Back to Schools: Orange County Board of Education Recommendations on School Reopenings during Covid-19

Until Gov. Gavin Newsom declared most California schools closed for the fall, he had left school re-openings to local officials. But before that declaration, Orange County Board of Education trustees had voted 4-1 to approve the reopening of schools in that county.

California Policy Center helped draft an early version of those recommendations, and though the final draft differed in only minor ways, we publish our draft here. 

This draft was developed in concert with board members Mari Barke and Ken Williams. They asked us to study an assertion made throughout California – a claim still advanced by the California Teachers Association – that closing the schools is essential to protecting children’s health. 

Are children really at risk of contracting, spreading and dying from Covid-19? We’ll let the following observations provide the detail, but there’s a simple answer to that question: No. And if the answer is no, then what is the value of masking and social distancing? Many but certainly not all of the experts who testified before the board on June 24, 2020, suggested there’s no value at all – and that masking and social distancing among younger children might actually create unintended problems for those students. Social distancing – that is, expanding the distance between students in each classroom – would also impose on school districts instant requirements for more teachers and more classrooms, a requirement that would further delay robust public education.

The costs of masking and distancing would be absolutely imperative if children contract, spread and are dying from Covid-19.

Finally, this is not intended to be an historical document. Though the Orange County Board of Education approved a document very much like this one, we update it here from time to time in order to reflect vital changes in the evolving science of Covid-19.

Recommendations for the Safe and Effective Reopening of Orange County Schools

Orange County Board of Education

June 24, 2020

Costa Mesa, California

Updated July 23, 2020

ACKNOWLEDGEMENTS 

The board wishes to thank experts who testified to the Board of Education at its June 24, 2020, townhall, including Steven Abelowitz, Stefan Bean, Clayton Chau, Kenneth S. Cheng, Simone Gold, Michael Eilbert, Mike Fitzgibbons, Joel Kotkin, Sherry Kropp, Mark MacDonald, Larry Sand, Michael A. Shires, and Don Wagner. You can find their biographies in the Appendix.

In thanking them here, we hope to make it clear that this final document is the work product of the Orange County Board of Education. We, the board, are its authors. None of the conclusions here reflect the thinking of every one of the experts who testified before us – let alone the public at large – though we’ve done our best to capture the general assessment of diverse expert opinion, including that of such organizations as the American Academy of Pediatrics, Centers for Disease Control, the Journal of the American Medical Association, and the National Academies of Sciences, Engineering, and Medicine. And, of course, some panelists were careful to say that they were speaking only for themselves and not necessarily for all colleagues or organizations with which they work in their professional capacities. 

BACKGROUND

Whether one likes it or not, it’s a fact that California public schools have become critical community institutions. They do more than teach. In the absence (or weakening) of other mediating civic institutions, they are also default childcare and recreation centers. They are physical and mental health care providers. For too many children, schools have become the one place where food is regularly available. 

All of our school employees are front-line detectors and reporters of child abuse and other family or neighborhood dysfunctions. The shutdown of our schools has not diminished these risks to children; abuse doesn’t stop merely because reporting from teachers is halted. Indeed, as one expert told us, children “are the silent casualties of this lockdown.” For too many children, our schools are a refuge from a difficult, even violent world, and now that refuge is closed. As one panelist, a recently retired school superintendent, put it, “We have hurt hundreds of thousands more children than we have helped.” 

There are reasonable arguments on all sides about whether this is the best and highest outcome for our school system, or why we often fall short of the high education standards we set for ourselves. But this is not the place for that debate. Here, we accept what is: that parents of school-age children – and children themselves – have come to rely on our schools. Deprived of these institutions even for a short time, many of our communities have been plunged into social and economic chaos.

But we saw a barrier to reopening the schools safely and effectively – not Covid-19 itself, but the widely held misconception that – promulgated by public officials, powerful interest groups and the media – that Covid-19 is a direct threat to the health of our children.

One of those public officials was Orange County Department of Education Superintendent Al Mijares. The superintendent convened his own a panel of experts; blocked public attendance; and produced no transcripts or recordings of their conversations.  The superintendent went so far as to bar even the elected trustees of the County Board of Education. We were not surprised when that process produced findings that did not deal honestly with mounting evidence about the impact of Covid-19 on children.

For that reason, we asked a number of experts to attend a special June 24, 2020, public hearing at the board’s Costa Mesa office. In contrast with the superintendent’s process, ours was open to the public inasmuch as that’s possible under the governor’s guidelines. Each board member had the opportunity to put their expert of choice on the panel; the board approved the resulting expert panel at its regular board meeting. Members of the public were allowed to attend in person on a space-available basis, and we simultaneously made it possible for the public to attend the livestreamed meeting; over the course of several hours, upwards of 1,000 joined from their computers or phones. As a measure of the public’s desire to learn more, hundreds submitted questions – many simply curious, some supportive, and some downright hostile to the board’s approved mission and the stated purpose of the public forum to discuss how to reopen Orange County schools.

We take even such criticism as evidence that the public is eager to participate in this conversation – in direct contrast with the inscrutable, secretive decision-making processes of other government agencies. And though we could not answer each of the more than 500 questions submitted during the meeting, we believe the experts’ recommendations in this document provide a general response to all.

INTRODUCTION

California schools were shut down in March 2020 in order to meet what state officials said was the short-term goal of “flattening the curve,” that is to slow the spread of Covid-19. Many of our experts said that decision was reasonable at the time, given the general lack of knowledge about the disease, even among disease experts. But continuing the shutdown despite new data, our experts said, has been a mistake with disastrous implications for children, their families and community. It hardly goes without saying that poorer families with fewer options, and families with special-needs children, have suffered most from the shutdown.

If there’s a silver lining, it’s that we’ve learned much about Covid in the meantime; what we know in June is not what we thought we knew in March. 

In considering whether to reopen Orange County schools this fall, we consulted data published internationally and locally. As with global data, data published by the Orange County Health Agency reveals that K-12 children are rarely sickened by the virus, are not a significant source of contagion, and have not died from the disease.

None of our panelists were surprised to learn that, across the country, childcare centers have operated safely and effectively throughout the pandemic. In New York, according to a June 24 report on National Public Radio, “YMCA of the USA and New York City’s Department of Education have been caring for, collectively, tens of thousands of children since March, and both tell NPR they have no reports of coronavirus clusters or outbreaks.” The childcare centers achieved this seemingly remarkable outcome with no masks and a minimum of social distancing. “As school districts sweat over reopening plans,” NPR’s report continued, “and with just over half of parents telling pollsters they’re comfortable with in-person school this fall, public health and policy experts say education leaders should be discussing and drawing on these real-world child care experiences.” Similarly, the remarkable thing in an LAist.com report was not that “66 percent of L.A. County’s licensed preschools and childcare centers had closed” as of April 29, but that 44 percent remained open – and that “the majority of home day care providers” never closed.

