Frequently Asked Questions
MIAAP Responds to FAQs Ask From School Districts
1. What should happen if a COVID-19 case occurs in a school?
Addressing the individual case
The MIAAP has produced a flow diagram detailing recommended steps to take if a potential case is identified within a school building (see below).
Addressing the school setting
Specific school protocols, such as those surrounding cohorting, will affect how many children and staff should be excluded from a school building after a COVID-19 case occurs. Strict cohorting policies will be very helpful for schools to be able to identify contacts, and to limit the effects of such an exposure event.
In the event of a COVID-19 at school, school personnel should plan to notify the local health department immediately for guidance. Next steps could include exclusion of portions of a classroom and other known contacts outside the classroom, an entire classroom, or potentially an entire school. The closure of an entire school has been suggested as necessary if there is evidence of continued transmission within a school building that has not been mitigated by less aggressive means.
2. How should school districts decide whether to choose in-person or virtual school, or potentially move between those options?
At this point, there is no standardized approach to deciding whether a community should offer virtual, hybrid, or full in-person school. Most algorithms suggest making this decision primarily on the COVID-19 burden within a community, although other considerations are also important, such as a district’s ability to pursue virtual learning, a district’s ability to put necessary safety measures in place for in-person learning, and any unique needs of that community’s students and staff. Algorithms for school opening most commonly use the following three data points: 1) the percent positivity rate for testing--as a measure of whether enough testing is being done to accurately understand incidence, 2) incidence of new cases per 100,000, and 3) incidence trend over time.
Although the specific cutoffs will be debated and different communities will likely settle on different numbers, one algorithm (PolicyLab, 2020) suggests looking for <5% positivity rate and ≤10 per 100,000 weekly new cases (calculated as a 7-day rolling average) + stable or decreasing incidence in order to reopen schools for in-person instruction. A partial reopening for younger or special needs children would be considered for <5% positivity rate and 10-35 per 100,000 weekly new cases + stable or decreasing incidence. This policy also suggests continuing the current level of in-person school at 5%-9% positivity rate, stable or decreasing incidence, and no evidence of transmission within a school. Communities with >9% positivity rates are recommended to return to online learning only. It is likely that numerous different policies will be created over the coming weeks and months, and that those policies will end up being adjusted as data regarding the safety and risks of in-person school accumulate over the course of the fall.
3. What are best practices for disinfecting school buildings?
The CDC has provided recommendations for routine cleaning and disinfection protocols, as well as recommendations on how to proceed if a COVID-19 case occurs in a building.
Routine cleaning and disinfection
This link includes considerations for routine cleaning and disinfection of community spaces: https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html, including:
• If the surface is not touched frequently, routine cleaning with soap and water is sufficient.
• Disinfection is not recommended for outdoor surfaces. Typically, pre-COVID-19 cleaning protocols can remain in place for outdoor spaces.
• If the area has not been used for at least 7 days, usual cleaning protocols are sufficient.
• High-touch surfaces (e.g. tables, desks, countertops, light switches, door handles, faucets, toilets, keyboards, and touch screens) should be disinfected at least daily, with more frequent disinfection depending on level of use. Items should be cleaned between each use as much as possible.
The CDC has created a toolkit specifically for school disinfection: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/clean-disinfect-hygiene.html#Safe. Schools should create a cleaning and disinfection plan appropriate to their environment, train staff on appropriate use of disinfectants and necessary PPE, and develop a cleaning and disinfection schedule. Appropriate disinfection products for COVID-19 are listed here: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19, or a dilute bleach solution can be used (a recipe is included in the school toolkit link above).
Within the school disinfection toolkit, two one-page printable handouts exist:
• “Six steps for properly cleaning and disinfecting your school” https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/Six-Steps-for-Cleaning-Disinfecting-school.pdf
• “For teachers: cleaning and disinfecting classrooms” https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/cleaning-disinfecting-school-classrooms.pdf
Disinfection after an identified COVID-19 within a school
CDC guidance regarding how to proceed in the event of a COVID-19 case in a school or community building exists in the school disinfection toolkit above and also here: https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html.
If a COVID-19 case is identified in a school building, the following steps are recommended by the CDC:
• Close off the area used by the person with COVID-19.
• Increase ventilation to the area by opening outside doors or windows before disinfection.
• Wait as long as possible before starting disinfection. If possible, wait 24 hours.
• Clean and disinfect surfaces in all rooms used by the person with COVID-19, including offices, bathrooms, and common areas.
o Give particular attention to high-touch surfaces.
o Cleaning with soap and water should occur before disinfection.
o Use an approved disinfectant. https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19
• Work with the local health department to identify whether a more significant closure of part or all of the school is warranted.
Reference
PolicyLab Policy Review. (2020, August 19). Evidence and Considerations for School Reopenings. Children’s Hospital of Philadelphia. Retrieved from: https://policylab.chop.edu/sites/default/files/pdf/publications/PolicyLab-Policy-Review-Evidence-Considerations-School-Reopenings-2020.pdf
What Guidance Exists Regarding Mask Exemption Requests for Children Attending In-Person School?
The CDC and AAP note the following situations where face coverings should not be used:
Children younger than 2 years old.
Anyone who has trouble breathing or is unconscious.
Anyone who is incapacitated or otherwise unable to remove the cloth face covering without assistance.
Beyond these contraindications, the AAP has not provided guidelines regarding specific medical conditions, but rather encourages decisions in the medical home by the primary care physician to evaluate each child on a caseby-case basis in partnership with the family and subspecialist(s). Read more.
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Return To Play After Coronavirus Infection?
More Information:
Sources: American Academy of Pediatrics (Copyright © 2020)
Centers for Disease Control and Prevention (Copyright © 2020)