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Shifting guidance poses challenges

On Friday, March 13, Gov. Wolf ordered all Pa. schools closed from March 16 through March 27; Bethlehem Area School District (BASD) treated these two weeks as an extended snow closure, with no formal education being delivered, although skill review materials were made available.

On March 30, BASD began providing online education to all its students, with paper copies of educational materials available to students without adequate computer and/or internet access. The schools of the Diocese of Allentown were also closed from March 16 through the end of the 2019–20 academic year. As of July 16, both the public and the Catholic schools in the Bethlehem area planned to reopen for in-person instruction; details of reopening plans as of mid-July are provided below, along with information from the Pa. Department of Health (PDH) as of the afternoon of July 16.

PDH moves goalposts

On the afternoon of July 16, Secretary of Education Pedro River and Secretary of Health Dr. Rachel Levine held a press conference to announce updated guidance for school reopening. The abundance of material released that afternoon created more questions than answers for administrators planning for school reopening.

Of particular note is the apparent change in guidance for face coverings for students and daycare participants. As recently as June 2, Secretary of Human Services Teresa Miller and Tracy Campanini, deputy secretary for the DHS Office of Child Development and Early Learning (OCDEL), told the press that in daycares, the state mandated cloth face coverings for staff only, and did not require six-foot distancing. In a June 5 interview, BASD Superintendent Dr. Joseph Roy indicated that this guidance likely signaled the state’s opinion on protocols for in-person instruction in grades kindergarten through five. However, on July 16, Secretary Levine’s office told the Bethlehem Press that “anyone 2 years old or older, that does not have a medical condition or disability, should wear a mask. This is for all school systems, day care settings, elementary, middle and high school. No one is immune to this virus.”

On the June 2 call, Secretary Miller and Deputy Secretary Campanini shared that from the beginning of the pandemic through the date of the press conference, only 18 cases of coronavirus had been diagnosed in staff members or children in daycares that stayed open to serve families of “essential” workers, such as medical personnel, grocery employees, and postal workers. These 18 cases were in 13 different facilities. This mirrors global data showing little to no child-to-child or adult-to-child transmission, particularly when children are not symptomatic for the disease.

More to the point, Deputy Secretary Campanini told the press on June 2, “So much of the [social distancing] messaging many people are familiar with is six feet. That’s not necessarily achievable in a childcare setting … Toileting, diaper changing […] all of that requires close contact.” She advised, “Practice good respiratory etiquette, staff should wear masks, practice frequent handwashing, and come up with a schedule for frequent disinfection of high-touch surfaces.”

On July 16, guidance from Secretary Levine’s office said, “All students must wear a face covering (cloth mask or face shield) that covers their nose and mouth inside the school and while outside when physical distancing is not feasible.”

The PDH defines a “face covering” as “factory-made, sewn by hand, or improvised from household items, including but not limited to, scarves, bandanas, T-shirts, sweatshirts, or towels,” and tells families, “specialized masks [such as procedural and surgical masks, including N95 respirators] should be reserved for appropriate occupational and health care settings,” despite the fact that valve-free N95 respirators block 95 percent of both large airborne droplets and aerosols, and cloth masks – which are less effective than N95s in the best of circumstances – lose up to 60 percent of their effectiveness when there are gaps around the edges (see coverage by The Scientist: https://www.the-scientist.com/news-opinion/how-face-masks-can-help-prevent-the-spread-of-covid-19-67646).

Additionally, observational studies on cloth mask use have been unable to separate mask use from other measures employed at the same time, including lockdowns, social distancing, and enhanced hand hygiene. One of the major studies on which the belief in cloth mask efficacy rests has a major shortcoming; in the authors’ words, “our measurements are carried out at low differential pressure values (2.5–13 Pa) across the fabrics […] at flow rates significantly lower (order of magnitude or more) than typical resting respiratory rates” (https://pubs.acs.org/doi/10.1021/acsnano.0c04676).

When asked on which data or studies the Department of Health is basing its school guidance, the department’s press liaison declined to comment. Asked to clarify whether schools would be required to institute mandatory mask use even in classrooms where six-foot distancing is achieved by desk placement, as Secretary Rivera’s July 6 guidance apparently indicated (see below), the Department of Health responded, “The Department of Health cannot speak to what PDE Secretary Rivera said earlier this month. However, the final guidance shared yesterday does go over instances where students will need to wear a mask […] all students must wear a face covering (cloth mask or face shield) that covers their nose and mouth inside the school and while outside when physical distancing is not feasible. However, schools should provide face covering breaks throughout the day. When taking one of these breaks, students should maintain a distance of at least 6 feet apart.”

