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CDC DIRECTED QUESTIONS

Q. How will these guidelines promote herd immunity? 

CDC: At this time we don’t have sufficient data to answer this question.

Q. How are we going to be able to delineate during cold and flu season? 

CDC:  Please visit our site on Similarities and Differences between Flu and COVID-19

Q. Is a surge in multisystem inflammatory syndrome in children (MIS-C) anticipated as COVID cases increase?

CDC: Although rare, some children have developed multisystem inflammatory syndrome (MIS-C) after exposure to SARS-CoV-2. As of 7/15/2020, CDC has received reports of 342 cases and 6 deaths in 37 jurisdictions. Children appeared to be less likely than adults to be infected or to have severe illness early in the COVID-19 pandemic. It’s unknown whether this increase in COVID-19 cases among children will also increase cases of MIS-C. CDC and our state partners will be monitoring for additional cases. CDC investigators are assessing reported cases and children’s health outcomes to try to learn more about specific risk factors for MIS-C, how the illness progresses in children, and how to better identify MIS-C and distinguish it from similar illnesses.

With this being said, a dramatic increase in COVID-19 cases may very well be associated with an increase in MIS-C among children, and so communities should prepare accordingly. CDC has a dedicated team investigating MIS-C to learn more about this syndrome and to communicate information to parents and caregivers, healthcare providers, and health departments. For more information about MIS-C, CLICK HERE 

Q. What is the recommendation on opening schools while there is a surge of infections and hospitalization occurring?

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/prepare-safe-return.html

CDC:  School administrators should make decisions in collaboration with local health officials based on a number of factors, including the level of community transmission, whether cases are identified among students, teachers, or staff, what other indicators local public health officials are using to assess the status of COVID-19, and whether student, teacher, and staff cohorts are being implemented within the school.

      If there is substantial, controlled transmission, significant mitigation strategies are necessary. These include following all the actions listed above and also ensuring that student and staff groupings/cohorts are as static as possible with limited mixing of student and staff groups, field trips and large gatherings and events are canceled, and communal spaces (e.g., cafeterias, media centers) are closed.

      If there is substantial, uncontrolled transmission, schools should work closely with local health officials to make decisions on whether to maintain school operations. The health, safety, and wellbeing of students, teachers, staff and their families is the most important consideration in determining whether school closure is a necessary step.  Communities can support schools staying open by implementing strategies that decrease a community’s level of transmission. However, if community transmission levels cannot be decreased, school closure is an important consideration. Plans for virtual learning should be in place in the event of a school closure.

Q. What are your recommendations for daily screenings - self-certification (including temp checks) versus school staff collecting temp and screening on a daily basis?

CDC:  CLICK HERE for guidance about screening students for symptoms of COVID-19.  Based on the best available evidence at this time:

    CDC does not currently recommend universal symptom screenings (screening all students grades K-12) be conducted by schools.

    Parents or caregivers should be strongly encouraged to monitor their children for signs of infectious illness every day.

    Students who are sick should not attend school in-person.

Q. Will Dr. Sauber-Shatz be making her statement available in print? Or is this available on the CDC website?

CDC:  Material from the presentation can be found on this website

Q. Is there research for how young children are able to practice wearing masks for long periods of time as well as maintain physically distancing for hours?

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/cloth-face-cover.html

CDC: Appropriate and consistent use of cloth face coverings may be challenging for some students, teachers, and staff, including:

    Younger students, such as those in early elementary school.

    Students, teachers, and staff with severe asthma or other breathing difficulties.

    Students, teachers, and staff with special educational or healthcare needs, including intellectual and developmental disabilities, mental health conditions, and sensory concerns or tactile sensitivity.

CDC recognizes there are specific instances when wearing a cloth face covering may not be feasible. In these instances, parents, guardians, caregivers, teachers, and school administrators should consider adaptations and alternatives whenever possible. They may need to consult with healthcare providers for advice about wearing cloth face coverings.

Younger children (e.g., preschool or early elementary-aged) may be unable to wear a cloth face-covering properly, particularly for an extended period of time. Wearing of cloth face coverings may be prioritized at times when it is difficult to maintain a distance of 6 feet from others (e.g., during carpool drop off or pick up, or when standing in line at school). Ensuring proper cloth face-covering size and fit and providing children with frequent reminders and education on the importance and proper wear of cloth face coverings may help address these issues. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html

CDC provides additional suggestions for parents to consider to help their child wear a cloth face-covering appropriately HERE.

Q. Deaf students can only understand what you are saying if your mouth is not covered with a face mask. How do we go about this scenario?

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html

CDC recognizes that wearing cloth face coverings may not be possible in every situation or for some people. In some situations, wearing a cloth face covering may exacerbate a physical or mental health condition, lead to a medical emergency, or introduce significant safety concerns. Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading if it is not possible to wear one.

