The focus of this week’s post is school leaders’ decisions on the return to in-person schooling, including whether, when, and how to structure the return to school. To inform these conversations, the nation’s health protection agency issued recommendations, a research center scanned and summarized school district plans, and two new studies quantified the risk associated with school connections.

CDC Guidance for School Decision-Makers

Last week, the Centers for Disease Control and Prevention (CDC) issued new guidance for school decision-makers in response to requests from schools and communities nationwide. The guidance includes indicators for assessing school reopening risks, summarized in this table, and emphasizes five key mitigation strategies for schools:

• Consistent and correct use of masks
• Social distancing
• Hand hygiene and respiratory etiquette
• Cleaning and disinfection
• Contact tracing, in partnership with the local health department

The core indicators—those the CDC encourages school and community leaders to employ—are based on self-assessment of the ability of schools to implement those mitigation strategies in conjunction with measures of community burden (the number of new cases per 100,000 in the past 14 days and the test positivity rate in the past 14 days). The recommendations emphasize the interdependence of schools and communities when making well-informed school planning decisions. Successfully lowering risk in schools will influence the level of risk in the broader community, and vice versa. The guidance also notes that these measures of risk should not be interpreted as “hard cut-offs” but instead as “broad guideposts” to inform decision-making, such as shifting to alternative learning models if in-person schooling is deemed high risk.

School District Responses to Reopening

A previous post highlighted efforts by the non-partisan Center on Reinventing Public Education (CRPE) to track state and school district reopening plans. CRPE recently released a summary report synthesizing the reopening decisions of a large sample of school districts (n=477) across the country. They use statistical weights to provide nationally representative findings. Nearly half (49%) of all districts will return to fully in-person instruction this fall. While rural areas are the most likely to do so, urban districts have largely opted for remote instruction (only 9% of urban districts plan to return in person this fall). The authors note that this has important implications for high-poverty districts, which are more likely to be in urban areas. Roughly 41% of districts serving the highest concentration of students in poverty will be starting remotely, with high-poverty households often facing additional hurdles for remote learning and students in those districts requiring special services and supports for their academic and social-emotional needs. In addition to these initial decisions, nearly three-quarters of districts have made operational plans for both in-person and remote learning scenarios, which the report notes will be important as districts cope and adapt to COVID-19’s challenges as the school year unfolds.

Prevalence of Risk Associated with Schooling

A recently released article in Health Affairs explores the prevalence of COVID-19 risk related to schools. The researchers analyzed pre-pandemic data from the Medical Expenditure Panel Survey, a nationally representative household survey administered by the Agency for Healthcare Research and Quality. Because the survey data contain detailed information on health, socioeconomic status, and employment for all members of the household, it facilitates analysis of the household connections to schooling. Among the research team’s findings:

• About 35% of all adults had a direct or within-household connection to schools.
• Between 42% and 51% of all school employees met the CDC definition of increased risk or potential increased risk for severe COVID-19.
• Between 33.9 million and 44.2 million adults meeting criteria for increased risk had direct or within-household connections to schools.

Authors of another recent study in the Annals of Internal Medicine use a similar strategy of analyzing nationally representative data, the National Health Interview Survey, coupled with CDC risk criteria to determine the prevalence of COVID-19 risk among those working in schools or living with school-aged children. Their results largely correspond to the previous study’s findings. Among teachers, nearly 40% had definite risk factors and almost 51% had definite or possible risk factors for severe COVID-19 illness. For non-teacher, school-based staff, 41% had definite and nearly 56% had definite or possible risk factors. When looking at the close to 70 million adults living with school-aged children, 41% had definite and 54% had definite or possible risk factors for severe COVID-19. Both studies suggest that decisions about in-person schooling affect both those in the school building and large numbers of adults sharing residences with school-aged children, many of whom have risk factors for severe COVID-19 illness.