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Last updated: 2/10/2021
As individual school districts tackle the challenge of providing education to students at the primary and secondary school levels during the pandemic, PanFab has committed to providing information that may be helpful to school staff. We will update this page on an ongoing basis, and we welcome additional questions which can be submitted below.
Video clips accompanying some questions below were excerpted from a question/answer session held for staff at Waltham Public Schools on 9/1/2020 with members of PanFab, addressing the specific implementation of the reopening plan in Waltham.
Disclaimer: The information provided below does not constitute medical advice, and the views expressed here do not necessarily represent those of Harvard, MIT, or other institutions with which PanFab members are affiliated. As scientific understanding of COVID-19 evolves, information presented here may become outdated. If you have medical concerns, you should contact your primary care physician.
Key Points
- If community transmission is high, in-person education should be limited to the populations least able to learn remotely.
- Layers of precautions include wearing masks and other PPE, ensuring good ventilation in indoor spaces, maintaining physical distance and time, washing hands, testing, and contact tracing. These layers work together to provide multiple means of protection. This is important because no single layer is perfect.
Multiple layers of precautions are like multiple layers of Swiss cheese; each layer has holes, but the overall defense is stronger with more layers. Here we show 5 very important protective measures against the spread of coronavirus, but there can be many more. Source: https://virologydownunder.com/the-swiss-cheese-infographic-that-went-viral/
Frequently Asked Questions
Questions are grouped according to their layer of precaution for ease of reference.
Masks and Personal Protective Equipment
1. How effective are masks? What are your recommendations for the most effective masks? What types of face coverings are least effective?
The most effective masks are those that (1) cover both mouth and nose, and (2) fit comfortably enough to be stable in place and tolerated throughout the entire day.
Mask efficacy is dependent on both the fit of the mask and its ability to filter particles from entering the airway. The best masks have multilayer construction; when using a fabric mask, 2 or 3 layers are preferred, ideally with 2 different materials (i.e. surgical masks have 3 layers, the first and third for liquid, and the middle layer for filtration).
Masks with valves should be avoided, as they do not filter one’s exhalation and therefore do not protect others around the wearer.
We know from data collected in the healthcare setting that wearing masks works. Transmission rates in the Mass General and Brigham hospitals plateaued once healthcare workers started wearing masks, and then rates dropped further with required masking in place for all patients, visitors, and staff as well. (Original publication here.) Mask cleanliness is important for optimal function. All mask wearers should be sure to keep hands clean and wash/sanitize them frequently and before and after removing the mask.
2. Should we be wearing eye protection (e.g. face shields, goggles, safety glasses)?
Face shields cannot replace masks in terms of protection for yourself and for others. However, face shields or other eye protection can still be helpful to reduce your exposure risk in very high-risk interactions.
There are multiple options when considering eye protection. Face shields cover the entire face, closed goggles protect eyes and touch the face, and open goggles lack complete protection on the sides (similar to glasses). All three options protect the eyes and act as a deterrent from touching your own eyes. A full face shield can help protect you from touching your nose and the mask itself.
The primary goal with eye protection is to prevent droplets from entering the eyes.
Eye protection may be more important for high-risk individuals. As individuals think about who should be wearing eye protection, some factors to consider are:
(1) the individual’s own risk tolerance (a personal calculation that lets a person decide how much risk of infection they are willing to accept) and
(2) personal risk level (includes immunocompromised/health concerns of your own or your family, or teachers who are working with high-risk students).
Each person’s personal risk level goes into their own risk tolerance assessment.
A face shield is NOT a replacement for a mask. Know that a mask is the first and most important protective measure and a face shield will not block small particles.. Assess the risk of the situation, such as a high risk of splash, and consider your own risk tolerance level to decide whether you want added protection.
3. As a teacher, do I need to be worried if a student’s mask is soiled?
This should not be concerning, as long as your own mask is clean.
Ventilation
4. If I’m in a classroom all morning with students, is it safe for me to take my mask off to eat lunch in that room?
Yes, but it is safest to do so after opening windows and allowing air to circulate for some time.
If you are the only one who has entered the space, then this practice is ok. If others are in the room, do your best to be further away from others, and try to increase ventilation. Particularly for lunch and recess, it is important to consider the outdoors as an alternative to the indoors setting.
For the indoor setting, all students should be eating at a desk (6 ft apart). If inside, have windows open to maximize ventilation when masks are off. Even in winter, lunch would be a good time to open windows. If eating alone in class (with students elsewhere), still try to open windows. It really comes down to ventilation - how long does it take virus to be taken out of the air. If windows are open, most likely expect the virus to be removed in about 30 minutes.
Ventilation is a critical method to reduce risk. Experts at the Yale School of Public Health have produced the below helpful flow-chart, which can be viewed on their page here.
https://publichealth.yale.edu/research/covid-19/schools/ventilation/
We also recommend the resources available at Schools For Health for more detailed risk reduction strategies, particularly related to ventilation.
5. What should teachers and staff look out for this fall in terms of COVID-19 as well as flu symptoms?
COVID-19 and flu symptoms can be hard to tell apart from one another, but the precautions we take to keep others safe from COVID-19 should also help slow the spread of flu this season.
Rates of flu and other viral infections will likely be lower this year due to the measures we are taking as a society to limit the spread of COVID-19. Symptoms can be similar; flu, like COVID-19, is often associated with fever/cough/muscle aches/fatigue. There is a wide variety of disease states in COVID-19, from respiratory failure to no symptoms. Loss of taste/smell is frequently a sign of COVID-19, but this can rarely occur with other respiratory viral infections as well.