Drawing on real-world experience, medical association reports, and primary data, our panel of experts recommend the timely reopening of Orange County schools in the fall. Their conclusions will surprise only those who have not considered the evidence:

• K-12 children represent the lowest-risk cohort for Covid-19. Because of that fact, social distancing of children is unnecessary and therefore not recommended. Similarly, requiring children to wear masks is not based on science. Requiring children to wear masks during school is not only difficult – if not impossible – to implement, but may even be harmful and almost certainly inhibits education. Masking children is therefore not recommended.
• Children play a very minor – if any – role in the spread of Covid-19. Indeed, teachers and staff are in greater danger of infection from other adults, including parents, than from students in their classrooms.
• Though our focus was primarily on K-12 students, our panel recommends that future guidelines for the reopening of schools focus primarily on adults – faculty, staff and parents. In that effort, we recommend beginning with the American Academy of Pediatrics report.
• Finally, participation in any reopening of public schools should be voluntary. These guidelines are recommendations, not “laws” or “regulations” or even “rules.” Parents, not government officials, are in the best position to determine the education environment that best suits their children and their unique family circumstances. Our school districts therefore should operate as flexibly as possible in allowing parents the maximum of freedom in sending their children to the district or public charter school that will provide that education. Some parents with the means will continue to opt for private schools or home schooling. 

In further exploring these recommendations, we ask the reader to note that we often simply rely on commonsense recommendations issued by the U.S. Centers for Disease Control and Prevention (“The Importance of Reopening America’s Schools this Fall”) and the American Academy of Pediatrics (“COVID-19 Planning Considerations: Guidance for School Re-entry”). Where students are concerned, we emphasize the following three recommendations: 

1. Temperature checks should be performed regularly. As with any illness, ill children, teachers, or staff should be sent home.
2. As always, good hygiene with frequent hand washing and the use of hand sanitizer should be encouraged.
3. Classrooms, meeting rooms, transportation vehicles (e.g., busses) and administrative offices should be thoroughly cleaned each night.

Our goal is to provide parents, teachers, schools trustees, administrators and other stakeholders with the evidence that following the CDC’s and the Academy of American Pediatrics’ simple, common-sense guidelines will allow us to reopen our schools safely this fall – and that our schools must reopen. 

SOCIAL DISTANCING, MASKING NOT RECOMMENDED

K-12 children represent the lowest-risk cohort for Covid-19. Because of that fact, social distancing of children is unnecessary and therefore not recommended. Similarly, requiring children to wear masks is not based on science. Requiring children to wear masks during school is not only difficult – if not impossible – to implement, but may even be harmful almost certainly inhibits education. Masking children is therefore not recommended.

There’s no question that children generally represent the lowest risk cohort for Covid-19. The American Academy of Pediatrics concludes:

SARS-CoV-2 appears to behave differently in children and adolescents than other common respiratory viruses, such as influenza, on which much of the current guidance regarding school closures is based. Although children and adolescents play a major role in amplifying influenza outbreaks, to date, this does not appear to be the case with SARS-CoV-2. Although many questions remain, the preponderance of evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from SARS-CoV-2 infection. In addition, children may be less likely to become infected and to spread infection. Policies to mitigate the spread of COVID-19 within schools must be balanced with the known harms to children, adolescents, families, and the community by keeping children at home.

Similarly, weeks before the Academy’s publication, the Journal of the American Medical Association reported, “it is important to emphasize that the overall burden of COVID-19 infection in children remains relatively low compared with seasonal influenza.” 

County government data supports this conclusion. As of June 24, the Orange County Healthcare Agency reported that residents under 24 (38 percent of the population) accounted for just 15 percent of all Covid-19 cases and no Orange County deaths (“Orange County Covid-19 cases and deaths by age,” Appendix). By contrast, people over 75 (just 13.5 percent of the population) accounted for 56 percent of all deaths. As one panelist put it, “This is a disease that kills our most elderly and spares our children. It may sound callous, but would we want it the other way around?”

The social and educational importance of vigorous – that is, unmasked and un-distanced, if you will – social interaction among children is well-documented, and is indeed foundational to American K-12 education. For that reason, it’s unsurprising that social distancing – particularly the total lockdown of schools – has already harmed the children it is intended to protect. An American Enterprise Institute working group notes, “The isolation brought about by social distancing can exacerbate children’s depression and anxiety. As students return, schools must have counseling support to address the numerous causes of trauma that result from the deaths of friends and family members, economic hardship from a parent losing his or her job, or abuse, violence, or neglect” (“A Blueprint for Back to School,” page 10, Appendix). 

Indeed, our expert panelists expressed the same concerns about the lockdown’s impact on our children’s health. A recently retired school superintendent summed up the conclusions of many on this issue: In closing our schools, “we have hurt hundreds of thousands more children than we have helped.”

Our professional educators and other support staff hardly need to be reminded to look for signs of distress, including distress caused by social distancing, among our students and colleagues. Because of the established link between social-distancing and child harm, we cannot support extraordinary efforts aimed at social-distancing at school.

 

There’s a complementary form of social-distancing that’s often recommended or even required in other school-reopening guidelines – and just as unwise as social-distancing itself: masks. The argument that children should wear masks to prevent the asymptomatic spread of the coronavirus to other students or a high-risk teacher or administrator is fallacious. 

Requiring children to wear face coverings may even be very harmful to the child. Learning is inhibited and critical social interactions among students and between student and teacher are fractured. Mandatory masks may well lead to a spike in childhood behavior problems such as learning disabilities, anxiety disorders, and depression to name a few.

Responding to guidelines published by our colleagues in the Los Angeles Unified School District, Dr. Alice Kuo, President of the Southern California chapter of the American Academy of Pediatrics, observed, “Our concern is that recently issued guidelines for schools re-opening in Los Angeles County are not realistic or even developmentally appropriate for children. For example, wearing masks throughout the day can hinder language and socio-emotional development, particularly for younger children.”

It’s important to note that masks are also deceptively sophisticated tools that require some training. Health professionals are generally trained and fitted properly with personal protective equipment (PPE) by a process called “fit testing” to make sure their masks are fit to function properly. That’s not the case with children and most adults who, without the benefit of fit-testing and long professional experience, naturally touch their faces and fiddle with their masks, thereby contaminating their hands and face coverings. 

Because children represent such a negligible risk, we cannot recommend masking children or social distancing. Indeed, we would ask those who would impose such requirements to respond to the overwhelming medical evidence that masks and distancing actually hamper learning.

Children play a very minor role in the spread of Covid. Teachers and staff are in greater danger from one another – from all other adults, including parents – than from children.  

If some are surprised that children are not vectors for Covid-19, it may come as a greater shock that many nonprofit childcare centers have remained open throughout the pandemic – even, as we note above, in New York City, the nation’s hotspot for viral spread. National Public Radio reports: 

any New York City childcare centers have stayed open for the children of front-line workers — everyone from doctors to grocery store clerks. YMCA of the USA and New York City’s Department of Education have been caring for, collectively, tens of thousands of children since March, and both tell NPR they have no reports of coronavirus clusters or outbreaks. As school districts sweat over reopening plans, and with just over half of parents telling pollsters they’re comfortable with in-person school this fall, public health and policy experts say education leaders should be discussing and drawing on these real-world childcare experiences.

