School leaders and decision-makers all across the country are trying to make decisions about whether to open schools for in-person education, when to open schools, and how to open schools safely both for students and their faculty and staff. These decisions are all the more difficult because unfortunately, for many parts of the country, there is significant community spread of the virus, school boards and leaders for the most part are not public health experts, there are significant political pressures and there are liability risks.
There certainly is guidance available from the CDC and the American Academy of Pediatrics. Obviously, complying with that guidance will be of significant help in defending a liability lawsuit, whereas decisions to depart from that guidance will create greater risk. Further, a decision to depart from the guidance may create job security risks for those leaders who are employed or political risks for those who are elected if we have the kinds of outbreaks and illness that has occurred at summer camps or that ends up contributing to strained hospital capacity. But, even with the guidance, there will be many unanswered questions, and boards and leaders would be well-advised to seek additional guidance from local public health agencies and medical experts.
Even a decision to follow the guidance may be challenging, especially with the fact that face masks and face coverings (for ease, I will subsequently refer to both as “face masks” or “masks”) have unfortunately become a political, emotional, and philosophical issue that strongly divides us, despite wide-spread agreement among medical experts, scientists and public health organizations that face masks, if worn correctly and by a sufficiently large enough percentage of the population, will significantly reduce the transmission of the SARS-CoV-2 virus when it is not possible to physically distance. The challenges for school boards and leaders who cave to the pressure not to mandate masks are that they will potentially be under pressure from teachers’ unions or associations concerned about protecting teachers’ health and lives, and potentially significant liability risks as rules of evidence will generally not allow for experts to introduce these political, emotional and philosophical arguments that are not supported by science or the expert community at large to be introduced in court as a defense.
My best advice to school boards and leaders is to undertake your due diligence, examine the guidance from the CDC, AAP and other reputable public health and medical organizations and then ask the following questions of the medical and public health experts who are advising you on your reopening policies, as a key element of coming to the best policy for your particular school or school district is to be fully informed of the risks and benefits, and a key element of defense in a liability action is to show that you were diligent in asking and considering the advice of experts. It may be helpful to ask and have these questions answered on the record both to demonstrate to the public your diligence, but also to create a record for your potential defense.
- Does the degree of community spread that we are seeing in our communities significantly increase the risk of exposure and transmission of the virus in our classrooms and school buildings that would then be likely to increase illness among our school children and staff?
- While there is evidence that children, if infected, tend to experience less serious illness, have there been children of the ages of our school children who have experienced severe enough illness to require hospitalization?
- If so, is there any effective way that we can identify which of our students could potentially develop serious illness so that we can take additional precautions to protect those students? If so, what would those additional precautions be?
- Studies suggest that the majority of children who are infected remain asymptomatic. If so, will symptom checkers or temperature screenings be able to identify those students who might then pose a risk of attending classes and transmitting the virus?
- If we cannot identify these students and parents are not aware that their child is sick and therefore know to keep their child home from school, what are the most effective means to prevent an infected, but asymptomatic (or pre-symptomatic) child from transmitting the virus to staff and students?
- What lessons can we learn from the outbreaks at summer camps that are applicable to our school reopening?
- This fall and winter, like every school year before the coronavirus, children will be exposed to a number of respiratory viruses and we know that many of these will be transmitted among students. Plus, we fully expect to have another influenza epidemic in the US. So, at points in time, the school is likely to have a number of children with fevers, coughs and runny noses. Because of the high disease activity of coronavirus across many parts of the country and disruptions in the supply chain, current testing for coronavirus is quite commonly delayed and often taking as much as 1 – 2 weeks for test results to come back. Since the Trump Administration has not announced any new strategies to address this testing logjam, we might assume that testing will continue to be a challenge this fall. If we have children who are ill, but we have these delays in testing, how are we going to know whether one or more of these children has infection with the SARS-CoV-2 virus and whether classmates and their teacher may have been exposed? I assume that we cannot close the school or quarantine teachers and classmates every time a student has a cold until we can get test results back a week later to confirm that is the case. What would our action be?
- One of the concerns about school reopening is that children may be exposed to the virus and while they are likely not to suffer severe illness, they may take the virus home with them. Do we know what percentage of our school’s children live with or stay with a vulnerable adult? Are there additional precautions we need to take for these children?