Given the shifting guidelines from the state and the apparent movement of goalposts from the mid-March goal of “flattening the curve” to avoid overwhelming hospitals to the mid-July goal of limiting even asymptomatic infections to an unspecified number, it is likely that both BASD and the Diocese of Allentown will revise even the limited reopening information they have provided to the public. For example, if masks are required for all students for the entire time they are indoors, it is unclear whether schools will choose not to implement six-foot distancing. Dates for the guidance from both school authorities are provided below.

BASD plans

as of July 14

At the June 22 school board meeting, Superintendent Dr. Joseph Roy responded to a public question by indicating that the district planned for a full reopening of its K through 12 schools, following the advice of local infectious disease experts, public health officials, and district health personnel to implement appropriate hygiene and other mitigation measures. During all of the superintendent’s communications with the community, he emphasized that the district is following the guidance of public health officials and infectious disease specialists at St. Luke’s and Lehigh Valley hospital networks, and during a conversation with the Press June 5, he pointed out, “Schools are not built for social distancing.” Referring to Pa. Dept. of Education (PDE) regulations, Dr. Roy stated flatly, “If the guidelines say six feet is mandatory, the best we can do is the hybrid [in-person and online instruction on alternate days] model.”

In a four-minute video message released July 14 on YouTube, the superintendent appeared to signal that some buildings will open on the aforementioned hybrid model. After noting, “Our goal is to be able to get students in school, with proper social distancing,” Dr. Roy said that BASD administration is still thinking about three scenarios: completely online; fully open in person; and a hybrid of in-person and online.

Dr. Roy said that the fully online option is “not likely now,” but noted, “I think we’ll see a mix of those [second and third] two scenarios, with all students returning at some levels, in some grades, and a hybrid at the other.” He added, “We’re finalizing those details as we speak,” commenting that “St. Luke’s infectious disease experts, St. Luke’s Community Health, and the City of Bethlehem Health Bureau are literally working with us to write our return-to-school plans.”

The district has not released specific infectious disease mitigation protocols, although Dr. Roy noted that on July 1, Secretary Levine issued a recommendation for face coverings to be worn in most out-of-home settings, and that on July 6, Secretary Rivera issued related guidelines, indicating that students in schools would constitute an exception to the face covering recommendation, if six-foot distancing can be maintained.

Fears of a forcible shutdown of schools based on rising positive test numbers in the county appear to be prompting a high level of caution among district administrators.

“One of the big issues,” Dr. Roy stated, “is not just to open schools, but to stay open, and that involves what the health bureau calls ‘surveillance’-monitoring and case tracking in the community. We want to make sure we don’t have widespread community spread of the virus, and we don’t want the opening of schools to contribute to that.”

“Our goal is by the end of July, beginning of August, to roll out plans for the school board to approve. we don’t want to make a premature decision; we want to make it with the approval, support, and advice of our public health experts.”

Diocese plans as of July 16

The Diocese of Allentown is the region’s Catholic education system, serving 9,700 students in seven high schools, 27 elementary schools and three special learning centers in Berks, Carbon, Lehigh, Northampton and Schuylkill counties. The press release issued July 16 by the diocese provides no more detail than the BASD information available to date; like BASD, the Catholic school system’s leadership emphasizes the importance of physical presence.

Chancellor of Catholic Education Dr. Brooke Tesché indicated that many new procedures will be in place to reduce students’ proximity to each other and to staff, including updated policies for non-instructional time. In addition, masks will be worn by students, faculty and staff when they cannot be at least six feet from others, and schools will reconfigure classroom seating so that masks will not be needed during typical lessons. Given the wide variation in enrollment figures across the diocese and the differing physical plants, classroom instruction will likely look very different from school to school.

The Office of Education is currently reviewing each principal’s health and safety plan. Once these plans are aligned with diocesan goals and approved, they will be posted on individual schools’ websites; the diocese is targeting July 24 for the release of this information.

PHOTO COURTESY OF VALLEY OF THE SUN YMCAChildren who participated in YMCA childcare during the spring of 2020 were taught to make “airplane arms” to maintain social distancing. A June 24 NPR feature by Anya Kamenetz explored the methods YMCA childcare centers used to protect children and staff from coronavirus transmission, including cloth face coverings for staff, daily temperature checks, and