Researchers from Brown and Harvard universities have similarly found that, as of June 24, the day of our hearing, in “916 childcare centers serving more than 20,000 children, just over 1% of staff and 0.16% of children were confirmed infected with the coronavirus.”

And the American Academy of Pediatrics reported in late June:

Although many questions remain, the preponderance of evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from SARS-CoV-2 infection. In addition, children may be less likely to become infected and to spread infection. Policies to mitigate the spread of COVID-19 within schools must be balanced with the known harms to children, adolescents, families, and the community by keeping children at home.

We’ll never have perfect information, but data increasingly supports the conclusion that children are not only not at risk of infection, but are not likely to pass the virus along to adults.

We therefore recommend that vulnerable adults who interact with our schools – including teachers, staff, parents – consider recommendations from the American Academy of Pediatrics.

Participation in any reopening of public education is voluntary. Parents, not government officials, are in the best position to determine the education that best suits their children. If a school district is unable or unwilling to provide that education, parents will be allowed to send their children to a district or charter school that will provide that education.

Perhaps our most important recommendation is based on the principle of individual choice – both for the families of our students and, to the extent possible, for select employees. Though it is important that we reopen our schools, some parents and some employees may reasonably question their own fitness for a fall return. We understand that multigenerational families, for instance, or families in which children or adults live with maladies that make them more vulnerable might feel safe at home. It’s important that school districts accommodate these choices to the best of their ability.

Similarly, parents must be free to move – must be assisted in moving – to any other school that serves their interests. We can suffer no obstacles to this freedom. Or goal is to see to the education of our children, not to produce a top-down, centralized approach that assumes all families make this important decision in the same way.

CONCLUSION

We’ve done our best to lay out the science that guided the creation of these recommendations. In adopting them, we hope the board will also ask the public to engage thoughtfully with them. It might be easy to resort to media reports of rises in Covid-19 cases or hospitalization rates, and from those reports to arrive at conclusions that contradict our recommendations. 

We would ask critics of these recommendations to respond directly to the science:

• The data show that children are nearly invulnerable to Covid-19 – rarely catch the disease, do not pass it on to others, and in only the most exceptional cases die from Covid-19. 
• Because that’s true, it’s a small step to reach the next conclusion: requiring masks or social-distance protocols is unnecessary, infeasible and perhaps even dangerous.

A public education system already facing complex challenges hardly needs to add these burdensome policies to a problem that does not exist. 

WHAT ADULTS CAN DO FOR CHILDREN

Among the many compelling expert arguments for reopening our schools, a number of us were also struck by something different, something we might call advice for adults. Several panelists – policy experts and medical doctors – admonished us to remember that the data is clear, but data can’t always penetrate fear. Among our greatest responsibilities as adults is our responsibility to model courage and persistence in the face of fear. Among these experts, Dr. Mark McDonald, a psychiatrist who specializes in at-risk youth, may have summed it up best:

Children are not dying from Covid-19. Children are not passing the disease on to adults. So the only question is, “Why are we even having this meeting tonight?” We’re meeting because we adults are afraid.

As parents, we will face many moments of anxiety: seeing our children off on their first day of kindergarten, their first day of camp, their first year of college. We may want to keep them home to protect them from the world, which can indeed be a frightening place. But let’s be clear: When we do that, we are not really protecting our children. We are only attempting to manage our own anxiety, and we do that at their expense. We are acting as negligent parents. We are harming our children. We are failing them.

We must agree to make decisions in the best interest of the children. If we do not – if, paralyzed by fear, we continue to act purely out of self-interest – we will ensure an entire generation of traumatized young adults, consigned to perpetual adolescence and residency in their parents’ garages, unable to move through life with independence, courage, and confidence. They deserve better — we owe it to them as parents.

APPENDIX 

American Academy of Pediatrics Guidelines

COVID-19 Planning Considerations: Guidance for School Re-entry

Critical Updates on COVID-19  /  Clinical Guidance  /  COVID-19 Planning Considerations: Guidance for School Re-entry

The purpose of this guidance is to support education, public health, local leadership, and pediatricians collaborating with schools in creating policies for school re-entry that foster the overall health of children, adolescents, staff, and communities and are based on available evidence. Schools 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/speech and mental health therapy, and opportunities for physical activity, among other benefits. Beyond supporting the educational development of children and adolescents, schools play a critical role in addressing racial and social inequity. As such, it is critical to reflect on the differential impact SARS-CoV-2 and the associated school closures have had on different races, ethnic and vulnerable populations. These recommendations are provided acknowledging that our understanding of the SARS-CoV-2 pandemic is changing rapidly.

Any school re-entry policies should consider the following key principles:

• School policies must be flexible and nimble in responding to new information, and administrators must be willing to refine approaches when specific policies are not working.
• It is critically important to develop strategies that can be revised and adapted depending on the level of viral transmission in the school and throughout the community and done with close communication with state and/or local public health authorities and recognizing the differences between school districts, including urban, suburban, and rural districts.
• Policies should be practical, feasible, and appropriate for child and adolescent’s developmental stage.
• Special considerations and accommodations to account for the diversity of youth should be made, especially for our vulnerable populations, including those who are medically fragile, live in poverty, have developmental challenges, or have special health care needs or disabilities, with the goal of safe return to school.
• No child or adolescent should be excluded from school unless required in order to adhere to local public health mandates or because of unique medical needs. Pediatricians, families, and schools should partner together to collaboratively identify and develop accommodations, when needed.
• School policies should be guided by supporting the overall health and well-being of all children, adolescents, their families, and their communities. These policies should be consistently communicated in languages other than English, if needed, based on the languages spoken in the community, to avoid marginalization of parents/guardians who are of limited English proficiency or do not speak English at all.

With the above principles in mind, the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020. Lengthy time away from school and associated interruption of supportive services often results in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. This, in turn, places children and adolescents at considerable risk of morbidity and, in some cases, mortality. Beyond the educational impact and social impact of school closures, there has been substantial impact on food security and physical activity for children and families.

Policy makers must also consider the mounting evidence regarding COVID-19 in children and adolescents, including the role they may play in transmission of the infection. SARS-CoV-2 appears to behave differently in children and adolescents than other common respiratory viruses, such as influenza, on which much of the current guidance regarding school closures is based. Although children and adolescents play a major role in amplifying influenza outbreaks, to date, this does not appear to be the case with SARS-CoV-2. Although many questions remain, the preponderance of evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from SARS-CoV-2 infection. In addition, children may be less likely to become infected and to spread infection. Policies to mitigate the spread of COVID-19 within schools must be balanced with the known harms to children, adolescents, families, and the community by keeping children at home.

Finally, policy makers should acknowledge that COVID-19 policies are intended to mitigate, not eliminate, risk. No single action or set of actions will completely eliminate the risk of SARS-CoV-2 transmission, but implementation of several coordinated interventions can greatly reduce that risk. For example, where physical distance cannot be maintained, students (over the age of 2 years) and staff can wear face coverings (when feasible). In the following sections, we review some general principles that policy makers should consider as they plan for the coming school year. For all of these, education for the entire school community regarding these measures should begin early, ideally at least several weeks before the start of the school year.