For example:

 People who are deaf or hard of hearing—or those who care for or interact with a person who is hearing impaired—may be unable to wear cloth face coverings if they rely on lipreading to communicate. In this situation, consider using a clear face covering. If a clear face covering isn’t available, consider whether you can use written communication, use closed captioning, or decrease background noise to make communication possible while wearing a cloth face covering that blocks your lips.

o Cloth face coverings are a critical preventive measure and are most essential in times when social distancing is difficult. If cloth face coverings cannot be used, make sure to take other measures to reduce the risk of COVID-19 spread, including social distancing, frequent hand washing, and cleaning and disinfecting frequently touched surfaces.

o Clear face coverings are not face shields. CDC does not recommend use of face shields for normal everyday activities or as a substitute for cloth face coverings because of a lack of evidence of their effectiveness for source control. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/cloth-face-cover.html

Q. Is the practice of daily temp checks reliable for assessing safety and risk of exposure?

CDC:  Daily temperature checks are commonly done as part of symptom screening. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/symptom-screening.html

Based on the best available evidence at this time:

      CDC does not currently recommend universal symptom screenings (screening all students grades K-12) be conducted by schools.

      Parents or caregivers should be strongly encouraged to monitor their children for signs of infectious illness every day.

      Students who are sick should not attend school in-person.

      Symptom screenings will fail to identify some students who have SARS-CoV-2 infection. Symptom screenings are not helpful in identifying individuals with SARS-CoV-2 infection who are asymptomatic or pre-symptomatic (they have not developed signs or symptoms yet but will later). Others may have symptoms that are so mild, they may not notice them. In fact, children are more likely than adults to be asymptomatic or to have only mild symptoms. The exact percentage of children with SARS-COV-2 infection who are asymptomatic is still unknown, but recent large studies have suggested around 16% of children with SARS-CoV-2 infection do not develop symptoms. This means that even when schools have symptom screenings in place, some students with SARS-CoV-2 infection, who can potentially transmit the virus to others, will not be identified.

      Symptom screenings will identify only that a person may have an illness, not that the illness is COVID-19. Many of the symptoms of COVID-19 are also common in other childhood illnesses like the common cold, the flu, or seasonal allergies. The table below illustrates some of the overlap between the symptoms of COVID-19 and other common illnesses.

o The overlap between COVID-19 symptoms with other common illnesses means that many people with symptoms of COVID-19 may actually be ill with something else. This is even more likely in young children, who typically have multiple viral illnesses each year. For example, it is common for young children to have up to eight respiratory illnesses or “colds” every year. Although COVID-19 and illnesses like colds or the flu have similar symptoms, they are different disease processes.

Q. If it is decided that students ride the bus (with up to 50 kids) with masks, is that considered social distancing?

CDC: The use of cloth face coverings is not a substitute for other strategies to prevent the spread of COVID-19.

 Concurrently implementing multiple strategies in school to prevent the spread of COVID-19 (e.g., social distancing, cloth face coverings, hand hygiene, and use of cohorting) https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/prepare-safe-return.html

Q. Is the 10% rule (for positive cases) still the recommendation for schools to close? So, if there are 900 students 90 have to be out with COVID to close the school? Or does the percentage include everyone in the school building?

The decision to close schools for in-person learning should be made together by local officials – including school administrators and public health officials — in a manner that is transparent for students, staff, parents, caregivers and guardians, and all community members.

The decision to close schools for in-person learning should take into account a number of factors, such as:

    the importance of in-person education to the social, emotional, and academic growth and well-being of students;

    the level of community transmission;

    whether cases have been identified among students and staff;

    other indicators that local public health officials are using to assess the status of COVID-19 in their area; and

    whether student and staff cohorts have been implemented within the school, which would allow for the quarantining of affected cohorts rather than full school closure.https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/reopening-schools-faqs.html

CLEANING

Q. Can you address the need to check hand sanitizers that are coming from some vendors in Mexico to make sure they do NOT contain methanol. The CDC just announced a comprehensive list of these brands.

Claire Barnett: Of course, good idea. We post a variety of notices, reports, and webinars to our curated weekly online NewsSlice. I will check to see if we posted this one or might repost given its importance.

Q. Who does an inspection of schools to ascertain compliance with health regulations?

Claire Barnett: First, which health regulations do you have in mind? Local health departments might inspect school kitchens and food service areas and or swimming pools. I am not aware of any other inspections that a health agency might routinely conduct.

Q.If a student was sent home for COVID symptoms, what happens to the classroom that the students and teacher were in. Do they go to a different room so that the room can be deep cleaned? Or do they resume class as normal until the school receives results?

Claire Barnett:Many children who have tested positive for COVID have no symptoms. COVID can produce symptoms that look like asthma or allergy or like the cold or flu. Schools would be making a mistake to automatically send a child home unless s/he had a fever. With or without a pandemic, schools routinely send kids home if they have a fever. Anyone with a fever and or serious intestinal upset should stay home.

Q.What do you recommend for schools to use as disinfectants that are certified "green" schools?

Claire Barnett: Great question. First of all, any school can buy and use third-party certified green cleaning products and or “safer” disinfectants. They are not restricted in any way to “green” schools. Per US EPA policy, disinfectants cannot carry a “green” certification label because disinfectants kill living organisms.

