Supporting in-person learning by adopting layered prevention strategies in schools
Dr. Tasaduk Hussain Itoo
Schools form an important part in providing formal education, besides ensuring safe and supportive learning environments for students — that is crucial for their social, moral, ethical and emotional development. They impart discipline among students and improve their life outcomes, besides they provide a source of employment for people to work at.
However, with the burden of COVID-19 pandemic — protection against exposure remains a crucial concern in school settings. Because of the highly transmissible nature of SARS-CoV-2 (COVID-19 virus), in particular of its emerging variants like Omicron, along with mixing of vaccinated and unvaccinated people in schools, it is important to consider and adopt multiple layered preventive strategies to ensure safety of students, teachers, staff and other working force.
Though COVID-19 outbreaks have occurred in school settings as well, however, multiple studies have shown that transmission rates within school settings, when multiple prevention strategies are in place, are typically lower than or similar to community transmission levels.
Experts suggest that schools should work with regulatory agencies and state, local, and territorial public health departments, and in compliance with state and local policies and practices — consistent with applicable laws and regulations — to determine the layered prevention strategies needed, by monitoring levels of community transmission (low, moderate, substantial, or high) and local vaccine coverage in the community and among students, teachers, and staff; strain on health system capacity within the community; COVID-19 outbreaks or increasing trends in the school or surrounding community; accessibility of SARS-CoV-2 testing resources for students, teachers, and staff — including other aspects.
Moreover, school administrators and public health officials together can ensure safe and supportive environments and reassure families, teachers, and staff by planning and using comprehensive prevention strategies for in-person learning. And schools can work with parents to understand their preferences and concerns for in-person learning.
This article while considering current scientific evidence — emphasizes in implementing layered prevention strategies (using multiple prevention strategies together) to protect students, teachers, staff, and other members to largely support in-person learning.
The first crucial layered prevention strategy to resume school operations — is to promote vaccination among all eligible students as well as teachers, staff, and their respective household members, besides establishing supportive policies and practices that make getting vaccinated as easy and convenient as possible.
Vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. Scientific evidence suggests that people who have completed the primary series of full vaccination (and a booster when eligible) are at substantially reduced risk of severe illness and death from COVID-19 compared with unvaccinated people. Moreover, when infections occur among vaccinated people, they tend to be milder than among those who are unvaccinated.
Another layered preventive strategy is to encourage consistent and correct mask use among teachers, staff, and students irrespective of their vaccination status so that they protect others as well as themselves. It is recommended that consistent mask use is especially important indoors and in crowded settings, when advisable physical distancing cannot be maintained –classroom settings in schools justifies a crucial example.
Moreover, passengers and drivers must wear a mask on school buses, including on buses operated by public and private school systems regardless of vaccination status. And it is important that schools should provide masks to those students who need them (including on buses), such as for students who forgot to bring their mask or whose families are unable to afford them.
The third important layered preventive strategy is to implement physical distancing to the extent possible within the structures but should not exclude students from in-person learning to keep a minimum distance requirement. Scientific evidence based on recent studies suggests that schools maintain at least 3 feet of physical distance between students within classrooms, combined with indoor mask wearing to reduce transmission risk. However, when it is not possible to maintain a physical distance of at least 3 feet, such as when schools cannot fully re-open while maintaining these distances — it is especially important to layer multiple other prevention strategies — such as screening testing, cohorting, improved ventilation, hand washing and covering coughs and sneezes, staying home when sick with symptoms of infectious illness including COVID-19, and regular cleaning to help reduce transmission risk.
Cohorting is a good layered preventive strategy that means keeping people together in a small group and having each group stay together throughout an entire day. Cohorting can be used to limit the number of students, teachers, and staff who come in contact with each other, especially when it is challenging to maintain physical distancing, such as among young children, and particularly in areas of moderate-to-high transmission levels.
Screening testing forms a crucial prevention strategy to identify infected people — including those with or without symptoms (or before development of symptoms) who may be contagious, so that measures can be taken to prevent further transmission. In schools, screening testing can help promptly identify and isolate cases, initiate quarantine to help reduce the risk to in-person education. Screening testing may be most valuable in areas with substantial or high community transmission levels, in areas with low vaccination coverage, and in schools where other prevention strategies are not implemented.
Moreover, to facilitate safe participation in sports, extracurricular activities, and other activities with elevated risk — schools should consider implementing screening testing for participants. Schools can routinely test student athletes, participants, coaches, trainers, and other people (such as adult volunteers) who could come into close contact with others during these activities.
Another important COVID-19 prevention strategy is improving ventilation — that can reduce the number of virus particles in the air. Along with other preventive strategies, including wearing a well-fitting mask –bringing fresh outdoor air into a building(school classrooms) keep virus particles from concentrating inside — this can be done by opening multiple doors and windows (taking into consideration any safety concerns), using child-safe fans to increase the effectiveness of open windows, and making changes to the air filtration systems.
Encouraging hand washing with soap and respiratory etiquette (covering coughs and sneezes) is an another important layered prevention strategy to keep people from getting and spreading infectious illnesses including COVID-19. Schools can monitor and reinforce these behaviours and provide adequate hand washing supplies. Besides, the usage of hand sanitizers containing at least 60% alcohol should be encouraged for teachers, staff, and older students who can safely use them.
Another layered prevention strategy is that students, teachers, and staff who have symptoms of infectious illness, such as flu or COVID-19, should stay home and be referred to their healthcare provider for testing and care, regardless of vaccination status. Staying home when sick with COVID-19 is essential to keep COVID-19 infections out of schools and prevent spread to others. Schools should also allow flexible and supportive paid sick leave policies and practices that encourage sick workers to stay home without fear of retaliation, loss of pay, or loss of employment level, besides should provide excused absences for students who are sick.
The penultimate and an important layered preventive strategy is contact tracing in combination with quarantining — people who had close contact with someone with COVID-19 should follow the recommended guidelines to protect themselves and others. This also allows identifying which students, teachers, and staff with positive COVID-19 test results should isolate, and which close contacts should quarantine (as per latest scientific guidelines). For example, as per CDC — people who have symptoms can end isolation after 5 full days only if they are fever-free for 24 hours without the use of fever-reducing medication and if other symptoms have improved. They should continue to wear a well-fitting mask around others at home and in public for another few days.
The last but not the least prevention strategy is disinfection and cleaning. In general, cleaning once a day is usually sufficient to remove potential virus that may be on surfaces. Disinfection using recommended disinfectants removes any remaining germs on surfaces, which further reduces any risk of spreading infection.
More to say, proper protocols and layered precautionary measures should be in place for visitors, while providing food services or school meals, during the periods of recess and physical education and for other sports events and extracurricular activities.
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