Physical Distancing Measures

Physical distancing, sometimes referred to as social distancing, is simply the act of keeping people separated with the goal of limiting spread of contagion between individuals. It is fundamental to lowering the risk of spread of SARS-CoV-2, as the primary mode of transmission is through respiratory droplets by persons in close proximity. There is a conflict between optimal academic and social/emotional learning in schools and strict adherence to current physical distancing guidelines. For example, the Centers for Disease Control and Prevention (CDC) recommends that schools “space seating/desks at least 6 feet apart when feasible.” In many school settings, 6 feet between students is not feasible without limiting the number of students. Evidence suggests that spacing as close as 3 feet may approach the benefits of 6 feet of space, particularly if students are wearing face coverings and are asymptomatic. Schools should weigh the benefits of strict adherence to a 6-feet spacing rule between students with the potential downside if remote learning is the only alternative. Strict adherence to a specific size of student groups (e.g., 10 per classroom, 15 per classroom, etc.) should be discouraged in favor of other risk mitigation strategies. Given what is known about transmission dynamics, adults and adult staff within schools should attempt to maintain a distance of 6 feet from other persons as much as possible, particularly around other adult staff. For all of the below settings, physical distancing by and among adults is strongly recommended, and meetings and curriculum planning should take place virtually if possible. In addition, other strategies to increase adult-adult physical distance in time and space should be implemented, such as staggered drop-offs and pickups, and drop-offs and pickups outside when weather allows. Parents should, in general, be discouraged from entering the school building. Physical barriers, such as plexiglass, should be considered in reception areas and employee workspaces where the environment does not accommodate physical distancing, and congregating in shared spaces, such as staff lounge areas, should be discouraged.

The recommendations in each of the age groups below are not instructional strategies but are strategies to optimize the return of students to schools in the context of physical distancing guidelines and the developmentally appropriate implementation of the strategies. Educational experts may have preference for one or another of the guidelines based on the instructional needs of the classes or schools in which they work.

Pre-Kindergarten (Pre-K)

In Pre-K, the relative impact of physical distancing among children is likely small based on current evidence and certainly difficult to implement. Therefore, Pre-K should focus on more effective risk mitigation strategies for this population. These include hand hygiene, infection prevention education for staff and families, adult physical distancing from one another, adults wearing face coverings, cohorting, and spending time outdoors.

Higher-priority strategies:

• Cohort classes to minimize crossover among children and adults within the school; the exact size of the cohort may vary, often dependent on local or state health department guidance.
• Utilize outdoor spaces when possible.
• Limit unnecessary visitors into the building.

Lower-priority strategies:

• Face coverings(cloth) for children in the Pre-K setting may be difficult to implement.
• Reducing classmate interactions/play in Pre-K aged children may not provide substantial COVID-19 risk reduction.

Elementary Schools

Higher-priority strategies:

• Children should wear face coverings when harms (e.g., increasing hand-mouth/nose contact) do not outweigh benefits (potential COVID-19 risk reduction).
• Desks should be placed 3 to 6 feet apart when feasible (if this reduces the amount of time children are present in school, harm may outweigh potential benefits).
• Cohort classes to minimize crossover among children and adults within the school.
• Utilize outdoor spaces when possible.

Lower-priority strategies:

• The risk reduction of reducing class sizes in elementary school-aged children may be outweighed by the challenge of doing so.
• Similarly, reducing classmate interactions/play in elementary school-aged children may not provide enough COVID-19 risk reduction to justify potential harms.

Secondary Schools

There is likely a greater impact of physical distancing on risk reduction of COVID in secondary schools than early childhood or elementary education. There are also different barriers to successful implementation of many of these measures in older age groups, as the structure of school is usually based on students changing classrooms. Suggestions for physical distancing risk mitigation strategies when feasible:

• Universal face coverings in middle and high schools when not able to maintain a 6-foot distance (students and adults).
• Particular avoidance of close physical proximity in cases of increased exhalation (singing, exercise); these activities are likely safest outdoors and spread out.
• Desks should be placed 3 to 6 feet apart when feasible.
• Cohort classes if possible, limit cross-over of students and teachers to the extent possible.
  • Ideas that may assist with cohorting:
    • Block schedule (much like colleges, intensive 1-month blocks).
    • Eliminate use of lockers or assign them by cohort to reduce need for hallway use across multiple areas of the building. (This strategy would need to be done in conjunction with planning to ensure students are not carrying home an unreasonable number of books on a daily basis and may vary depending on other cohorting and instructional decisions schools are making.)
    • Have teachers rotate instead of students when feasible.
    • Utilize outdoor spaces when possible.
    • Teachers should maintain 6 feet from students when possible and if not disruptive to educational process.
    • Restructure elective offerings to allow small groups within one classroom. This may not be possible in a small classroom.

Special Education

Every child and adolescent with a disability is entitled to a free and appropriate education and is entitled to special education services based on their individualized education program (IEP). Students receiving special education services may be more negatively affected by distance-learning and may be disproportionately impacted by interruptions in regular education. It may not be feasible, depending on the needs of the individual child and adolescent, to adhere both to distancing guidelines and the criteria outlined in a specific IEP. Attempts to meet physical distancing guidelines should meet the needs of the individual child and may require creative solutions, often on a case-by-case basis.

Physical Distancing in Specific Enclosed Spaces

Bussing

• Encourage alternative modes of transportation for students who have other options.
• Ideally, for students riding the bus, symptom screening would be performed prior to being dropped off at the bus. Having bus drivers or monitors perform these screenings is problematic, as they may face a situation in which a student screens positive yet the parent has left, and the driver would be faced with leaving the student alone or allowing the student on the bus.
• Assigned seating; if possible, assign seats by cohort (same students sit together each day).
• Tape marks showing students where to sit.
• When a 6-foot distance cannot be maintained between students, face coverings should be worn.
• Driver should be a minimum of 6 feet from students; driver must wear face covering; consider physical barrier for driver (e.g., plexiglass).
• Minimize number of people on the bus at one time within reason.
• Adults who do not need to be on the bus should not be on the bus.
• Have windows open if weather allows.

Hallways

• Consider creating one-way hallways to reduce close contact.
• Place physical guides, such as tape, on floors or sidewalks to create one-way routes.
• Where feasible, keep students in the classroom and rotate teachers instead.
• Stagger class periods by cohorts for movement between classrooms if students must move between classrooms to limit the number of students in the hallway when changing classrooms.
• Assign lockers by cohort or eliminate lockers altogether.

Playgrounds

Enforcing physical distancing in an outside playground is difficult and may not be the most effective method of risk mitigation. Emphasis should be placed on cohorting students and limiting the size of groups participating in playground time. Outdoor transmission of virus is known to be much lower than indoor transmission.

Meals/Cafeteria

School meals play an important part in addressing food security for children and adolescents. Decisions about how to serve meals must take into account the fact that in many communities there may be more students eligible for free and reduced meals than prior to the pandemic.

