Coronavirus

Operating schools during COVID-19: CDC’s Considerations

Summary of Recent Changes As of December 31, 2020 Incorporated new evidence about COVID-19 in children Updated language for clarity Updated language for consistency with other CDC COVID-19 guidance Updated language about keeping schools open, in addition to opening them for in-person learning Added information about animals in the classroom View Previous Updates Considerations for…

Summary of Recent Changes

As of December 31, 2020

  • Incorporated new evidence about COVID-19 in children
  • Updated language for clarity
  • Updated language for consistency with other CDC COVID-19 guidance
  • Updated language about keeping schools open, in addition to opening them for in-person learning
  • Added information about animals in the classroom

View Previous Updates

Considerations for schools

As communities in the United States consider how to safely re-open K-12 school buildings for in-person learning and activities and keep them open, CDC offers updated considerations for mitigation strategies that school administrators can use to help protect students, teachers, and staff and slow the spread of the virus that causes 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, as this may change rapidly. Strategies should be implemented in close coordination with state, local, or tribal public health authorities, 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).

Guiding principles to keep in mind

Opening schools for in-person learning as safely and quickly as possible, and keeping them open, is important given the many known and established benefits of in-person learning. In order to enable in-person learning and assist schools with their day-to-day operations, it is important to adopt and diligently implement actions to slow the spread of the virus that causes COVID-19 inside the school and out in the community. Implementing these actions in schools will reduce the risk of in-school spread of COVID-19 regardless of the underlying community burden – with risk being the lowest if community spread is low and proven mitigation strategies are implemented consistently.

COVID-19 in Children and Adolescents

While fewer children than adults have had COVID-19 in the United States, the number of school-aged children with COVID-19 has been increasing.1 Children and adolescents can be infected with the virus that causes COVID-19, can get sick with COVID-19, and can spread the virus to others.2

Most children and adolescents with the virus that causes COVID-19 have mild symptoms and some have no symptoms at all.2-4 The symptoms of COVID-19 are similar in adults and children and can look like other common illnesses, such as colds, strep throat, influenza, or allergies.2-4 Children, like adults, who are infected but have no symptoms can still spread the virus to others.5 For more information on symptoms of COVID-19 in children, visit COVID-19 in Children and Teens.

Children and adolescents with underlying medical conditions are at increased risk for severe illness from COVID-19. Additionally, some children may develop the rare but serious condition associated with COVID-19 called Multisystem Inflammatory Syndrome in Children (MIS-C). While the number of children who have been hospitalized with COVID-19 has been low compared with adults, one-third of hospitalized children with COVID-19 have been admitted to the intensive care unit.6 Most deaths in the U.S. from COVID-19 are among adults; however, children in the United States have died from COVID-19.7

Because children with the virus that causes COVID-19 can spread it to other children and to adults,2,5,8,9 it is important to take measures to minimize risk of spread in school settings. Implementation of multiple mitigation strategies can limit the spread of the COVID-19 in many settings.10,11 Application and adherence to multiple mitigation measures provided in this document help schools reopen and stay open safely for in-person learning.

Resuming and maintaining in-person learning may pose risks to children, teachers, school administrators, and other staff in the school environment, and their families and household members. Among adults, older age and having underlying medical conditions increases the risk for severe illness from COVID-19. For information about who is at increased risk, visit People at Increased Risk.

Deciding how to open for in-person learning

School officials should make decisions about school opening and about staying open for in-person learning based on CDC’s Indicators for Dynamic Decision-making. The many benefits of in-person schooling should be weighed against the risks of spreading COVID-19 in the school and community. Working with States, Tribes, Localities, and Territories (STLT), schools can weigh levels of community transmission and their capacity to implement appropriate mitigation measures in schools to protect students, teachers, administrators, and other staff.

Taking actions to reduce the spread of the virus that causes COVID-19

The virus that causes COVID-19 is mostly spread during close contact by respiratory droplets released when people talk, sing, breathe, cough, or sneeze. The virus that causes COVID-19 can sometimes be spread through the air by airborne transmission or through touching contaminated surfaces or objects. 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 learning model and implementation of proven mitigation strategies

In general, the risk of spread of COVID-19 in schools increases across the continuum of virtual, hybrid, to in-person learning. The risk for hybrid and in-person learning can be lowered depending on the mitigation strategies put in place and the extent to which they are 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, activites, and events.

Some risk:

  • Hybrid Learning Model, where most students and teachers participate in virtual learning and some students and teachers engage in in-person learning, with:
    • Small, in-person classes, activities, and events
    • Cohorting and alternating or staggered schedules, rigorously applied
    • No mixing of groups of students and teachers throughout/across school days
    • No sharing of objects between students and teachers
    • Students, teachers, and staff following all steps to protect themselves and others at all times including proper use of face masks, social distancing, and hand hygiene
    • Regularly scheduled and consistent (i.e., at least daily or between uses) cleaning of frequently touched areas

Medium risk:

  • Hybrid Learning Model, where most students and teachers engage in in-person learning and some students and teachers participate in virtual learning, with:
    • Larger in-person classes, activities, and events
    • Cohorting and alternating or staggered schedules applied with some exceptions
    • Some mixing of groups of students and teachers throughout/across school days
    • Minimal sharing of objects between students and teachers
    • Students, teachers, and staff following all steps to protect themselves and others such as proper use of face masks, social distancing, and hand hygiene
    • Regularly scheduled (i.e., at least daily or between uses) cleaning of frequently touched areas

Higher risk:

  • Students and teachers engage entirely in in-person learning, activities, and events with:
    • Some mixing of groups of students and teachers throughout/across school days
    • Some sharing of objects between students and teachers
    • Students, teachers, and staff following some steps to protect themselves and others such as proper use of face masks, social distancing, and hand hygiene
    • Irregular cleaning of frequently touched areas

Highest risk:

  • Students and teachers engage entirely in in-person learning, activities, and events with:
    • Students mixing freely between classes and activities
    • Students and teachers freely sharing objects
    • Students, teachers, and staff do not/are not following steps to protect themselves and others such as proper use of face masks, social distancing, and hand hygiene
    • Irregular cleaning 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 become sick with COVID-19 or be exposed to someone 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 can make multiple recommended changes to encourage behaviors that reduce the spread of the virus that causes 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 in-person school.

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 the consistent and correct use of masks. The use of masks is one of many important mitigation strategies to help prevent the spread of COVID-19. Masks offer some protection to the wearer and are also meant to protect others, in case the wearer is infected with the virus that causes COVID-19. Masks are not Personal Protective Equipment (PPE) (e.g., surgical masks, respirators).
  • Consistent and correct 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
  • Consistent and correct use of masks may be challenging for some students, teachers, and staff, including:
    • 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% 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 can make multiple recommended changes to physical spaces to maintain a healthy environment.

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 regularly. Use of shared objects (e.g., gym or physical education equipment, art supplies, toys, games) should be limited when possible. If shared objects are used, students should wash hands or use hand sanitizer before and after use.
  • 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 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. Students should wash hands or use hand sanitizer before and after 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 child-safe 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 fan placement to help draw fresh air into the classroom from open windows or to blow air from the classroom out open windows).
    • 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).
  • 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 the virus that causes COVID-19, 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

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