Kaua‘i County Council and schools reopening

The Kaua‘i County Council is voting on a resolution that encourages a return to full-time in-person education as soon as possible for elementary and secondary school children. Their resolution is based on strong positions from the American Academy of Pediatrics (AAP), the Centers for Disease Control (CDC), as well guidance from the Hawai’i State Department of Health (DOH) on this subject. The CDC and the AAP are re-emphasizing the vitally important role that our teachers, coaches, and school systems play in the lives of our children and the great loss it has been for our children to have lost a year of in-school learning. These organizations agreed that schools needed to close and now they agree that they should try hard to reopen.

Among the reasons for this push to reopen is the increasing evidence that “SARS-CoV-2 appears to behave differently in children and adolescents than other common respiratory viruses, such as influenza,” (AAP 1/5/21). Children play a major role in spreading colds and flu but this does not seem to be the case with SARs-CoV-2. There have also been some very large studies showing that transmission from children in school settings (particularly where there is proper masking, ventilation etc.) appears to be very low.

The proposed County Council Resolution pushes for re-opening based on the recommendations from the DOH, the CDC, and the AAP. But the Resolution does not discuss in depth the details for a reopening plan.

These details are constantly being updated by the CDC, AAP, and DOH and are freely available for all to review at each organization’s respective website. Most board-certified pediatricians and pediatric specialists in America belong to the AAP. The AAP updated their recommendations on January 5, 2021. The material below is directly from these updated recommendations. It is our hope that the Hawaii Department of Education will fully utilize these recommendations as they plan the coming semesters.

The AAP opens their guidance by stating that the organization “strongly advocates that all policy considerations for school COVID-19 plans should start with a goal of having students physically present in school.”

The AAP clearly states that “desks should be placed at least 3 feet apart and ideally 6 feet apart… 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.” At least six feet is important during mealtimes when masks are off.

For Elementary Schools they state the following: “Desks should be placed at least 3 feet apart, and ideally 6 feet apart. “If this (6 feet) reduces the amount of time children are present in school, harm may outweigh potential benefits.” (6 feet added for clarification.)

It is important to note the AAP is willing to relax their guidance from 6 feet to 3 feet if it means kids are in school more often even in communities where there is still COVID-19 community spread occurring. Kaua‘i really has among the lowest levels of community spread in the country, making shorter distances between desks significantly less risky than in places with higher levels of community spread.

The APP recommends that class cohorting be maintained as much as possible where children remain in their own bubble and teachers move class to class rather than students moving whenever possible.

Both The CDC and the AAP are very specific on mask policies. Masks need to be worn basically all the time while on school campuses except for eating, drinking, special need situations, and certain outside sports activities.

Ventilation is vital and all windows and doors should be open to the full extent that is safe. Moving activities outside should be encouraged. While adequate ventilation during the winter on the mainland can be challenging due to cold weather, another benefit of Hawai’i is that we can simply open our windows and doors.

The AAP discusses extensively that the greatest risk of transmission on school campuses is from parents and staff.

They discuss the need for teachers to strictly maintain the 6 foot distancing guidelines and the need for parents and teachers to not congregate in lounges, parking lots, etc.

Guidelines also discuss using your community metrics to help guide how aggressively school systems move towards reopening and school sports. Metrics should include community spread and immunizations for the teachers and the community in general.

The county of Kaua‘i has less community spread than almost any county in America and we lead the nation in the percent of our population immunized. Immunizations for teachers and staff has been a high priority since January. Based on our extremely low levels of community spread, metrics developed by both the CDC and the DOH show that we are well within the threshold for opening schools to full-time, in-person education.

We respect that this subject of reopening is a hot topic across the country and that opinions on this subject differ widely. We felt as Drs. that it might be helpful to the discussion to directly outline recommendations from organizations such as the CDC and the AAP.

We also hope that one lesson we never forget, as we move away from this pandemic, is how important our school systems are in the lives of our children and for the advancement of society.

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• D. Kapono Chong-Hanssen M.D. — Board Certified Family Practice, Medical Director; Ho‘ola Lahui Hawai‘i/Kaua‘i Community Health Center

• Jonathan Dworkin M.D. — Board Certified in Internal Medicine and Infectious Disease, Waimea, Hawai’i

• Lee Evslin M.D. — Board Certified Pediatrician, Former CEO of Wilcox Medical Center, Kaua‘i Medical Clinic, Kapaa, Hawai’i

• Karl Kaiyala PhD — Research associate professor (emeritus), University of Washington