Keeping Schools Open During COVID

Taylor Nichols, MD
6 min readJan 26, 2022
Teacher and students wearing masks

Reasonable precautions like getting vaccinated, wearing better masks, and improving ventilation and filtration are not draconian measures and will help keep students and teachers in school. We should be utilizing every strategy to keep children in school AND keep people safe. Preventing people from getting sick and having to stay out of school to isolate is actually the most helpful strategy to keep schools open and keep students in school. I want children to be able to be in school. I also I want them and their teachers to be protected and safe. Pooled testing and the utilization of rapid testing to identify individual cases and for test-to-stay can and should play a role so we can detect infections early and minimize any class- or school-wide quarantine. We have the tools we need now to be able to do this effectively.

The biggest problem is people pushing contradictory messaging and spreading misinformation. Trust me, as a parent, I want children to be able to be in-person learning and have as much social interaction and engagement as possible. Maligning and tearing down reasonable public health precautions is actually harmful, will increase spread and thereby decrease our ability to keep schools open as too many people will end up out of class with COVID infections.

Schools are having a hard time keeping classrooms open because teachers and subs are out in such high numbers with COVID. Would those who would prefer to minimize COVID precautions rather step in to fill their place, or utilize these reasonable and not particularly onerous precautions? I wonder.

Those spreading misinformation like to cite papers which find decreased rates of spread of SARS-CoV-2 in classrooms as compared to the community, but neglect to recognize that ALL OF THESE SOURCES CITE THESE LAYERED PRECAUTIONS AS THE REASON FOR DECREASED TRANSMISSION.

From the CDC: “The majority of cases that are acquired in the community and are brought into a school setting result in limited spread inside schools when multiple layered prevention strategies are in place.

CDC guidance identifies multiple prevention strategies that schools can implement in a layered approach to promote safer in-person learning and care. These include promoting vaccination, consistent and correct use of masks for people who are not fully vaccinated, physical, distancing, screening testing in schools to promptly identify cases, improved ventilation, handwashing and respiratory etiquette, staying home when sick and getting tested, contact tracing in combination with isolation and quarantine, and routine cleaning with disinfection under certain conditions. When prevention strategies are consistently and correctly used, the risk of SARS-CoV-2 transmission in the school environment is decreased use of multiple strategies — also called layered prevention — provides greater protection in breaking transmission chains than implementing a single strategy.”

As Harvard acknowledged: “School closures have impacted children on many fronts, from academics and social interaction to equity, food security, and mental health. Keeping children safely in school is a priority for the CDC.

Vaccination, masking, and test to stay are three of several prevention strategies that, when layered together, help to minimize the spread of COVID-19 in schools. Other prevention strategies include physical distancing; screening, testing, and contact tracing; staying home when sick; and frequent handwashing. Schools should also do their best to improve ventilation, by opening windows and doors, for example.”

In regards to children spreading COVID:

“And a November 2021 study conducted by Harvard researchers again confirmed that children carry live virus capable of infecting others. The amount of virus found in children — their viral load — was not correlated with the severity of their symptoms. In other words, a child with mild or no symptoms may have just as many viral particles in their nose and mouth as a child that has more severe symptoms. So, the presence of a high viral load in infected children increases the likelihood that children, even those without symptoms, could readily spread the infection to others. The bottom line? Public health measures are as important for kids and teens as they are for adults.”

What about the actual target population — children? What does the American Academy of Pediatrics have to say? First, acknowledging — as I have:

“Schools and school-supported programs are fundamental to child and adolescent development and well-being and provide our children and adolescents with academic instruction; social and emotional skills, safety, reliable nutrition, physical/occupational/speech therapy, mental health services, health services, preventive oral health care, and opportunities for physical activity, among other benefits”

While also recognizing that safety is key to keeping schools open and suggesting:

“Schools must continue to take a multi-pronged, layered approach to protect students, teachers, and staff (ie, vaccination, universal mask use, physical distancing, ventilation when resources are available, screening, testing, hand washing, staying home and getting tested when sick, contact tracing, isolation, and quarantining).

* All eligible individuals should receive the COVID-19 vaccine. All students older than 2 years and all school staff should wear face masks at school (unless medical or developmental conditions prohibit use), regardless of vaccination status.

*Adequate and timely COVID-19 testing resources must be available and accessible as a means for limiting spread and helping symptomatic students who do not have COVID-19 return in a timely way; testing should not be considered a primary form of prevention and should not be the only mitigation strategy.”

https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools

How about peer-reviewed scientific papers and not advisory recommendations?

“This association of K–12 school visits with case growth is stronger when mask wearing is not mandated for staff at school. These findings support policies that promote masking and other precautionary measures at schools and giving vaccine priority to education workers.”

Or how about: “[I]t is becoming clear that children and youth can acquire and transmit COVID-19 in school settings and that transmission clusters and outbreaks can be large. In addition, respiratory viral loads are as high in children and youth as in adults, pre- and asymptomatic transmission occur, and the possibility of aerosol transmission has been established.”

Here’s the other factor: these types of messages are sowing doubt in reasonable precautions and preventative measures and driving down mask and vaccination rates in the community (which these people very clearly are doing though they refuse to understand or acknowledge this). Driving down the rates of the utilization of reasonable precautions and public health preventative measures will only serve to increase the spread of the SARS-CoV-2 in the community.

Increased community transmission will drive more infections from the community into the classrooms. That will only further increase the amount of time students and teachers and staff have to quarantine due to exposures or isolate due to illness. This minimization of mitigation will only lead to increased school closures, decreased time spent on in-person learning — which they purport to be their goal — and increased rates of illness and potentially increased rates of hospitalization and even death in the community.

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Taylor Nichols, MD

Humanist. Emergency Medicine and AddictiEmergency + Addiction Medicine | Health policy and advocacy | Health tech and innovation