Principle 2: Risk Stratification and Prevention
Perform regular individual and family COVID-19 risk assessments for students and staff to determine who can participate in in-person learning, facilitate access to key childhood and flu vaccines, and promote immune system strengthening practices. Of note, children under five appear to be at lower risk of severe COVID-19 disease than adults and older children, but may be asymptomatic and transmit it to others.
2.1 Provide staff and families with information about risk in their primary languages to aid with decision making
Likely Implementation Level DISTRICT
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Take a balanced view of risk: School policies should be guided by supporting the overall health and well-being of all children, adolescents, their families, their communities and school staff.
Clearly communicate the balanced view with the community during all steps of the reopening process.
Establish clear guidance on groupings of staff and students who are at high risk of COVID-19 infection and serious illness and should not join in-person learning, and pair this with clear plans for equitable support for learning remotely.
Starting Point Tools
Parabola Project: Communicating About Reopening Measures with Families Toolkit. This toolkit provides insights for principals and district leaders on how to effectively communicate to families about reopening plans. The toolkit was developed in partnership with Learning Heroes and Edge Research.
Parabola Project’s balanced view of risk slide to support messaging.
The American Academy of Pediatrics perspective on balanced risk for children.
Considerations and Questions for Team Decision-Making and Reflection
How will we communicate how the school is balancing risk of COVID-19 transmission with other risks associated with school closure clearly to all stakeholders?
Other Resources
Country/District Examples
¡Colorín Colorado!: School Responses to COVID: ELL and Immigrant Considerations
SIS School Communication to Families about Health Safety Expectations
Ideas
For risk level by county consider using a red/orange/yellow/green method; ex: Risk Level by State/County.
For COVID-19 data and risk level for your community www.covidactnow.org.
Summary of Literature
Children have milder cases of COVID-19, and they also catch COVID-19 and spread COVID-19 less frequently than adults (Wilson 2020).
Multisystem inflammatory syndrome is a rare condition, likely affecting no more than 1 in 1,000 children who contract the virus (Verdoni et al. 2020).
Risk for a community is based upon a combination of how much infection is in the community, the rate of spread, the death rate, and COVID-19 test positivity rate. When the viral infection rate (R number) is below 1, transmission in the community is contained (Aronson et al. 2020).
2.2 Develop a strategy for health promotion and disease prevention
Likely Implementation Level DISTRICT
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Immunizations: Existing school immunization requirements should be maintained and not deferred because of the current pandemic.
Influenza vaccination: 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 who do not have health conditions that preclude them from vaccinations.
Prioritize (if possible, expand, don’t cut) needed health services for students, including behavioral and reproductive health, counseling services, and social/emotional supports.
Continue school nutrition and other health programs, and adapt for accessibility during school closures.
Remind staff and families about existing school policies and guidelines for health.
Incorporate COVID-19-related disease prevention and health education into curriculum.
Create and display signs around school with reminders of rules and responsibilities.
Determine messages that the school will share about the necessity of immunizations and the option of primary care provider vs. pharmacies like CVS vs. school-based immunizations. Incorporate this message in the Family Messaging Guide to be sent from the district.
Starting Point Tools
Parabola Project: Student “Mask Culture” Toolkit
CDC Vaccine and Immunization Overview (including videos to share with parents)
Considerations and Questions for Team Decision-Making and Reflection
Consider beginning each school day with a morning health message to the entire school to reinforce healthy behaviors, using language that is positive and affirming and does not shame or create fear (Jones et al. 2020).
How might we reduce access challenges for students, staff, and families in need of immunization? Can we establish new partnerships?
Consider partnering with local youth organizations (e.g. sports, theater, etc.) to emphasize the importance of social distancing, mask wearing and speaking out about these needs with adolescent peers.
Other Resources
Country/District Examples
Niagara Region Public Health: School-based vaccine program video
Ideas
Require all returning students to document immunization status.
Share requirements for immunization updates with parents to promote updating of all immunizations.
If school-based clinics exist, use this as an immunization update clinic upon reopening.
Identify a local health care partner to provide at-school vaccinations for staff members.
Summary of Literature
School districts should involve School Health Services early in reopening planning to collaboratively consider strategies that address and prioritize immunizations and other needed health services for students, including behavioral and reproductive health services (Cooper et al. 2020).
When children are out of school they’re less physically active, have irregular sleep patterns, and consume less favorable diets, resulting in weight gain and loss of cardiorespiratory fitness (G. Wang et al. 2020).
Research shows that the posttraumatic stress scores for children who were quarantined after a health-related disaster were four times higher than the scores for children who weren’t quarantined (G. Wang et al. 2020).
Students have fallen behind in routine immunization since the start of the pandemic (Santoli et al. 2020).
While there doesn’t appear to be a significantly increased risk of severe COVID-19 among children with immunosuppression (Boast et al. 2020; Turner et al. 2020), families and health care providers may choose to keep these children out of in-person school settings.
2.3 Develop a plan to support high-risk staff and students who need to stay home
Likely Implementation Level DISTRICT
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Provide details on risk factors to families and identify high-risk staff and students.
Staff age 65 or older, or with serious underlying health conditions that put them at high risk of illness due to COVID-19, should be encouraged to talk to their health care providers to assess their risk and to determine if they should avoid in-person contact.
Create a process for students, parents/caregivers, and staff to self-identify as high-risk for severe illness due to COVID-19 and have a plan in place to address requests for alternative learning arrangements or work reassignments if possible.
Offer, as feasible, options that limit exposure risk for staff at higher risk for infection and severe illness.
Offer options that limit exposure risk for students at higher risk of severe illness (e.g., remote and virtual learning opportunities).
Be aware that staff may need to stay home when they are sick, have been exposed to someone in quarantine, or are caring for someone who is sick.
Review all current plans (e.g., Individual Healthcare Plans, Individualized Education Plans) for accommodating students with special health care needs and update their care plans as needed to decrease their risk for exposure to COVID-19.
For students who will not return to face-to-face classes, create a plan for ensuring equitable continuity of learning through remote means.
Ensure the district has data infrastructure and tools in place to support remote work and learning for students and staff.
Starting Point Tools
Example Instructional Continuity Plan from FDOE (see p. 75-78)
TLA Always Ready for Learning Resource Hub (See Designs for Teaching and Learning, Technology and Data Infrastructure)
Considerations and Questions for Team Decision-Making and Reflection
Given local context and plans, what are the options for students and staff who self identify as high-risk to engage in work and learning?
Other Resources
Ideas
Maintain (do not cut) support for school counselors.
Meaningfully engage and consult with local bargaining units regarding high-risk staff and teachers.
Identify building or cohort-based substitutes who can step in for staff needing to take leave.
Summary of Literature
Adults with underlying conditions (especially obesity, diabetes, cardiovascular disease, cancer, chronic respiratory disease, chronic kidney disease, and immunosuppression) are at most risk for complications of COVID-19 infections.
Children usually have milder cases of COVID-19 and they also catch COVID-19 and spread COVID-19 less frequently than adults (Wilson 2020; Boast et al. 2020; Boulad et al. 2020; Li et al. 2020; Lee and Raszka 2020; Munro and Faust 2020; Ludvigsson 2020a; Ludvigsson 2020b).
There doesn’t appear to be a significantly increased risk of severe COVID-19 among children with immunosuppression (Boast et al. 2020; Turner et al. 2020).
It may be difficult to distinguish COVID-19 from acute chest syndrome among children with sickle cell disease (Cooper et al. 2020).