Only disinfectants on the US EPA “N List” will deactivate the human coronavirus, thus we endorse the work of the Responsible Purchasing Network (Oakland, CA) that culled the US EPA N List to produce a list of disinfectants that are less hazardous/safer for human health.

Q. Is it recommended to wait 24 hours to clean the isolation room at school? Why or why not?

Claire Barnett: Wait times are recommended; consult with your local health department. Since the coronavirus can remain active on hard and soft surfaces for days or hours, waiting 24 hours provides a time when some of the viral load will become less infective and or the ventilation system may clear out some of the airborne particles or aerosols.

Q.How [should] waste generated from learners and staff (e.g., face masks; gloves) be handled after use?

Claire Barnett: Good question. The school custodian and or facility director who is responsible for removing school waste should advise you.  

Q. Can we clean with soap and water in between classes at a high school level and still be OK (with a disinfecting after school ends)?

Charles Gerba:  It is crucial to understand the difference between “cleaning” and disinfecting. Cleaning is the removal of pathogens from a surface. It does not kill the pathogen. In fact, as you clean you may be moving the pathogens from one surface to another, thereby spreading them widely.

The act of cleaning with soap and water works to clean the surface of your hands, with the water washing the pathogens down the drain. Cleaning a desk off doesn’t kill the pathogens…they’re on whatever you used to clean the surface. And while soap may kill some of the pathogens on the desk, it will NOT kill all of them the way a disinfectant would.

Please note that disinfectants must be put on surfaces that are cleaned. They can be readily compromised in their ability to kill pathogens if the surface is dirty. Sometimes “dirt” on surfaces in not visible to the naked eye. It could be oil from human hands, droplets of saliva, dust, or soil from play areas. It’s best if you clean and then use a disinfectant wipe on the desks and chairs between classes. Use a wipe according to package label instructions. Use one wipe for every 2-3 desks since you must get the surface wet, not just damp. Don’t let students sit at the desks until they are dry. Look for disinfectants that have a clean and disinfect claim for one-step disinfecting.

Encourage students to use hand sanitizer and NOT to touch their eyes or mouth.

Q.  Can elementary kids clean their desks with soap and water, then we use a disinfectant later? At what age would you recommend for students using a disinfectant wipe?

Charles Gerba:  Students should not use disinfectant wipes UNLESS they can read and fully follow the instructions for their use. So older high school students who are responsible and won’t engage in horseplay might be able to do this. Some disinfectants can cause serious eye damage, so children who use them must then wash and dry their hands and be sure not to touch their eyes until they have done so. This is a tall order for most children. Most manufacturers recommend that ADULTS do this task, not students.  See the soap and water answer above…washing with soap and water just moves the pathogens around and doesn’t kill them effectively. You must clean before you disinfect.

Q. Does the research discussed about fomites also apply to COVID-19?

Charles Gerba: Fomites play a role in infections where the pathogen can survive on a surface for a period of time. Norovirus can live for a month on a door handle. COVID-19 is less hardy but lives up to a week on certain surfaces. It is highly infectious so if you touch something with the virus on it, then touch your eyes or mouth, you could be infected. Fomites are not, according to some, as important and virus suspended in air. This is a legitimate concern.

Lancet says: A clinically significant risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission by fomites (inanimate surfaces or objects) has been assumed on the basis of studies that have little resemblance to real-life scenarios…. None of these studies present scenarios akin to real life situations… the chance of transmission through inanimate surfaces is very small, and only in instances where an infected person coughs or sneezes on the surface, and someone else touches that surface soon after the cough or sneeze (within 1–2 h).

I do agree with erring on the side of caution. Washing hands often or using hand sanitizers is a great idea. https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30561-2.pdf

Q. Are cleaning products/disinfecting products asthmagens? 

Charles Gerba: There are many ingredients in cleaning products and as a whole, no they are not asthmagens. If one finds they are experiencing an allergic reaction, they should look for fragrance-free products as fragrance is often the offending ingredient. Often the problem occurs with spraying – this can occur with vinegar and water, thymol which is an allergen, and many other liquids. The good news is that there are disinfecting products in wipe forms that do not require spraying. These are not allergens or asthmagens because they do not volatilize even when they dry on a surface. Quaternary ammonium compounds do NOT have an odor and are NOT ammonia…they have no smell. This is a common misconception. Clorox, Lysol and other companies have quat-based wipes on the EPA N list that are effective and safe when used as directed.

Q. After playing outside, is hand-sanitizer just as good as hand washing?

Charles Gerba: Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of pathogens. There is data that shows hand sanitizers will kill certain viruses but the FDA has disputed these claims.

I encourage hand sanitizer use only when washing with soap and water isn’t possible. Although alcohol-based hand sanitizers can inactivate many types of microbes effectively when used correctly, people may not use a large enough volume of the sanitizers or may wipe it off before it has dried. CDC Guidance.  

