Medical Health Cluster

15 enero, 2022


Communities around the United States held their breath in fall 2021 when most children and teachers returned to school in person. The start of the school year was relatively uneventful thanks to vaccines, masks, physical distancing in classrooms, and, in some cases, improved ventilation in school buildings. But by the holidays, the highly contagious omicron variant had emerged, causing a worldwide spike in cases and localized community spread that led to increasing infection rates within schools.

There are no easy answers when it comes to opening or closing schools in year three of the COVID-19 pandemic. Omicron cases continue to climb, and more children than ever are being hospitalized as the health care system is overwhelmed. Schools aren’t seen as vectors of the disease, yet no indoor gathering space is immune to omicron. But if schools close, even temporarily, there are ripple effects as caregivers take time off from work to be at home, and children suffer from learning loss and social isolation. Here, experts from across Johns Hopkins weigh in on best practices for students, teachers, and families.

A case for weekly testing

David Dowdyassociate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health

This week has been the first time since the beginning of the pandemic that my own daughter (a high schooler) has said that she would prefer to be virtual than in-person. I would personally support an approach of consistent weekly testing, with a short-term move to virtual learning if positivity levels are above a high threshold (for example, more than 5% of students, or 50 students per school, testing newly positive). And return promptly to in-person learning once positivity levels fall below that level. But schools should only move to virtual if other distancing measures are being taken to slow the spread—it makes no sense to close schools while keeping restaurants, bars, and gyms open at full capacity. For students and teachers who themselves are infected, exposed, or immunocompromised, we need to do everything we can to preserve their educational experience—and livelihood—in the midst of any surge. And re-evaluate frequently, expecting that waves can arrive quickly but are unlikely to last more than a few weeks in any one place.

A nationwide shortage of substitute teachers

Robert Balfanzprofessor, Center for Social Organization of Schools at the Johns Hopkins School of Education

Schools should stay open. It is clear that virtual schooling is disruptive for teachers, students, and parents resulting in multiple negative consequences. But the real question is given omicron can schools stay open? What is often missed in debates about school closures is there is a nationwide substitute teacher shortage. What was in many ways a thankless job before the pandemic has come to be seen as something to be avoided. Part of this is the labor market—there are more opportunities that pay better—and part of it is being a substitute teacher during a pandemic means not knowing what you’re walking into, as different schools have different safety protocols and cultures. When schools can’t find substitutes, teachers have to give up their planning periods to teach the classes of absent teachers. With omicron, some schools will reach a breaking point: There will be more teachers out sick or in quarantine than there are teachers who can take their classes. At this point, schools cannot operate because students cannot be left unattended. Nor will students in classrooms without teachers be learning. So, in order to keep schools open, we need to find a solution to the substitute crisis.

A more nuanced, collaborative approach

Annette Andersondeputy director of Johns Hopkins Center for Safe and Healthy Schools

By now, the fervor building since before winter break around the safety of reopening schools has reached a fever pitch. Social media has quickly and openly laid bare positions in stark contrast to each other, with prominent figures publicly disagreeing with one another. Unfortunately, it appears that everyone has been forced to choose between two bad options: Stay open, and unconscionably risk the health and safety of students and staff, or close, and risk the mental health of the same. Luckily, we have more options. Given that this is year three of the pandemic, we need to find a better way to prepare for a possible onslaught of future variants that could continue to disrupt our schools. Our current situation demonstrates a missed opportunity for better transparency and communication. Parents are frustrated by ambiguous, sometimes contradictory messaging. I think it’s important to own that some parents and school staff who are now calling for a pivot to remote learning feel gaslit and condescended to in conversations with some public health professionals. We have officials demanding that schools reopen by relying on data alone. Johns Hopkins has the unique opportunity to approach this crisis with the best research from both the public health and education fields. If anything, this impasse makes it clearer than ever that we always need to seek to understand first.

Keep mental health in mind

Jennifer Katzensteindirector of psychology and neuropsychology and co-director of the Center for Behavioral Health at Johns Hopkins All Children’s Hospital

This is a complex issue, and I encourage families to evaluate their own circumstances and make the decision that is best for them, especially if there are any immunocompromised individuals in their home or “bubble.” Returning to school in-person must include appropriate physical distancing, mask-wearing, vaccination, and all appropriate precautions in place. I encourage a family to understand the complexity of virtual education and determine if this is an appropriate learning style for their child, as well as if the delivery of the education is sufficient to meet the needs of their child. Social interaction is protective against anxiety and depression, thus the importance of social interactions provided via in-person school should be considered. Further, in person schooling provides childcare for our overtaxed parents and caregivers whose mental health has been challenged throughout the pandemic—not only stress surrounding the pandemic in general, but also worries related to childcare, job security, and for some, balancing remote work with virtual school. With safety precautions and PPE in place, returning to school in-person may be a mentally healthy choice for the entire family.