• Consider having students cohorted, potentially in their classrooms, especially if students remain in their classroom throughout the day.
• Create separate lunch periods to minimize the number of students in the cafeteria at one time.
• Utilize additional spaces for lunch/break times.
• Utilize outdoor spaces when possible.
• Create an environment that is as safe as possible from exposure to food allergens.
• Wash hands or use hand sanitizer before and after eating.

Cleaning and Disinfection

The main mode of COVID-19 spread is from person to person, primarily via droplet transmission. For this reason, strategies for infection prevention should center around this form of spread, including physical distancing, face coverings, and hand hygiene. Given the challenges that may exist in children and adolescents in effectively adhering to recommendations, it is critical staff are setting a good example for students by modeling behaviors around physical distancing, face coverings and hand hygiene. Infection via aerosols and fomites is less likely. However, because the virus may survive in certain surfaces for some time, it is possible to get infected after touching a virus contaminated surface and then touching the mouth, eyes, or nose. Frequent handwashing as a modality of containment is vital.

Cleaning should be performed per established protocols followed by disinfection when appropriate. Normal cleaning with soap and water decreases the viral load and optimizes the efficacy of disinfectants. When using disinfectants, the manufacturers’ instructions must be followed, including duration of dwell time, use of personal protective equipment (PPE), if indicated, and proper ventilation. The use of EPA approved disinfectants against COVID-19 is recommended (EPA List N). When possible, only products labeled as safe for humans and the environment (e.g., Safer or Designed for the Environment), containing active ingredients such as hydrogen peroxide, ethanol, citric acid, should be selected from this list, because they are less toxic, are not strong respiratory irritants or asthma triggers, and have no known carcinogenic, reproductive, or developmental effects.

When EPA-approved disinfectants are not available, alternative disinfectants such as diluted bleach or 70% alcohol solutions can be used. Children should not be present when disinfectants are in use and should not participate in disinfecting activities. Most of these products are not safe for use by children, whose “hand-to-mouth” behaviors and frequent touching of their face and eyes put them at higher risk for toxic exposures. If disinfection is needed while children are in the classroom, adequate ventilation should be in place and nonirritating products should be used. Disinfectants such as bleach and those containing quaternary ammonium compounds or “Quats” should not be used when children and adolescents are present, because these are known respiratory irritants.

In general, elimination of high-touch surfaces is preferable to frequent cleaning. For example, classroom doors can be left open rather than having students open the door when entering and leaving the classroom or the door can be closed once all students have entered followed by hand sanitizing. As part of increasing social distance between students and surfaces requiring regular cleaning, schools could also consider eliminating the use of lockers, particularly if they are located in shared spaces or hallways, making physical distancing more challenging. If schools decide to use this strategy, it should be done within the context of ensuring that students are not forced to transport unreasonable numbers of books back and forth from school on a regular basis.

When elimination is not possible, surfaces that are used frequently, such a drinking fountains, door handles, sinks and faucet handles, etc., should be cleaned and disinfected at least daily and as often as possible. Bathrooms, in particular, should receive frequent cleaning and disinfection. Shared equipment including computer equipment, keyboards, art supplies, and play or gym equipment should also be disinfected frequently. Hand washing should be promoted before and after touching shared equipment. Computer keyboard covers can be used to facilitate cleaning between users. practices should be used for indoor areas that have not been used for 7 or more days or outdoor equipment. Surfaces that are not high touch, such as bookcases, cabinets, wall boards, or drapes should be cleaned following standard protocol. The same applies to floors or carpeted areas.

Outdoor playgrounds/natural play areas only need routine maintenance, and hand hygiene should be emphasized before and after use of these spaces. Outdoor play equipment with high-touch surfaces, such as railings, handles, etc., should be cleaned and disinfected regularly if used continuously.

UV light kills viruses and bacteria and is used in some controlled settings as a germicide. UV light-emitting devices should not be used in the school setting, because they are not safe for children and adults and can cause skin and eye damage.

Testing and Screening

Virologic testing is an important part of the overall public health strategy to limit the spread of COVID-19. Virologic testing detects the viral RNA from a respiratory (usually nasal) swab specimen. Testing all students for acute SARS-CoV-2 infection prior to the start of school is not feasible in most settings at this time. Even in places where this is possible, it is not clear that such testing would reduce the likelihood of spread within schools. It is important to recognize that virologic testing only shows whether a person is infected at that specific moment in time. It is also possible that the nasal swab virologic test result can be negative during the early incubation period of the infection. So, although a negative virologic test result is reassuring, it does not mean that the student or school staff member is not going to subsequently develop COVID-19. Stated another way, a student who is negative for COVID 19 on the first day of school may not remain negative throughout the school year.

If a student or school staff member has a known exposure to COVID-19 (e.g., a household member with laboratory-confirmed SARS-CoV-2 infection or illness consistent with COVID-19) or has COVID-19 symptoms, having a negative virologic test result, according to CDC guidelines, may be warranted for local health authorities to make recommendations regarding contact tracing and/ or school exclusion or school closure.

The other type of testing is serologic blood testing for antibodies to SARS-CoV-2. At the current time, serologic testing should not be used for individual decision-making and has no place in considerations for entrance to or exclusion from school. CDC guidance regarding antibody testing for COVID-19 is that serologic test results should not be used to make decisions about grouping people residing in or being admitted to congregate settings, such as schools, dormitories, or correctional facilities. Additionally, serologic test results should not be used to make decisions about returning people to the workplace. The CDC states that serologic testing should not be used to determine immune status in individuals until the presence, durability, and duration of immunity is established. The AAP recommends this guidance be applied to school settings as well.

Schools should have a policy regarding symptom screening and what to do if a student or school staff member becomes sick with COVID-19 symptoms. Temperature checks and symptom screening are a frequent part of many reopening processes to identify symptomatic persons to exclude them from entering buildings and business establishments. The list of symptoms of COVID-19 infection has grown since the start of the pandemic and the manifestations of COVID-19 infection in children, although similar, is often not the same as that for adults. School policies regarding temperature screening and temperature checks must balance the practicality of performing these screening procedures for large numbers of students and staff with the information known about how children manifest COVID-19 infection, the risk of transmission in schools, and the possible lost instructional time to conduct the screenings. Schools should develop plans for rapid response to a student or staff member with fever who is in the school regardless of the implementation of temperature checks or symptom screening prior to entering the school building. In many cases, it will not be practical for temperature checks to be performed prior to students arriving at school. Parents should be instructed to keep their child at home if they are ill. Any student or staff member with a fever of 100.4 degrees or greater or symptoms of possible COVID-19 virus infection should not be present in school.

In lieu of temperature checks and symptom screening being performed after arrival to school, methods to allow parent report of temperature checks done at home may be considered. Resources and time may necessitate this strategy at most schools. The epidemiology of disease in children along with evidence of the utility of temperature screenings in health systems may further justify this approach. Procedures using texting apps, phone systems, or online reporting rely on parent report and may be most practical but possibly unreliable, depending on individual family’s ability to use these communication processes, especially if not made available in their primary language. Although imperfect, these processes may be most practical and likely to identify the most ill children who should not be in school. School nurses or nurse aides should be equipped to measure temperatures for any student or staff member who may become ill during the school day and should have an identified area to separate or isolate students who may have COVID-19 symptoms.