Q. Is it true the sun and with the right humidity level has killed the virus within seconds?

Charles Gerba: According to the World Health Organization, the novel coronavirus doesn’t die until it reaches 132 degrees Fahrenheit. Humidity is not likely to be effective…it’s plenty humid in North Carolina and Florida where there are lots of cases of the virus. UV-C light which is one band of light in sunlight will kill the virus in time on surfaces when used in closed systems like HVAC systems.  WHO Report   

Q.  Is it true that the SARS-COV2 virus on playground equipment is killed by UV rays outdoors?

Charles Gerba: The World Health Organization says there is no evidence that says sunlight will kill the virus 

Q I am not confident that our schools will have provided enough of the necessary cleaning supplies for classrooms and the health office prior to school beginning. Will Lysol wipes or generic equivalents sufficient to clean surfaces say in the health office?

Charles Gerba: You must clean first because any residual organic matter of any kind may inactivate the disinfecting properties of a wipe. Lysol Wipes or other wipe listed on the EPA N list will disinfect surfaces sufficiently if you follow label directions.

Q. What do you recommend for children with eczema and/or parents not wanting children to use hand sanitizers? 

Charles Gerba: Soap and water

Q. How do we support staff who are medically vulnerable?

Charles Gerba: That’s a question for each school district to answer.

Q. As an elementary school nurse, should my personal office be an isolation room? 

Charles Gerba: No it is better to have a separate space. 

Q.  Do I isolate and send home every child with a fever? 

Charles Gerba: Yes 

Q. Do I isolate and send home every child with one symptom of COVID-19, but no fever? 

Charles Gerba: Yes

Q. What type of PPE is recommended for a Speech Pathologist since therapy focuses on the child's mouth, nose, and face? Many children drool and have open mouths most of the therapy time. 

Charles Gerba: The United Federation of Teachers says that if secretions, mucous, blood or body fluids is unavoidable, gloves should be used as well as a mask. Though this guidance is for school nurses, it should apply for speech pathologists as well. https://www.uft.org/chapters/doe-chapters/school-nurses/you-should-know-school-nurses/influenza-like-illness-protocol. Be sure to wash hands often, have a change of clothes available, consider using a medical face shield to keep the child from getting droplets of saliva on you. Wash the shield after every session and then disinfect it.

Q Please address current recommendations regarding masks, including who should wear them, what type should be worn and by whom.  

Charles Gerba: The AAP says any child over 2 years of age should wear a cloth mask. https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Cloth-Face-Coverings-for-Children-During-COVID-19.aspx. The CDC also recommends this and some school districts are mandating masks. Cloth masks need to be changed often. Once they are moist, which doesn’t take long, they should be discarded.

Q. Are alcohol-based hand sanitizers safe to use in preK?

Charles Gerba: The CDC suggests that for children under six years of age, hand sanitizer should be used with adult supervision. Always store hand sanitizer out of reach of children and pets. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html

Q.  Is benzalkonium chloride effective in hand sanitizer?

Charles Gerba: Yes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301780/

Q Is vinegar a safe disinfectant? 

Charles Gerba: It is not on the EPA’s N list so not for Covid

Q. What do you recommend for schools to use as disinfectants that are certified "green" schools?

Charles Gerba: Refer to List N or the interactive List N tool for the most up-to-date disinfectant list from EPA. Is it recommended to wait 24 hours to clean the isolation room at school? Why or why not?

CDC guidance is to close off areas visited by ill persons. Open outside doors and windows and use ventilating fans to increase air circulation in the area. Wait 24 hours or as long as practical before beginning cleaning and disinfection. There are now portable air cleaning devices that include ULPA HEPA filters and UV-C lighting that circulate the air in the room quickly through the machine and help to removed pathogens and particulates from the air. In a 10’x10’x10’ closed room air circulates through the machine once a minute. These are being ETL certified for efficacy and safety. Don’t get lulled into buying ozone generators to clean air—these can only be used where living creatures (kids, pets) are NOT present. These are not recommended. Portable air cleaning equipment should include both ULPA Hepa filters AND UV-C lights, because HEPA filters do not kill the pathogens and depending on the efficacy may not filter them from the air. ULPA HEPA filters are 99.999% effective for pathogens down to 0.12 microns in size. COVID 19 for example ranges in size from 0.06 to 1.4 microns. The UV-C lighting in combination with the ULPA Hepa filters are advised to help assure that the viruses are killed. For information on these devices you can call 888-756-5766. https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html

Q Is there a benefit to using an electrostatic cleaning machine? Does the electrostatic cleaner leave a residue that needs to be cleaned later? 

Charles Gerba: Application of a dilute sodium hypochlorite disinfectant using an electrostatic sprayer can provide rapid and effective decontamination of portable equipment and large open areas.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275188/

However, unless the pesticide product label specifically includes disinfection directions for fogging, fumigation, or wide-area or electrostatic spraying, EPA does not recommend using these methods to apply disinfectants. EPA has not evaluated the product’s safety and efficacy for methods not addressed on the label. https://www.epa.gov/coronavirus/can-i-use-fumigation-or-wide-area-spraying-help-control-covid-19

Q. Does steam kill viruses?

Charles Gerba: Hospitals use steam to sterilize medical equipment but it is used in a controlled setting under pressure (which allows the steam to reach higher temperatures). Hand steam cleaners for disinfecting surfaces are used in health care settings are available, but use has largely been I healthcare facilities trained personnel. .

