The Relentless School Nurse: Read & Share the ‘Equity Schools Policy Plan: Supporting Healthy, Inclusive, In-Person Schools

You can join this group of public health leaders to bring an actionable, evidence-based policy plan to your school districts and communities to address school safety as we open the 2022-2023 school year.  

The information for this blog post was retrieved directly from http://equitypolicyplan.org/

Equity Schools Policy Plan: Supporting healthy, inclusive, in-person schools

The Equity Schools Policy Plan provides school safety standards aligned with evidence, equity, and inclusion. It is intended to provide a practical approach to implementing sensible mitigation when and where it is most needed, supporting living well socially, emotionally, and physically – together in the continuing pandemic. 

Equity Schools Principles

Schools are centers of the community bringing together students, families, educators, and staff with different risks of severe disease or economic hardship due to COVID infections.  Schools should be healthy, inclusive, and open as much as possible. COVID policies are equity and inclusion policies. Reducing COVID cases reduces COVID hospitalizations, deaths, and missed work and paychecks that disproportionately affect people who are Black, Hispanic, Native American, low-income, and at high risk of severe COVID. Keeping schools healthy and open supports equitable and inclusive learning environments for all children, families, teachers, and staff. Layered mitigation is most effective. Each mitigation strategy helps reduce COVID, and no mitigation strategy is sufficient to control COVID on its own. Mitigating surges supports mental health. Mitigation policies support students remaining together, in person, and reduce the chance that they, their families, or their teachers get COVID which could harm their health, education, or work and economic stability.

Support vaccination

• Arrange a back-to-school festival that has food, games, school supplies, and includes a vaccine clinic for students, caregivers, teachers, and staff
  • Offer vaccination opportunities during times and at locations that best meet family needs, including after work/weekend hours.
  • Advertise and staff vaccination events in multiple languages, with trusted community leaders
• Work with local health departments to promote COVID vaccines as part of the bundle of back-to-school vaccines
• Start laying the groundwork to incorporate COVID vaccines into the list of general vaccine standards for schools 

Plan for mask mandates at the start of surges

• Schools are crowded indoor settings that get hit first and most in surges. Students and teachers have little choice but to be in school even when transmission is high.
• Leaders should implement data-driven mask mandates that turn on when CDC county transmission level is substantial/high
• Masking does not have to be never or always. 
  • Consider temporary mandates at key times
    • At the start of surges
    • For the first 1-2 weeks of the new school year
    • For the first week upon returning from school breaks, particularly if combined with testing
• Students may be provided with more opportunities to interact without masks outdoors during periods when mask mandates are in place.
  • Outdoor or more distanced lunches can also be implemented during periods of substantial/high transmission.
• Schools should provide 5 to 10 KF94/KN95/N95 masks twice a year that can be reused for each student (Project N95 may be able to support resource-limited settings; school districts can also work with county and state departments of public health to coordinate mask resources).
• Options for communities where mask mandates are banned, but transmission is high:
  • School administrators can lead by example to encourage teachers and students to wear high filtration masks..
  • Maintain positive messaging: masks show how school communities care for each other.
  • Provide masks in many locations, with easy access.
  • Other layers of mitigation are even more important if mask mandates are banned: vaccination, boosting, regular opt-out testing, voluntary masking,  ventilation and filtration.
• August 2022 CDC operational guidance supports universal masking in schools (and all community settings) to meet the needs of people at high risk of getting very sick with COVID. Every school is likely to have students and educators in this category. The CDC guidelines also support universal masking if CDC community levels are high, though schools should consider turning on mask mandates earlier in surges, because they are crowded indoor settings that will be affected first in surges, hospitalizations are a lagging indicator, and it will be too late to reduce spread once there are outbreaks.

Support testing

• Provide weekly, opt-out surveillance PCR-testing or rapid testing to identify students who are infectious and prevent large outbreaks. If not possible year-round, then work with local and state health departments to have test supplies to distribute to families 
  • At the start of surges
  • Prior to the first day of school
  • At the start of school vacations, with instruction for students and staff to test before returning to school
• Provide families with rapid tests to have at home in case a child or household member becomes sick
  • Create or clarify the reporting process(es) for families who have a positive case in the household, and ensure that reporting is accessible.
• August 2022 CDC operational guidance supports screening testing in periods of medium community levels in schools with people at high risk of severe COVID, which most schools will have. They also support testing in key periods such as return from breaks.