COVID-19 infection manifests similarly to other respiratory illness in children. Although children manifest many of the same symptoms of COVID-19 infection as adults, some differences are noteworthy. According to the CDC, children may be less likely to have fever, may be less likely to present with fever as an initial symptom, and may have only gastrointestinal tract symptoms. A student or staff member excluded because of symptoms of COVID-19 should be encouraged to contact their health care provider to discuss testing and medical care. In the absence of testing, students or staff should follow local health department guidance for exclusion.

Face Coverings and PPE

Cloth face coverings protect others if the wearer is infected with SARS CoV-2 and is not aware. Cloth masks may offer some level of protection for the wearer. Evidence continues to mount on the importance of universal face coverings in interrupting the spread of SARS-CoV-2. Although ideal, universal face covering use is not always possible in the school setting for many reasons. Some students, or staff, may be unable to safely wear a cloth face covering because of certain medical conditions (e.g., developmental, respiratory, tactile aversion, or other conditions) or may be uncomfortable, making the consistent use of cloth face coverings throughout the day challenging. For individuals who have difficulty with wearing a cloth face covering and it is not medically contraindicated to wear a face covering, behavior techniques and social skills stories (see resource section) can be used to assist in adapting to wearing a face covering. When developing policy regarding the use of cloth face coverings by students or school staff, school districts and health advisors should consider whether the use of cloth face coverings is developmentally appropriate and feasible and whether the policy can be instituted safely. If not developmentally feasible, which may be the case for younger students, and cannot be done safely (e.g., the face covering makes wearers touch their face more than they otherwise would), schools may choose to not require their use when physical distancing measures can be effectively implemented. School staff and older students (middle or high school) may be able to wear cloth face coverings safely and consistently and should be encouraged to do so. Children under 2 years and anyone who has trouble breathing or is unconscious, incapacitated, or otherwise unable to remove a face covering without assistance should not wear cloth face coverings.

For certain populations, the use of cloth face coverings by teachers may impede the education process. These include students who are deaf or hard of hearing, students receiving speech/language services, young students in early education programs, and English-language learners. Although there are products (e.g., face coverings with clear panels in the front) to facilitate their use among these populations, these may not be available in all settings.

Students and families should be taught how to properly wear (cover nose and mouth) a cloth face covering, to maintain hand hygiene when removing for meals and physical activity, and for replacing and maintaining (washing regularly) a cloth face covering.

School health staff should be provided with appropriate medical PPE to use in health suites. This PPE should include N95 masks, surgical masks, gloves, disposable gowns, and face shields or other eye protection.  School health staff should be aware of the CDC guidance on infection control measures. Asthma treatments using inhalers with spacers are preferred over nebulizer treatments whenever possible. The CDC recommends that nebulizer treatments at school should be reserved for children who cannot use or do not have access to an inhaler (with spacer or spacer with mask). Schools should work with families and health care providers to assist with obtaining an inhaler for students with limited access. In addition, schools should work to develop and implement asthma action plans, which may include directly observed controller medication administration in schools to promote optimal asthma control. If required while waiting for a student to be picked up to go home or for emergency personnel to arrive, when using nebulizer or a peak flow meter, school health staff should wear gloves, an N95 facemask, and eye protection. Staff should be trained on proper donning and doffing procedures and follow the CDC guidance regarding precautions when performing aerosol-generating procedures. Nebulizer treatments should be performed in a space that limits exposure to others and with minimal staff present. Rooms should be well ventilated or treatments should be performed outside. After the use of the nebulizer, the room should undergo routine cleaning and disinfection.

School staff working with students who are unable to wear a cloth face covering and who must be in close proximity to them should ideally wear N95 masks. When access to N95 masks is limited, a surgical mask in combination with a face shield should be used. Face shields or other forms of eye protection should also be used when working with students unable to manage secretions.

On-site School Based Health Services

On-site school health services should be supported if available, to complement the pediatric medical home and to provide pediatric acute and chronic care. Collaboration with school nurses will be essential, and school districts should involve School Health Services staff early in the planning phase for reopening and consider collaborative strategies that address and prioritize immunizations and other needed health services for students, including behavioral health and reproductive health services.

Education

The impacts of lost instructional time and social emotional development on children and adolescents should be anticipated, and schools will need to be prepared to adjust curricula and instructional practices accordingly without the expectation that all lost academic progress can be caught up. Plans to make up for lost academic progress because of school closures and distress associated with the pandemic should be balanced by a recognition of the likely continued distress of educators and students that will persist when schools reopen. If the academic expectations are unrealistic, school will likely become a source of further distress for students (and educators) at a time when they need additional support. It is also critical to maintain a balanced curriculum with continued physical education and other learning experiences rather than an exclusive emphasis on core subject areas.

Students With Disabilities

The impact of loss of instructional time and related services, including mental health services as well as occupational, physical, and speech/language therapy during the period of school closures is significant for students with disabilities. Students with disabilities may also have more difficulty with the social and emotional aspects of transitioning out of and back into the school setting. As schools prepare for reopening, school personnel should develop a plan to ensure a review of each child and adolescent with an IEP to determine the needs for compensatory education to adjust for lost instructional time as well as other related services. In addition, schools can expect a backlog in evaluations; therefore, plans to prioritize those for new referrals as opposed to re-evaluations will be important. = Many school districts require adequate instructional effort before determining eligibility for special education services. However, virtual instruction or lack of instruction should not be reasons to avoid starting services such as response-to-intervention (RTI) services, even if a final eligibility determination is postponed.

Behavioral Health/Emotional Support for Children and Adolescents

Schools should anticipate and be prepared to address a wide range of mental health needs of children and staff when schools reopen. Preparation for infection control is vital and admittedly complex during an evolving pandemic. But the emotional impact of the pandemic, financial/employment concerns, social isolation, and growing concerns about systemic racial inequity — coupled with prolonged limited access to critical school-based mental health services and the support and assistance of school professionals — demands careful attention and planning as well. Schools should be prepared to adopt an approach for mental health support.

Schools should consider providing training to classroom teachers and other educators on how to talk to and support children during and after the COVID-19 pandemic. Students requiring mental health support should be referred to school mental health professionals.

Suicide is the second leading cause of death among adolescents or youth 10 to 24 years of age in the United States. In the event distance learning is needed, schools should develop mechanisms to evaluate youth remotely if concerns are voiced by educators or family members and should be establishing policies, including referral mechanisms for students believed to be in need of in-person evaluation, even before schools reopen.

School mental health professionals should be involved in shaping messages to students and families about the response to the pandemic. Fear-based messages widely used to encourage strict physical distancing may cause problems when schools reopen, because the risk of exposure to COVID-19 may be mitigated but not eliminated.