Q. What is the difference between disinfectant, sanitizing and fumigation?

• Clean—use soap and water to decrease the presence of COVID-19 and other microbes. This wipes them from the surface being cleaned. They are captured on the cleaning rag and can be readily spread elsewhere.

• Sanitize—use a product to lower the number of germs to a safe level. These products are generally not registered to kill viruses. Read product labels for pathogens they will kill.

• Fumigation - to apply smoke, vapor, or gas to disinfect.

• Disinfect—use of EPA registered product “N List” products to deactivate viruses

- Not all products kill COVID-19. If the label says corona virus it will work

- Check and follow label directions

- Always follow “sit time” requirements “Dwell time” is the amount of time the products need to be on the surface in liquid/wet form to effectively kill the targeted pathogens.

- Never overuse or allow students to apply disinfecting products

- Electrostatic spraying is unproven

Q. Use of ozone or steam cleaning is under review Where does hydrogen peroxide based cleaning supplies fall into cleaning supplies. 

Charles Gerba: There are hydrogen peroxide based products on the EPA N List. Check to make sure the one you are using is included.

Q. What can be used as an alternative to bleach for laundry at schools? 

Charles Gerba:  Clorox II works. There are also disinfectants on the EPA N List that are appropriate for laundry use and are not bleach. Additional guidance from the CDC:

• Do not shake dirty laundry.

• Wear disposable gloves while handling dirty laundry.

• Dirty laundry from a person who is sick can be washed with other people’s items.

• Wash items according to the label instructions. Use the warmest water setting you can.

• Remove gloves, and wash hands right away.

• Dry laundry, on hot if possible, completely.

• Wash hands after putting clothes in the dryer.

• Clean and disinfect clothes hampers. Wash hands afterwards.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html

Q. What are considered the "high touch" surfaces that should be prioritized for cleaning several times per day?

Charles Gerba: Any object people touch a lot. Their chairs, tables, door knobs, light switches, handles, desks, toilets, faucets, sinks, stair rails, rails on school buses, keyboards, mice, cell phones, toggle on a water fountain, handle on a pencil sharpener.. Door plates on doors that push to open, faucets, door latches and counters in restrooms. Locker locks and doors, shared objects in the class room. Assign someone to make a list. Make it a class project to count how many people touched something common in the room to raise awareness and compile a list for facilities maintenance personnel. In studies we did, the dirtiest location was the teacher’s desk.

Q. Are water bottle filling stations a problem or concern?

Charles Gerba: People can also fill their water bottles at home if they are worried about using public drinking water dispensers, but in-fact there is no evidence we found that these are likely to be a significant source of viral infection. https://www.covid-19facts.com/?p=83769 Keep in mind that any faucet or handle on the filling station that people touch will be problematic and should be routinely disinfected.

Q.  While waiting and monitoring children in an isolation room till their parents arrive should they wear N95 masks and what other PPE would you recommend? 

Charles Gerba:  Masks continue to be misunderstood. Cloth masks are to keep people wearing them from sneezing or coughing on others nearby. They do NOT prevent breathing in air that has coronavirus in it. If the school nurse can get an N95 masks that is good but only for a brief period of time and then it must be disinfected. It’s better to use disposable paper or cloth masks. These again do not prevent you from breathing in air that has the virus in it.

Q. Should these items then be placed in a biohazard bag or would a regular designated disposable bin? How [should] waste generated from learners and staff (e.g., face masks; gloves) be handled after use?

Charles Gerba: Use lined trash can

• Place used disposable gloves and other contaminated items in a lined trash can.

• Use gloves when removing garbage bags, and handling and disposing of trash. If you can, seal the top of the trash can liner before disposing of the bag. Wash hands afterward.

• If possible, dedicate a lined trash can for the person who is sick.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html


CONNECTEDNESS

Q.  How do you anticipate relationship building with our students when they are not in your classroom - It seems very difficult in a google classroom or Zoom meeting - when you have never met before?

Marci Hertz:  This is definitely much harder when students are not in your classroom in-person. This will vary by the age of the students and the size of your classes, but I would think creatively of how to get to know your students? What types of information do you learn when they are there in person? Can you ask them to complete an age-appropriate version of the “All About Me” activity—what do they like to do in their free time? What do they like most about school? The least? What support would they like from their teachers? If it’s possible to schedule individual phone calls with students and discuss their submission, that would be ideal, but realize this would be a large burden on already over-burdened teachers. Scheduling small group calls might be another, less burdensome option. Take advantage of the tools available on the online platform you’re using, like breakout rooms, chat, and hand-raising to engage students with you and each other. Also, if there are opportunities for safe, in-person interaction, for example at food pick up locations, consider assisting or attending these, while taking appropriate precautions.

Q. One of my fears is that when my students come back to school for only 2 days a week and then realize that they can not come back for another week. How can I help them deal with the sense of loss of school community?