A comprehensive approach

Andrew Pekoszprofessor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health

There are some things that are so important we need to find a way to make them happen even though this COVID-19 pandemic is not over yet. Getting our children back in school is one of these things. There are safe ways to bring students back to in person learning while also minimizing the chances of SARS-CoV-2 spread. A comprehensive approach involving masks, regular testing, attention to high-risk behavior, options for hybrid learning and vaccination of all eligible individuals will limit transmission in schools. None of these should be taken off the table because all add layers of protection that together make up a safe learning environment.

Mitigation measures make schools safer

Gigi Gronvallassociate professor at the Johns Hopkins Bloomberg School of Public Health and senior scholar at the Center for Health Security

This is an extremely stressful, uncertain time for everyone. We have been navigating changes in policy and what we know about the virus since March 2020, and people are exhausted. The decisions around keeping schools open are difficult, in large part because not all schools have done the same things to protect children and staff. Many schools in the U.S. never switched to remote learning, some schools remained open without any mitigation measures at all, and private schools have generally not closed, even in 2020, with a variety of mitigation measures in place. My children go to Baltimore City Public Schools, and after virtual learning began in 2020, many of their classmates left to go to private/parochial schools and will not return to public schools. I fear another exodus from public schools will occur here and more broadly if they close or go virtual again. But, at this point school closures are unnecessary, because we now know the mitigation measures to make schools safe for students and staff, and the federal government made funding available to implement many of these measures: Ideally, staff should be vaccinated (and boosted), students should be vaccinated, everyone should be masked, there should be portable HEPA air filter devices in all classrooms, mechanical ventilation mechanisms should be run at the highest level of filtration possible (MERV-13 or better), there should be a surveillance testing program to identify cases, as well as symptomatic testing and a test-to-stay program to identify positive cases in surveillance testing. I am comfortable with in-person school in Baltimore City because they are using the tools we have: masks, ventilation, testing, and vaccination to protect teachers, students, administrators, and communities. Of course, there is more work to do, and for the long-term, it will be important to increase the currently low vaccination rates in K-12 students across the country.

Prioritize schools to keep families safe

Elizabeth Stuartprofessor in the departments of Mental Health, Biostatistics, and Health Policy and Management in the Johns Hopkins Bloomberg School of Public Health

While it may feel like we’re back in 2020 or 2021 in terms of continued debates about in-person schooling, it’s important to remember that we are in a very different place now. We have more tools at our disposal—most crucially vaccinations for kids 5 and up and more access to tests. And we also know better now what works to prevent COVID-19 transmission in schools. As colleagues and I found in research using data from across the United States, schools are not necessarily safe in that without adequate protections, in-person schooling can increase COVID-19 risk in households, especially when community transmission rates are high. But importantly, they can be made safe. In particular, strategies such as universal masking, symptom checks, improved ventilation, vaccination of as many people as possible, and strategic use of PCR and rapid antigen tests can make schools safe. Given the substantial concerns about the short- and long-term implications of virtual schooling on children and adolescents, it is crucial for schools to be prioritized and given the resources to help them open safely.

Keeping kids in school is a community effort

Keri Althoffassociate professor at the Johns Hopkins Bloomberg School of Public Health

We know how to greatly reduce the likelihood of COVID-19 transmission in schools with distancing, correct and consistent masking, and ventilation. Keeping kids in school during COVID-19 is a community effort, with parents reducing their family’s exposure to the virus during non-school hours—for example ordering in instead of eating out and outdoor playdates—and keeping kids at home when they are not well; staff and teachers protecting themselves with vaccination and reduced exposures during non-school hours; community members volunteering when staffing shortages from illness occur; and all community members being mindful of their role in transmission to others, including children, staff, and teachers. And, of course, vaccinating and boosting eligible children increases their protection from severe COVID-19 illness and helps keep them in the classroom.

Créditos: Comité científico Covid

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