When schools do reopen, plans should already be in place for outreach to students who do not return, given the high likelihood of separation anxiety and agoraphobia in students. Students may have difficulty with the social and emotional aspects of transitioning back into the school setting, especially given the unfamiliarity with the changed school environment and experience. Special considerations are warranted for students with pre-existing anxiety, depression, and other mental health conditions; children with a prior history of trauma or loss; and students in early education who may be particularly sensitive to disruptions in routine and caregivers. Students facing other challenges, such as poverty, food insecurity, and homelessness, and those subjected to ongoing racial inequities may benefit from additional support and assistance.

Schools need to incorporate academic accommodations and supports for all students who may still be having difficulty concentrating or learning new information because of stress associated with the pandemic. It is important that schools do not anticipate or attempt to catch up for lost academic time through accelerating curriculum delivery at a time when students and educators may find it difficult to even return to baseline rates. These expectations should be communicated to educators, students, and family members so that school does not become a source of further distress.

Mental Health of Staff

The personal impact on educators and other school staff should be recognized. In the same way that students are going to need support to effectively return to school and to be prepared to be ready to process the information they are being taught, teachers cannot be expected to be successful at teaching children without having their mental health needs supported. The strain on teachers this year as they have been asked to teach differently while they support their own needs and those of their families has been significant, and they will be bringing that stress back to school as schools reopen. Resources such as Employee Assistance Programs and other means to provide support and mental health services should be established prior to reopening. The individual needs and concerns of school professionals should be addressed with accommodations made as needed (e.g., for a classroom educator who is pregnant, has a medical condition that confers a higher risk of serious illness with COVID-19, resides with a family member who is at higher risk, or has a mental health condition that compromises the ability to cope with the additional stress). Although schools should be prepared to be agile to meet evolving needs and respond to increasing knowledge related to the pandemic and may need to institute partial or complete closures when the public health need requires, they should recognize that staff, students, and families will benefit from sufficient time to understand and adjust to changes in routine and practices. During a crisis, people benefit from clear and regular communication from a trusted source of information and the opportunity to dialogue about concerns and needs and feel they are able to contribute in some way to the decision-making process. Change is more difficult in the context of crisis and when predictability is already severely compromised.

Food Insecurity

In 2018, 11.8 million children and adolescents (1 in 7) in the United States lived in a food-insecure household. The coronavirus pandemic has led to increased unemployment and poverty for America’s families, which in turn will likely increase even further the number of families who experience food insecurity. School re-entry planning must consider the many children and adolescentswho experience food insecurity already (especially at-risk and low-income populations) and who will have limited access to routine meals through the school district if schools remain closed. The short- and long-term effects of food insecurity in children and adolescents are profound. Plans should be made prior to the start of the school year for how students participating in free- and reduced- meal programs will receive food in the event of a school closure or if they are excluded from school because of illness or SARS-CoV-2 infection.

Immunizations

Existing school immunization requirements should be maintained and not deferred because of the current pandemic. In addition, although influenza vaccination is generally not required for school attendance, in the coming academic year, it should be highly encouraged for all students. School districts should consider requiring influenza vaccination for all staff members. Pediatricians should work with schools and local public health authorities to promote childhood vaccination messaging well before the start of the school year. It is vital that all children receive recommend vaccinations on time and get caught up if they are behind as a result of the pandemic. The capacity of the health care system to support increased demand for vaccinations should be addressed through a multifaceted collaborative and coordinated approach among all child-serving agencies including schools.

Organized Activities

It is likely that sporting events, practices, and conditioning sessions will be limited in many locations. Preparticipation evaluations should be conducted in alignment with the AAP Preparticipation Physical Evaluation Monograph, 5th ed, and state and local guidance.

Additional Information

If you need a print version of this guidance, use the Print icon at the top of the page or download a pdf here.

• Information for Parents on HealthyChildren.org: Returning to School During COVID-19
• Guidance Related to Childcare During COVID-19
• Guidance on Providing Pediatric Well-Care During COVID-19
• List of latest AAP News articles on COVID-19
• Pediatrics COVID-19 Collection
• COVID-19 Advocacy Resources(Login required)
• Centers for Disease Control and Prevention: Considerations for Schools
• Centers for Disease Control and Prevention: School Decision Tree
• Centers for Disease Control and Prevention: Activities and Initiatives Supporting the COVID Response

Resources

• Coalition to Support Grieving Students
• Using Social Stories to Support People with I/DD During the COVID-19 Emergency
• Social Stories for Young and Old on COVID-19

Interim Guidance Disclaimer: The COVID-19 clinical interim guidance provided here has been updated based on current evidence and information available at the time of publishing. Guidance will be regularly reviewed with regards to the evolving nature of the pandemic and emerging evidence. All interim guidance will be presumed to expire in December 2020 unless otherwise specified.

Last Updated

06/25/2020

© Copyright 2020 American Academy of Pediatrics. All rights reserved.

APPENDIX 

Southern California Chapter of the American Academy of Pediatrics (June 2, 2020)

APPENDIX 

“Orange County Covid-19 cases and deaths by age” (June 16, 2020)

Source: Orange County Healthcare Agency

APPENDIX

EXPERT PANELISTS

Dr. Steven Abelowitz is past Pediatric Department Chair, Hoag Memorial Hospital Presbyterian. He is board certified in Pediatric Medicine and Medical Director of Coastal Kids Pediatric Medical Group in Newport Beach, Irvine, Laguna Niguel, and Ladera Ranch. Among other credentials and honorifs, Dr Abelowitz is a fellow of the American Academy of Pediatrics and board certified in Pediatric Medicine.

Dr. Clayton Chau is the director of the OC Health Care Agency, having worked for the agency’s Behavioral Health Services team from 1999-2012. He was most recently Chief Clinical and Strategy Officer for Mind OC, the not-for-profit created to support the advancement of Be Well OC. Dr. Chau has been Regional Executive Medical Director of the Institute of Mental Health and Wellness, Southern California Region; was an appointee of the 23rd U.S. Secretary of Health and Human Services serving on the Interdepartmental Serious Mental Illness Coordinating Committee; Senior Medical Director for Health Services at L.A. Care Health Plan, the largest nonprofit health plan in the nation; Co-Principal Investigator for a multi-year Center for Medicare & Medicaid Services’ Innovation grant in Transforming Clinical Practice. Dr. Chau received his PhD in Clinical Psychology from Chelsea University in 2004, and his medical degree from the University of Minnesota in 1994. He completed his psychiatry residency at the University of California, Los Angeles/San Fernando Valley followed by a fellowship with the National Institute of Mental Health in psychoneuroimmunology focusing on substance use disorder and HIV. He has served as an Associate Clinical Professor and Lecturer at a variety of renowned academic institutions including the University of California, Los Angeles and the University of California, Irvine. Dr. Chau has conducted international trainings in the areas of health care integration, health care system reform, cultural competency and mental health policy.

Dr. Michael Eilbert is a hospitalist and pulmonologist practicing medicine in Newport’s Hoag Memorial Hospital Presbyterian. He has been in private practice for more than 20 years in Orange County. In this pandemic, Dr. Eilbert is actively involved in the treatment and care of acute Covid positive patients. He is a member of the Board of Directors of the Orange County Medical Association (OCMA) and president elect to OCMA.

