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Opinion by Drs. Elizabeth Miller and Julie M. Donohue

Of the many difficult decisions elected officials have faced during the COVID-19 pandemic perhaps none is more fraught than whether to open schools for in-person instruction. In most of the United States, the choice of fully in-person, hybrid, or fully remote instruction has been made by local school districts. Remote instruction was the dominant choice this fall when evidence was limited on the role of schools in transmission and there was uncertainty about the best approaches to virus mitigation in schools. Since the start of the school year, epidemiologic data indicate that transmission of the COVID-19 virus within school settings appears to be low. Some stakeholders are now suggesting that schools should not resume in-person instruction until vaccines are available to school staff. That approach ignores the mounting evidence on the relative risks and benefits of in-person vs. remote learning for virus transmission and for overall well-being for children, families and communities.

Child care centers and schools play a critical role in educating students and delivering to students (and their families) vital services such as meals, psychosocial support, special education services, safety from violence and connection to community-based resources. The Centers for Disease Control and Prevention released guidelines on January 21st of this year on operational considerations in schools so that schools may safely reopen with recommended mitigation practices. With continued attention to reducing community transmission and limiting school-related activities such as indoor sports practice and competitions, transmission risk can be lessened.

Currently, the two vaccines available in the United States are being distributed to those individuals who are designated as Phase 1A based on their occupation, age or health status. School teachers and staff are considered Phase 1B, and given limited supply of vaccines today, it remains unclear when vaccines for Phase 1B will be available. Advocacy efforts from national and local organizations request that vaccines be made more widely available to those working in schools to help further reduce risk with in-person instruction.

Distribution of vaccines, however, should not be the deciding factor for school reopening. The preponderance of data suggest that in-person instruction can be conducted safely. Universal face mask use, physical distancing, de-densified classrooms and common areas, increased room ventilation and access to rapid testing have all been shown to help with reducing in-school transmission. In-person instruction should be prioritized for younger children who are less susceptible to the virus. Younger children are also least likely to benefit from remote learning, and the impact on caregivers due to lost work hours and wages from at-home instruction is greatest for young children. Children with special education needs should also be prioritized for in-person instruction.

The evidence is also growing that remote instruction is disproportionately impacting the learning of children and youth in minoritized and marginalized communities where access to technology, adult caregiver availability to monitor learning (limited due to the need for caregivers to work in essential services), limited English proficiency and housing instability, further exacerbate already profound racial inequities in education. From a health and social equity perspective, we urge school administrators to learn from scientific evidence and the experience of school districts around the country to guide decision-making about resuming in-person instruction with alacrity.

Elizabeth Miller, M.D., Ph.D., is director of the Division of Adolescent and Young Adult Medicine at UPMC Children’s Hospital of Pittsburgh and professor of pediatrics and of behavioral and community health sciences at the University of Pittsburgh. Julie M. Donohue, Ph.D., is professor and chair of the Department of Health Policy and Management at the University of Pittsburgh’s Graduate School of Public Health.

Read full story  First Published in the Pittsburgh Post-Gazette, February 14, 2021, 5:45am