Marci Hertz: This is definitely tricky, especially for younger children. A sense of routine is very important; if there is consistency to days/weeks then it’s important to share this with students. A primary source of anxiety is not knowing what is coming, so preparing them for when they are not in the school building will be important. What will they be expected to do virtually? How can they check in with each other and with the teacher? What can they work on virtually that they can share when they return? If students have access to the internet, is there a place in Google Hang Outs or somewhere else that they can dialogue with you and other students? Can they complete assignments with other students on the phone or via video? Post videos (some type of screening by school staff may have to occur before these go live). Consider creative ways to offer clubs or after school activities online or connect kids with similar interests.

Q.  How do we bring up children's socio-emotional development when they cannot physically meet? Virtual is not real enough and cannot replace in-person connection.

Marci Hertz: 100% true that virtual cannot replace in-person connection, but if the school district has determined or families have determined it’s not safe for their student(s) to return, then we have to do the best we can virtually. There are, thankfully, ways to address social-emotional development virtually. There are a lot of great online resources related to social emotional learning at CASEL as well as online discussion groups and boards: https://casel.org/covid-resources/ including lots of professional development opportunities for staff and curricula that are offered online. The key principles that CASEL recommends to promote SEL in a distance learning environment are:

Finally, many local school district staff also putting SEL activities online for teachers to implement with students and/or school counselors or social workers conducting online sessions with classes or small groups of students. If the virtual options won’t work for your students, then reaching out to them individually via email or phone to do a wellness check-in; there also SEL videos and exercises students can complete individually and email back to the teacher.

INDOOR AIR QUALITY

Q. How can we increase the ventilation of outside air if our school windows don't open? –

Claire Barnett: Why don’t they open? Are they nailed or painted shut? Are there security concerns? Or is the school dependent on a closed mechanical system and the windows are closed by design? The solution will vary depending on the circumstances. This and several other good questions would benefit from a specific technical webinar on IAQ.

Q. Some plants are known to clean the air such as snake plants. Has anyone studied how filling indoor spaces with identified plants affects COVID?

Claire Barnett: SARSCoV2 is a virus, not a living organism. Plants could not ‘clean’ it out of the air. There is wishful thinking literature indicating plants might help indoor air quality, but quite a bit of concern exists in that potted plants indoors contribute to mold and pests in schools.

Q. There have been warnings about using disinfectants while students are present in the building due to respiratory irritation. What are some of the concerns?

Claire Barnett: Disinfectants are registered for use by US EPA as “antimicrobial pesticides”; they are designed to kill or deactivate target organisms. Some disinfecting products contain chemicals listed as “asthmagens”, chemicals that cause or trigger asthma, so using them could trigger asthma in children and or in staff, especially in cleaners applying them. The asthmagen list is maintained by the Association of Occupational and Environmental Clinics (AOEC.org) and relied upon by occupational health professionals. Other disinfectants may contain fragrances, which can irritate airways and are also associated with neurological symptoms.

Q. How do health offices manage if there are no windows? Air purifiers/cleaners?

Claire Barnett: See the CALL to ACTION: PANDEMIC V SCHOOLS, Appendix on 11 Considerations for School Nurses.  If there are no windows, are there air vents allowing air into the space or vents to the outside? A school health care office should be vented directly to the outside. If there is no vent, one could installed in an outside wall. If there are no windows and no vents and the office cannot be moved, yes, a portable room air cleaner with a HEPA filter would be helpful. Do not use air cleaners that create ozone.

Q. Can you go over the recommended C02 Levels again?

Claire Barnett: CO2 is what we all exhale, less oxygenated, stale air. Levels in workspaces like classrooms should stay under 1,000 parts per million (PPM) while the room is occupied. Do not accept or rely on measures taken when the room is empty or school closed for the weekend. Adult critical thinking skills start to decline at 1,000 PPM.

Q. What is the difference between negative and positive air pressure?

Claire Barnett: Negative pressure is when air is being drawn out from a space (vent over your kitchen stove); positive pressure is when air is being blown in or forced into a space.

Q. Is placing desks 3 feet apart acceptable when everything says that staying 6 feet apart is needed?

Claire Barnett: I can’t really answer this one. We need more science on children and their transmission rates. In the absence of science, practice an abundance of caution.

Q. Are HEPA filters in classrooms and Health offices recommended?

Claire Barnett: What is recommended is fresh air flow and ventilation to at least meet current standards in cubic feet per minute per person. If the outdoor air is not clean, ventilating system filters will help (MERV 13).

Q. Should nurse offices use an air filtration/cleaner unit, if you please cite info substantiating this use? Should health offices utility window exhaust fans to increase air exchange. What is the minimum air exchange per hour in schools and health offices?

Claire Barnett:These are complex questions. Not all mechanical systems are alike, not all schools are alike, and some individual buildings may have been built then added to with different operating systems. In our CALL TO ACTION- PANDEMIC v SCHOOLS there are Appendices on Air, Ventilation and Aerosols, and on Considerations for School Nurses. US EPA’s IAQ Tools for Schools in mentioned and linked in the document and will provide a basic understanding of indoor air challenges and solutions in schools.

MASKS/PPE/DIVIDERS

Q. With increased CO2 and mask use, what are the implications for continuous/long-term use by children in school?

Charles Gerba:   AAP recommends cloth masks for kids over the age of 3. It does not address the CO2 issue. You might want to contact the school physician or your public health department about this.  Click here for a helpful link. 