An important message for parents is that it is critical to not send kids to school with any suspected symptoms of COVID-19 OR flu. This applies to teachers and staff as well.
If a student reports new onset of symptoms to a teacher during the school-day, schools should have protocols to escort the child to the school nurse for evaluation in an isolation room. If a child is found to be sick, the child should be sent out of school for testing. Anyone experiencing high fever, chest pain, or difficulty breathing should seek immediate medical attention.
With respect to COVID-19 vs. the seasonal flu, Australia is currently in flu season (September 1, 2020), and they are normally heavily involved in determining which flu strains come up each year. They are testing any symptomatic people, and have found that mask wearing and 6ft distancing is resulting in far fewer flu cases than in previous seasons. This is likely because COVID-19 precautions prevent widespread flu transmission as well.
6. When should we be opening windows?
Whenever possible.
By any standard, 1-3 air changes per hour is poorly ventilated. In a study that measured airflow rates before and after window opening, there was a difference after only opening windows 6 inches. Air flow went up to 6-7 air changes per hour. This is comparable to hospitals with COVID-19 patients coming in. Data shows that the biggest way to increase ventilation is to open windows. Potentially try to have kids bring in jackets/sweatshirts etc. so can try to keep windows open even in the winter.
Distancing and Classroom Safety
7. When students are unmasked and eating indoors, how can we protect teachers and students while eating inside?
This is where multiple layers of protection are important - when masks are off, distancing and good ventilation are key.
Try to make sure everyone is 6 feet apart. Try to be in a room alone if possible, wipe down high contact areas, and avoid touching your own face.
Take your mask off holding only the ear loops, and place your mask somewhere safe (such as in a paper bag). Try to keep kids separated as much as possible, minimize the number of students per closed room, and encourage quiet talking or no talking while unmasked.
8. When students bring their things into a classroom, do we need to worry about virus on their items? If I am only touching certain things in classroom and no one else is touching them, do I need to sanitize those things on a regular basis, and if so, how often?
Most importantly, be intentional about washing and sanitizing your hands; keeping hands clean is most important. You don’t have to wipe things down if it’s only you touching them.
Evidence is that the vast majority of the virus is transmitted in the air rather than via surfaces. A recent study found that virus on the surface of N95s didn’t survive for over an hour. You can find residual RNA on surfaces for a long time, but the infectious virus particle itself seems to be inactivated quickly. Generally when thinking about risk reduction, focus more on airborne transmission and people sharing close spaces than surface transmission.
Testing and Tracing
9. What is the timeline for when someone is exposed and when they should get tested
Earliest testing 2 days after exposure, and from there up to 14 days.
The earliest you would want to get tested would be 2 days after exposure, and from there up to 14 days. You are most likely to have a positive test around 7-10 days after exposure. There are rare scenarios that people are detectable even later (i.e. 14 days). If someone is symptomatic after exposure, they should be tested ASAP. If asymptomatic, test no sooner than 3 days after a potential exposure.
10. What types of COVID-19 tests are available and how long do they usually take?
3 types: molecular tests, antigen tests, and antibody tests. Molecular tests are the most sensitive.
There are different types of tests. Molecular tests, or PCR tests, make many copies of RNA virus; these are the most sensitive tests. Antigen tests give answers more quickly, but are less accurate. Because you need more virus to see a positive result on an antigen test, there is a smaller window of time when an antigen test will be positive. Put another way, it is more likely that you will have a false negative antigen test, than a false negative PCR test. Finally, antibody tests detect proteins in the blood that are made in response to viral infection, telling you if you previously had an infection at some point in the past.
11. What should happen when there is a positive case in the school. Who needs to quarantine? A whole class? Just people who’ve been closer than 6ft?
In most school settings, it is difficult to be certain that students in a class did not spend a significant amount of time within 6 feet of each other that would allow for virus transmission. We thus instead propose the following recommendations, based on the 48 hours prior to the positive test OR symptom onset:
If the students have spent a full day together in the 48 hours before the infected index case developed symptoms or tested positive: best practice would be to quarantine a whole class. If a whole class is quarantined, that may facilitate continuation of the class remotely during the quarantine period. Family members of the quarantined student do not need to quarantine unless that student tests positive. Exposed students and staff should get a PCR-based test 4-5 days after the last known exposure or a rapid test 7-10 days after the last known exposure.
If the original case was not in the school in the 48 hours before diagnosis or symptom development: there is no need to quarantine.
Vaccination
12. Do the COVID-19 vaccines work? Will they be safe for staff and students?
The data on all vaccines currently being distributed in the US shows that they are safe and effective at reducing the risk of COVID-19. It is still critical that people remain vigilant about precautions such as wearing masks, and physical distancing.
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Contributors
Main Contributors
Avilash Cramer PhD, Ellen DeGennaro, Aditi Gupta PhD, Avery LaChance MD, Nicole LeBoeuf MD MPH, Jamie Lichtenstein PhD, Jordan Said, Helen Yang
Additional Contributors
John Doyle PhD, Stephen Kissler PhD, Matthew R. Leibowitz MD
Special thanks to Karina Mondragon-Shem, Shelly Dong, and Luis Freitas for providing translations
Last modified 11mo ago