Inspect filter housing and racks to ensure appropriate filter fit and check for ways to minimize filter bypass
    • Check filters to ensure they are within service life and appropriately installed.
  • Consider running the HVAC system at maximum outside airflow for 2 hours before and after the school is occupied.
  • Ensure restroom exhaust fans are functional and operating at full capacity when the school is occupied.
  • Inspect and maintain local exhaust ventilation in areas such as restrooms, kitchens, cooking areas, etc.
  • Use portable high-efficiency particulate air (HEPA) fan/filtration systems to help enhance air cleaning (especially in higher risk areas such as the nurse’s office).
  • Inspect and maintain local exhaust ventilation in areas such as bathrooms, kitchens, cooking areas, etc.
  • Use portable high-efficiency particulate air (HEPA) fan/filtration systems to help enhance air cleaning (especially in higher risk areas such as nurse’s office and special education classrooms).
  • Generate clean-to-less-clean air movement by re-evaluating the positioning of supply and exhaust air diffusers and/or dampers (especially in higher risk areas such as the nurse’s office).
  • Consider using ultraviolet germicidal irradiation (UVGI) as a supplement to help inactivate SARS-CoV-2, especially if options for increasing room ventilation are limited.
  • Ventilation considerations are also important on school buses.

*Note: The ventilation intervention considerations listed above come with a range of initial costs and operating costs which, along with risk assessment parameters such as community incidence rates, facemask compliance expectations and classroom density, may affect considerations for which interventions are implemented.  Acquisition cost estimates (per room) for the listed ventilation interventions range from $0.00 (opening a window; inspecting and maintain local exhaust ventilation; disabling DCV controls; or repositioning outdoor air dampers) to <$100 (using fans to increase effectiveness of open windows; or repositioning supply/exhaust diffusers to create directional airflow) to approx. $500 (adding portable

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