Q. What are your thoughts of preschoolers who are not willing/medically able to wear masks?

AAP has some excellent tips on how to help kids get over the scariness of wearing a mask.

• Look in the mirror with the face coverings on and talk about it.

• Put a cloth face covering on a favorite stuffed animal.

• Decorate them so they're more personalized and fun.

• Show your child pictures of other children wearing them.

• Draw one on their favorite book character.

• Practice wearing the face covering at home to help your child get used to it.

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Cloth-Face-Coverings-for-Children-During-COVID-19.aspx

Masks will not protect the wearer but help to minimize exposure of those around them. Children not wearing masks can more readily infect others with coughing, sneezing, vocalizing that spreads fine saliva droplets, and close contact. The school should adopt a policy on how to protect others in the class from unmasked children. Distance will be crucial. Remind all kids not to touch their faces, eyes, noses, mouths. This is a challenge as kids are CONSTANTLY doing this without even realizing it. Some schools are creating cohorts of limited numbers of children (6 or so) to limit exposure to those who may have the virus but who are symptomatic it. This is easier said than done. Perhaps you can consider doing groups of masked children and other groups of unmasked children. Make sure children wash hands or use hand sanitizer frequently.

Q. I have been seeing and hearing mixed messages in regards to PPE in the school health office. What do school nurses need to wear and have on hand in the office? COVID enters the body through the eyes, nose and mouth. So having protection in those areas makes sense. 

Charles Gerba:  School nurses need to wear a mask, and gloves (if handling body fluids). They need to have additional masks on hand for anyone who does not have one or whose mask has been damaged or contaminated. Here is what the CDC say for “caregivers”

• Wear gloves when you touch or have contact with the sick person’s blood, stool, or body fluids, such as saliva, mucus, vomit, and urine. Throw out gloves into a lined trash can and wash hands right away.

• The caregiver should ask the sick person to put on a cloth face covering before entering the room.

• The caregiver may also wear a cloth face covering when caring for a person who is sick.

• To prevent getting sick, make sure you practice everyday preventive actions: clean hands often; avoid touching your eyes, nose, and mouth with unwashed hands; and frequently clean and disinfect surfaces.

• CDC guidance also includes wearing face shields.

• Have extra clothing so that you can change if a child sneezes or coughs on you.

Q.  Can the masks with cutouts in the front (so that you can see the mouth) be used for the kids who are deaf?

Yes and here is a pattern to make one.  All the sites on hearing impaired recommend them, again no peer reviewed studies to recommend them that I could find. This study however says they work for them. There are masks that have plastic so the mouth can be seen but a cough or sneeze by the wearer will not spread through the room.

https://www.ingentaconnect.com/content/aaa/jaaa/2017/00000028/00000001/art00006

Q. If sneeze guards are in place, do the students need to keep their mask on?

Health officials in Switzerland recently warned that shields alone may not offer as much protection as masks alone. In a recent outbreak at a hotel some employees and a guest who wore plastic visor-style shields tested positive for COVID-19, while those who wore masks did not.  AARP Guidance

Q. My school wants to implement plastic guards between desks in quadrants. Is this sufficient in the requirements of social distancing. Probably. The idea is to prevent respiratory events from touching other students. These partitions have to be disinfected, though.

Q. Will the use of plexiglass partitions in the cafeteria allow students to be closer than 6 feet during meals?

Physical barriers are an example of an engineering control that can reduce droplet transmission in these settings. Plexiglass, a transparent acrylic plastic, can be used as partitions between individuals.  ACOEM guidance.   

You’ll want to consider having kids all sit on the same side of each cafeteria table rather than face to face across the table. With barriers, the distance between students as they sit can be normal, not 6 feet. The whole idea is to keep a sneeze or cough from touching someone who is closer than six feet to the sneezer/cougher

RECESS

Q. Is there evidence yet that these measures for recess have helped prevent the spread of COVID-19 in schools?

The Global Recess Alliance has released a statement on recess in relation to school closures due to the COVID-19 pandemic. The Global Recess Alliance is a newly-formed group of scholars, health professionals, and education leaders who advocate for making recess an essential piece of school reopening plans.

Playworks:  Safe Return to Play Guide and Recess Guidelines

Edutopia: This link to an article survey teacher internationally states that outdoor recess remains an integral part of the school day in countries from Germany to New Zealand, Canada and the Netherlands—even as adults enforce playground rules around social distancing and post-recess hygiene. Monkey bars, slides, and other playground equipment are still in use, though the structures are frequently cleaned, writes Jodi Hirsch, a kindergarten teacher in Israel. Games that involve tossing balls back and forth or frequent touching, like the game of tag, are discouraged. Already, teachers report, kids have invented an alternative in which the shadows of their peers are tagged as the game progresses. Other rules that appeared frequently across the globe: staggered times for recess to eliminate congestion, and designating areas of the playground for each class to discourage unnecessary mixing of groups.