Dr. Pate's blog 
Dr. Pate, Thank you for drafting these well-crafted questions for school districts and school leaders. I was the “anonymous” teacher listening to the panel on yesterday’s Idaho Matters program and who had my question read aloud to the panel. I left the program feeling like my question was completely skirted and that the only “issue” the panel heard was about first graders wearing masks all day. That is the very least of my concerns. I am literally terrified to go back to an in-person classroom environment and my colleagues in my neighborhood school share this concern. We’re being asked to risk our lives, not to mention the lives of others/students, in order for the State of Idaho to receive federal money. We all know that this has become a political issue and no one from the State Board of Education or the the Boise School District will stand up and properly address concerns about reopening too soon; only HOW we’re opening, and the protocols and procedures for addressing Covid. In my opinion, that’s NOT how we keep staff and students safe. Remote learning or a delayed school year does. The community spread in Ada County is becoming increasingly alarming. Yesterday’s Covid positive numbers about knocked me out of my seat! I don’t see how we can significantly reduce these numbers in less than 4 weeks when my school district plans to open it’s doors to thousands of students and staff. I do my part by wearing a mask and staying home except for essential grocery shopping and have been doing so since March. But that’s not enough when so many people refuse to wear masks, even though mandated in Ada County, and take away my right to remain healthy. I am sharing your blog post with Lisa Roberts, Deputy Superintendent and Coby Dennis, Superintendent of the Boise School District. I completely respect you as a physician and former CEO of SLHS and trust what you have to say and the questions you have raised that must be answered. Again, thank you!
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Thank you, Samantha for your note, but more importantly for being a teacher! I so appreciate the dedication and commitment of our teachers, but especially all the comments from teachers I hear and read and how evident it is that they love and care for our kids.
I am very sorry for the fear and concerns you and other teachers have.They are very reasonable. I completely understand, because I have experienced many of these same emotions when I had to care for people with unknown new infections, but of course, unlike school, we could not delay and I had to take care of these patients when they became sick before we understood how to contract or treat the illness.
I don’t think you will have to worry too much for right now, because I see that the Central District Health just came out with their Category rating for Ada County and it is Category 3, or what some refer to as red. My understand that public schools in Boise and West Ada will not open as long as we are in that category and those categories get updated at two week intervals. Therefore, I fully expect you to be beginning the school year online. I am very hopeful that this may send a powerful message to the community that we have to take this seriously and take these precautions to lower the spread of the disease so that we can get schools opened safely.
Thanks for following the blog!
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Nobody has talked about PE classes. High school students are expected to dress down for PE, which is fine. However, things are different now. Many locker rooms do not have adequate ventilation, and I’m concerned about social distancing when kids are getting dressed for class, not once but twice. Then the next class comes in. This goes on for several periods a day. And what about the sharing of sports equipment and weights in PE classes? Can you offer any suggestions what might work best for students and teachers? I’m very concerned for my safety as a PE teacher, thank you.
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Hi Mike. I have addressed some questions from parents about specific sports. While there are some, like wrestling, that I can’t figure out how they could be done safely; there are others like cross-country track, pole vaulting and swimming that I could. However, I point out to all of these parents that even though there are safe ways to do many of these sports, the other point to be considered is what is else is occurring. For example, it likely is pretty safe for a swimmer to be swimming laps. But, swimmers should not be wearing masks while they are swimming and if members of the swim team are congregated at pool-side while their teammate is in the pool and they don’t have their masks on and they are yelling for their teammate (which increases the amount of virus expelled and the distance it travels, now a safe sport has become dangerous. So, we have to consider what other activities are taking place? Are there team meetings with everyone in close contact and no masks? Are there away games and people car pooling or riding buses, both of which can be very dangerous? You bring up some other valid concerns. When I was last in a locker room, we were in very close contact and ventilation was very poor (you can especially tell in a room full of sweaty guys). Further, these kids will not be wearing masks into the showers. So, you are correct – this will create a risk. I don’t have a good solution for this one, other than stagger the use and with the decreased number of kids in the locker room at one time, try to distance them, but I remain concerned about this one. And, you are right, shared PE equipment will create risks. Those items will need to be sprayed or wiped down, so it is important to figure out the cleaning materials and who is going to clean those items (I would suggest showing the students how to do it and have them wipe things down as soon as they finish their use). Also, keep in mind that when people are exerting themselves, they breathe faster and heavier. This will also increase the amount of virus in droplets and the distance they can travel. So, especially if class is indoors, be sure to shoot for double the distance you ordinarily would.
Thanks for following the blog and thanks for being a teacher!
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