Dr. Mike Fitzgibbons is a hospitalist and an Infectious Disease specialist practicing medicine in central Orange County for over three decades. He is on staff at St. Joseph Hospital in Orange. A graduate of Georgetown Medical School, Dr. Fitzgibbons completed his residency and fellowship at UC Irvine Medical Center. In the current pandemic, Dr. Fitzgibbons is actively involved in the treatment and care of acute Covid-positive patients. He is an expert on infectious pathogens and their associated morbidity and mortality. Dr. Fitzgibbons is a delegate to the California Medical Association and active in public policy on health and medical issues with the Orange County Medical Association.

Dr. Simone Gold is a board-certified emergency physician in Los Angeles, California. She graduated from Chicago Medical School before attending Stanford University Law School to earn her Juris Doctorate degree. She completed her residency in Emergency Medicine at Stony Brook University Hospital in New York. Dr. Gold has had a life-long interest in health policy, and worked in Washington D.C. for the former Surgeon General, as well as for the Chairman of the Labor & Human Resources Committee. She has also worked as a physician advisor determining inpatient or outpatient status, and as a physician-attorney advocate for hospital-clients with Medicare and Medicaid appeals. She is a published author and editor of several magazine and newspaper articles.

Joel Kotkin is the Presidential Fellow in Urban Futures at Chapman University in Orange, California and Executive Director of the Houston-based Urban Reform Institute. He is Senior Advisor to the Kem C. Gardner Policy Institute; Executive Editor of the widely read website Newgeography; and a regular contributor to the City Journal, Daily Beast, Quillette, American Affairs and Real Clear Politics. Kotkin has recently completed several studies including on urbanism, the future of localism, the changing role of transit in America and most recently California’s lurch towards feudalism. He is co-author, with Michael Lind, on a report published in 2018 on the revival of the American Heartland for the Center for Opportunity Urbanism. As director of the Center for Demographics and Policy at Chapman University, he was the lead author of a major study on housing, and recently, with Marshall Toplansky, published a strategic analysis for Orange County.

Sherry Kropp PhD served in Orange County’s Los Alamitos Unified School District since 1985 and was superintendent from 2011 until her retirement in 2019. A graduate of Orange County schools, she began her teaching career in 1978 as an English, math, and biology teacher and coach in Washington state before returning to Southern California. Before she was named Superintendent of Los Alamitos Unified School District, Dr. Kropp was a teacher, assistant principal, and interim principal at Los Alamitos High School, a principal at a continuation high school, and a director and assistant superintendent in the district. She was selected Teacher of the Year twice while teaching in Washington state, Administrator of the Year while the Principal at Laurel High School (Los Alamitos), and received the Honorary Service Award twice – as the Assistant Principal and as the Superintendent. She has a bachelors degree in English, masters in Educational Administration, and a doctorate in Educational Leadership.

Dr. Mark McDonald is a double board-certified child and adolescent psychiatrist in private practice in Los Angeles. He studied classical cello and world literature at UC Berkeley before beginning medical training at the Medical College of Wisconsin, and completed his adult psychiatry residency at the University of Cincinnati and child psychiatry fellowship at Harbor-UCLA in Los Angeles. He specializes in working with children with autism and trauma, as well as obsessive-compulsive and bipolar disorders. He is a candidate in psychoanalysis at the Psychoanalytic Center of California (PCC).

Larry Sand is an education policy expert with an insider’s view: he began teaching in New York in 1971, and, in 1985, taught elementary school as well as English, math, history and ESL in the Los Angeles Unified School District, where he also served as a Title 1 Coordinator. Retired but not retiring, he is the president of the nonprofit California Teachers Empowerment Network (CTEN), a nonpartisan group dedicated to providing teachers with reliable and balanced information about professional affiliations and positions on education issues. In 2011, realizing that parents, taxpayers and others frequently receive faulty information from the mainstream media, CTEN expanded its mission to help the general public understand the array of educational issues facing our country today.

Michael A. Shires, Ph.D is associate dean for strategy and special projects and an Associate Professor at Pepperdine University School of Public Policy. Shires has a long record of success finding new strategies and solutions to problems across a wide range of organizations, from small and mid-sized businesses to nonprofit organizations and think tanks to local communities and governments. Over 25 years, he has worked extensively with new organizations with line responsibility for developing management and educational systems. Dr. Shires has published extensively on state and local government finance in California, K-12 education policy and higher education policy. His research includes not only the nuts and bolts of state and local governance and finance, but also the ethics and politics of decision-making at these levels

Orange County Supervisor Don Wagner was re-elected to the Third Supervisorial district seat in March 2020. He represents nearly 600,000 residents in Orange County’s Third District (Anaheim Hills, Irvine, Orange, Tustin, North Tustin, Villa Park, Yorba Linda, and the unincorporated canyons). A practicing attorney, he has also served as a community college district trustee, state legislator, and mayor of Irvine from 2016 – 2019.

APPENDIX

Additional Reading

Integrated analysis

Notably, there was a particularly low expression of ACE2 in the few young pediatric samples in the analysis.

Children are unlikely to have been the primary source of household SARS-CoV-2 infections

Whilst SARS-CoV-2 can cause mild disease in children, the data available to date suggests that children have not played a substantive role in the intra- household transmission of SARS-CoV-2.

Covid-19 in schools

A review showed that it was most likely, but not certain, that these two children were infected by transmission in the school environment.

LA Times: “We do not want another Gabriel Fernandez’ Coronavirus leads to ‘alarming’ drop in child abuse reports

“We usually have a lot of eyes and ears out there making sure children are safe. But right now we don’t know what is happening behind closed doors,” Los Angeles County Sheriff Alex Villaneuva said Monday in an interview. “We are at the mercy of those who report. We need the community to take up the slack,” he said.

NPR: With School Buildings Closed, Children’s Mental Health Is Suffering

Nightmares. Tantrums. Regressions. Grief. Violent outbursts. Exaggerated fear of strangers. Even suicidal thoughts. In response to a call on social media, parents across the country shared with NPR that the mental health of their young children appears to be suffering as the weeks of lockdown drag on.

JAMA: School Reopening—The Pandemic Issue That Is Not Getting Its Due

The risks posed by delaying school openings are real and sizeable, particularly for students from low-income families. The phenomenon of summer learning loss has been well established, with children losing a mean of 1 to 3 months in varying subjects. Some estimate that there will be a 9-month to 12-month loss when children return to school in the fall, and this will only be compounded if distance learning continues. No credible scientist, learning expert, teacher, or parent believes that children aged 5 to 10 years can meaningfully engage in online learning without considerable parental involvement, which many families with low incomes are unable to provide because parents must work outside the home.

The Atlantic: The Worst Situation Imaginable for Family Violence

Already, there are worrying signs of an uptick in violence against children. In late March, a hospital in Fort Worth, Texas, reported six apparent physical-abuse cases in a week; it typically sees about eight a month. The National Sexual Assault Hotline saw an increase in calls from children during March compared with the previous month.