MiddleWeb, by Tan Huynh highlights how his school reopened, and specifically mentions recess. He also uses the moniker the “3 S’s of Schools Reopening: Space, Schedules and Systems.” ►Recess: Students are not allowed to play basketball, but they are allowed to play football (soccer, not American football!). They are allowed to be on the playground equipment. A teacher is assigned a duty in each part of the playground to remind students to maintain social distancing.

The National Position Statement on Recess:  Developed by the Recess Project in partnership with PHE Canada, the National Position Statement on Recess has been launched this month. The Recess Project is an action-research collaboration, led by Dr. Lauren McNamara, Ryerson University, involving school boards, administrators, staff, policymakers, and) elementary school students.  The Recess Project’s collaboration has led to a number of outcomes beyond research: a national position statement, free evidence-based resources for educators and administrators, and advocacy initiatives designed to mobilize systemic changes more effectively.

Science Magazine Article:  School openings across  globe suggest ways to keep coronavirus at bay, despite outbreaks

Australian Health Protection Principal Committee The guidance here is really detailed. 

UNICEF, World Bank & World Food Programme:

Q. If schools have to have indoor recess do you think they need to be wearing their masks?

Cathy Ramstetter: Unless the indoor space is so large and well ventilated OR the children are under the age of 6-10 (depending on state/local requirements) such that there is good airflow and adequate distancing (3 feet minimum), yes, masks need to be worn.

Q.  I would like to see an expansion of outdoor education. Any suggestions?

Here are links to some outdoor education articles and a solid research compilation from UW-Stephens Point (from 2012).

The Case for the Outdoor Classroom, New York Times (July 17, 2020)

Outdoor Classrooms in the Age of COVID-19: Pros and Cons, Education Week (June 1, 2020)

Outdoor Education – Research Summary - UW-Stevens Point


SOCIAL-EMOTIONAL LEARNING (SEL)

Q. Any sources for teachers to implement some of the social-emotional learning?

Lindsay Titus:  Here are a few websites that I believe help answer this question:

     CASEL: Collaborative for Academic, Social, and Emotional Learning website has a variety of information for educators for all levels           (classroom, school, district, community).

     COMMONSENSE.ORG: This website has games and apps for different domains of SEL. There are also articles associated with each        topic for educators to gain more knowledge about specific SEL domains.

     THE PATHWAY2SUCCESS: This is a teacher website that has hundreds of easy to use and implement SEL resources.

     This is a PDF about Rethinking Learning: A Review of Social and Emotional Learning for Educational Systems

     RESPONSIVE CLASSROOM has a page specifically for resources for educators! 

STAFF WELLNESS 

Q.  I find that many of my younger staff are not very resilient. How do we help less resilient adults become resilient enough to manage these uncertain times for themselves, as well as teach these skills to our children?

A.  Becky MacGregor: This is a great question. We're finding in the wellness industry there are generational gaps in capacity for adapting and coping. Here are a couple of strategies and resources you can use:

1. Facilitate a cohort of older/younger teachers. Think of it like mentorships - How some who are more resilient and able to cope can work with and mentor the younger teachers - A buddy group; if you will.

2. In these community circle like meetings, you can have resilience/coping lessons that open discussion and sharing. This peer group social interaction helps everyone's wellbeing gives the younger staff the opportunity to ask questions and/or hear from others how they handle adversity and get support in that way.

3. I use the book/workbook Onward as a good reference for educators with easy to implement activities to facilitate Q&A. Here are some links:
     > The Onward book
     > 
The Onward workbook
     > Downloadable tools 

Many activities can also be adapted for students. Teachers can have community circles for themselves and turn it around to use for their classroom.

4. Be flexible and patient with co-workers. And ALWAYS direct any coworker who is really struggling to either your EAP services or your benefit plan providers telemedicine/behavior/mental health resources. Sometimes what a person might need is just a qualified ear to listen.

Q. How can we help our staff feel comfortable and safe? Many are very fearful to return. If they don’t feel safe, I don’t think that they will be able to be effective in helping students.

Becky MacGregor: This, honestly, is the million-dollar question! Depending on their level of anxiety around this issue, they may need to talk to a qualified counselor. If you are the principal or another leadership figure at your school/district, the first thing to do is present YOUR CALM - and security around safety. Re-state all that is being done on all levels - Point back to cleaning, social distancing, the statistics for people who are healthy - the very low risk when taking precautions (WHO has stated several times that asymptomatic transmission is VERY rare). The more reassuring YOU can be to staff, the more calm and safe they will feel. For some that will mean repeatedly giving them a delineated list of ALL the measures/precautions being taken. Don't underestimate the value of consistent, simple, verbal reassurance. It goes a long way. For some, they may have valid concerns because of existing comorbidities or living with others who are at high risk. For others, it's their frustration coming out and (quite honestly) could be using the fear-factor as an excuse. Fear and safety are real but could be over-exaggerated in some of these circumstances. As a principal leader, the culture at your school starts from the top down. You want to put a check on destructive attitudes and positively handle them to enable a supportive environment for everyone is important. Simply said - Don't let the 'cancer in the clinic" poison the well with attitudes that bring everyone down.