In-person school can be safe. CDC reports how schools with little COVID-19 spread are making it work

In-person schooling can be safe, U.S. health researchers argue, but it requires schools and their surrounding communities to commit to a slew of public health precautions to prevent the spread of COVID-19.

President Joe Biden and his administration have made a return to in-person instruction a priority, setting out to reopen most schools within his first 100 days. Last week, Biden directed the Departments of Education and Health and Human Services to provide clear guidance and resources to reopen schools and child care centers.

On Tuesday, two epidemiologists and a researcher from the Centers for Disease Control and Prevention published an opinion piece in the Journal of the American Medical Association, writing that "accumulating data now suggest a path forward to maintain or return primarily or fully to in-person instructional delivery."

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As schools in the U.S. and abroad have reopened amid the pandemic, there "has been little evidence that schools have contributed meaningfully to increased community transmission," the scientists said. The researchers cited studies of COVID-19 cases in schools in Mississippi, North Carolina and rural Wisconsin, as well as a European CDC report that found schools were not associated with accelerating community transmission.

By taking various public health precautions, it's possible to prevent transmission in schools, the researchers concluded. Here's what they want to see happen:

Limit spread in surrounding communities

It might seem obvious, but the researchers said preventing transmission in schools requires preventing transmission in surrounding communities.

They recommended taking public health precautions such as limiting indoor dining at restaurants to prevent spread.

Wear face masks

The researchers recommended universal face mask use in schools.

According to a fall CDC study among children and teens who were tested at health care facilities associated with a large academic medical center in Mississippi, kids who tested positive were less likely to have had reported consistent mask use by students and staff in their school, and attending in-person school or child care was not associated with increased likelihood of infection.

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Stay 6 feet apart

The researchers recommended schools increase physical distance in classrooms and common areas.

According to a fall study published in the peer-reviewed journal Pediatrics, coronavirus transmission was limited in 11 North Carolina school districts that held in-person classes for nine weeks. Contact tracers identified 773 cases of COVID-19 transmitted through the community during that time – only 32 infections were acquired at school.

Researchers suggested that wearing face masks, maintaining 6 feet distance and washing hands contributed to the schools’ success. Most of the cases of transmission were related to absent face coverings, the researchers found.

Limit indoor sports

Some school activities, such as team sports practices and competitions, have increased the risk of transmission among students and staff, the researchers said.

The researchers cited a CDC study of an outbreak associated with a high school wrestling tournament in Florida. A total of 130 wrestlers, coaches, and referees attended the tournament at two schools over two days. Of the 54 people tested for COVID-19 afterward, 38 were positive, and they went on to infect at least 41 other people, including household members and teammates.

"Indoor practice or competition and school-related social gatherings with limited adherence to physical distancing and other mitigation strategies could jeopardize the safe operation of in-person education," the researchers said.

The researchers recommended that colleges and universities recruiting student athletes should consider recruitment approaches that "do not penalize students for interruptions to high school sports related to the pandemic to avoid incentivizing activities posing high risk for SARS-CoV-2 infection."

Keep students in pods

The researchers recommended using hybrid attendance models to prevent crowding and to limit the total number of contacts that students and staff have.

In the North Carolina study, for example, the 11 districts studied implemented a hybrid model for nine weeks. For many schools, that meant students attended in-person school for two days each week, with Wednesday used for cleaning the building during remote instruction for all students.

According to a fall CDC study of 17 rural Wisconsin schools, COVID-19 incidence in schools conducting in-person instruction was lower than that in the surrounding community. Of 191 cases identified in students and staff, 7 cases – all among students – were linked to in-school transmission, and there was no in-school transmission between separate classroom cohorts.

Increase air ventilation

The researchers recommended increasing room air ventilation.

The researchers noted that one high school in Israel saw a large outbreak of COVID-19 within two weeks of reopening. Several factors contributed to the outbreak, researchers said, including crowded classrooms, a lack of face mask use and air conditioning that recycled air in closed rooms during a heat wave.

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Screening tests

The researchers recommended expanding routine coronavirus testing to rapidly identify and isolate people with asymptomatic infections.

The studies of COVID-19 cases in Mississippi, North Carolina and Wisconsin did not involve schools that regularly tested for COVID-19.

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Continue virtual school options

The researchers recommended that staff and students should continue to have options for online education, particularly those at increased risk of severe illness or death from COVID-19.

This article originally appeared on USA TODAY: COVID in schools: CDC reports how classes can be safe, prevent spread