 

Improve ventilation and filtration

• Clean air, particularly when combined with mask policies that can turn on and off, is key to reducing transmission of airborne viruses.
• Schools should target 5-6 or more air changes per hour (ACH)
• Use CO2 monitors to measure air exchange
  • Classrooms should aim to have CO2 concentrations of no more than 1100 ppm (~ 15-20 cubic feet per minute/person). Consumer monitors such as Aranet4 provide easy to use, accurate and precise measurements and color-coded guides.
• Use high-quality filtration systems – either central or portable – to clean the air
  • MERV 13 or higher filters should be used and replaced every 3 months. HVAC professionals should be consulted to make sure HVAC systems are sized to handle filters above MERV 13.
  • Properly sized portable air cleaners with HEPA filters, Corsi-Rosenthal boxes, or Supplementary Air Filtered Exchanges (SAFE) boxes should be used when when HVAC cannot accommodate MERV 13 or above or ventilation is insufficient to achieve 5-6 ACH (Note: air purifiers remove particulates and pathogens from the air but do not change CO2 concentrations)
• Schools that do not meet ventilation or filtration standards should implement standards for turning mask policies on throughout the year or at lower levels of transmission 

Supporting isolation when infectious 

• Isolation policies reduce onward transmission of COVID. While there is a cost to isolation for students who miss school and parents who miss work, it reduces onward transmission and the total number of students and educators who become sick and miss work. Every student who is identified as positive should be sent rapid tests home for return-to-school testing. More should be available upon request.
  • Students and educators should isolate for at least 5 days and until they consistently test negative on rapid tests for 24 to 36 hours. The cost of an infectious person infecting others is higher than the cost of isolating until recovered.
• All school teachers and staff should be paid for time isolating.
• Do not count student absences due to isolation toward penalties for absences.
• Provide family support for isolation, such as food vouchers.

Keep high-risk families safe in surges

• High-risk families should be allowed to participate in schools remotely when the county COVID community level is high 
  • Annually evaluate the resources available within schools/school districts that facilitate remote participation in school (e.g., number of homes without Internet; availability of hotspots). 
  • Consider partnerships with multiple districts and regions to support remote learning options that can be used for both high-risk families and children in isolation

Support mental health, community, and togetherness

• This plan aims to help everyone who is in schools and has household members in schools have a healthy school year physically, socially, and emotionally.
• We recommend focusing mask mandates on periods of high transmission so there are opportunities to interact without mask mandates when COVID transmission is lower.
• We recommend increasing all mitigation in surges because protecting oneself and one’s peers, teachers, family, and community from COVID supports physical, social, and emotional health. Mask mandates allow people to continue to gather in schools without high risk of COVID transmission during periods of high transmission. Polls routinely indicate most people support mask mandates in surges.
• We recommend increasing opportunities for interacting with one another more safely outside, where masks can be optional, during high transmission periods.

Authors:

Julia Raifman, ScD, Boston, Massachusetts

Lorenzo Servitje, PhD, MPH, Bethlehem, Pennsylvania

Theresa Chapple, PhD, Oak Park, Illinois

Deshira D. Wallace, PhD, Chapel Hill, North Carolina

Elizabeth Jacobs, PhD, Tucson, Arizona

Michelle Ko, MD, PhD, Davis, California

Rebecca Mitchell, DVM, PhD, Snellville, Georgia

Jon Levy, ScD, Boston, Massachusetts

Local leaders, parents, and administrators: Sign up to join a Coalition aiming to implement the Equity Policy Plan: tinyurl.com/EquityCoalition Public health, medical, and education professionals: Sign on to support the Equity Schools Policy Plan: https://tinyurl.com/EquityPolicyPlan (Note: This is a living document and we welcome feedback. We will incorporate any further suggestions into new versions of this document, not modify the document you support.)

Equity Schools Policy Plan (1)