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Teaching in person

Emerging concerns

  • If community transmission is high, students and staff are more likely to come to school while infectious. CDC, March 19, 2021.
  • Despite high levels of community transmission, emerging evidence shows that when mitigation strategies are followed, school reopenings do not significantly contribute to higher levels of viral transmission. National Public Radio, October 21, 2020.
  • Racial and ethnic minorities have experienced a disproportionate impact of COVID-19 in the United States. Clinical Infectious Diseases, February 15, 2021.

Ethical principles

  • Be attuned to cultural, social, and historical contexts that influence community health and receptivity to public health partnerships. APHA Code of Ethics 4.4.7.
  • Promote sharing decision making, information, and resources with community partners. APHA Code of Ethics 4.4.8.
  • [Public health practices and policies should be] designed with input from community members and be sensitive to local values and customs. APHA Code of Ethics 4.5.1.
  • Restrictions on individual liberties should not be adopted unless there is a reasonable expectation that they will have a significant impact of the disease, and they should be terminated when they no longer appear to offer significant benefits. WHO Ethics in Pandemic Flu
  • A balance between centralized, federal control and state and local community implementation of central guidelines must be effectively struck. This process should be especially attentive to historically marginalized communities and those where sensitivity to cultural, racial, religious or other values must be incorporated. CDC Ethics in Pandemic Flu

Recommendations and practices

Emerging concerns

  • Schools are using tests that are not vetted by the FDA. New York Times, March 30, 2021.
  • Schools unable to implement CDC guidelines due to budget concerns, physical space, employee workforce constraints. Washington Post, July 8, 2020; New York Times, July 8, 2020.
  • Overcrowding and older buildings pose considerable challenges for districts seeking to safely reopen. New York Times, August 5, 2020.
  • Schools lack isolated spaces for staff when not working with children. Washington Post, July 3, 2020.

Ethical principles

  • It is legitimate to take costs into consideration in determining whether a particular accommodation is warranted. WHO Ethics in an Outbreak
  • Costs and other practical constraints (e.g. logistics, distance, available workforce) may legitimately be taken into account to determine whether a less restrictive alternative is feasible under the circumstances, particularly in settings with severe resource constraints. WHO Ethics in an Outbreak

Recommendations and practices

Emerging concerns

  • Risk of within-school transmission is low for both students and staff when schools implement and adhere to prevention measures. Pediatrics, April 1, 2021; CDC, March 26, 2021; CDC, January 29, 2021.
  • While the risk of within-school transmission is low when prevention measures are implemented, extracurricular activities such as sports may pose a greater risk. JAMA, January 26, 2021.
  • Educators might play a central role in within-school transmission networks, particularly when mitigation strategies are not well adhered to. CDC, February 26, 2021.

Ethical principles

  • Policies and procedures should be based on sound scientific evidence or on the best evidence available. In addition, the policy’s measures should reflect the severity of the situation while remaining as minimally invasive as possible. Indiana University
  • Incorporate scientifically vetted, research-based data to the fullest extent possible. APHA Code of Ethics, 4.5.2.
  • Recognize and acknowledge when evidence is changing or incomplete and when assumptions or contexts change the relevance of evidence. APHA Code of Ethics, 4.10.5.

Recommendations and practices

Emerging concerns

  • School teachers and staff face a disparate risk of COVID-19 compared to children. The Atlantic, June 25, 2020.
  • Approximately 1 in 4 teachers are at higher risk for serious illness from COVID-19. Kaiser Family Foundation, July 10, 2020.
  • Multisystem Inflammatory Syndrome (MIS-C) is a rare, yet serious pediatric condition related to COVID-19. Journal of Medical Virology, June 25, 2020.
  • Underlying conditions were more common among school-aged children with severe outcomes related to COVID-19. COVID-19 Trends Among School-Aged Children, CDC, October 2, 2020.
  • The Pfizer-BioNTech coronavirus vaccine was reported to be safe for adolescents ages 12-15, and Moderna has begun a clinical trial of their vaccine for children. New York Times, March 31, 2021; AAP News, March 16, 2021.

Ethical principles

  • Information available will change continuously throughout the pandemic, requiring adjustments of response strategies based on ongoing assessments of the risks and potential benefits of interventions. These adjustments, and the justification for them, should be communicated to the public. WHO Ethics in Pandemic Flu
  • Reduce or eliminate negative impacts on communities and the environment, particularly as these negative impacts tend to be disproportionately experienced by individuals already faced with health inequities. APHA Code of Ethics 4.5.8.
  • Ensure that reasonable alternative options are considered and evaluated and that final public health policies and plans are designed to most effectively accomplish stated goals while minimizing the potential for harm. APHA Code of Ethics 4.5.9.
  • No policy can be developed, much less implemented, without an assurance that its justification and rationale have been made clear to those who will be affected by it. Indiana University

Recommendations and practices

Teaching remotely

Emerging concerns

  • Schools provide many resources to children beyond education, such as safety, food, socialization. JAMA, June 1, 2020.
  • Over half of all elementary and secondary students depend on the National School Lunch Program, and 12.5 million students participate in the School Breakfast program. Trust for America’s Health, July 2020.
  • Students receive mental health support through school. New York Times, July 23, 2020.
  • Approximately 1 in 5 reports regarding child abuse and neglect are made by school officials. US DHHS Report on Child Maltreatment, 2018.
  • Students already at educational and social risks are most vulnerable to falling behind academically. JAMA, June 1, 2020.
  • Special education is exceptionally challenging to deliver remotely. New York Times, April 23, 2020.

Ethical principles

  • Ensure that resulting interventions do not have a disproportionately negative impact on minority or otherwise vulnerable populations (including children and elders) and that there is an effort to enhance the resilience of populations and ecosystems to prevent future harm. APHA Code of Ethics, 4.2.9.
  • Portray risk in a variety of ways. APHA Code of Ethics, 4.3.4.
  • Public health measures such as home isolation, quarantine, or closure of schools and work facilities can induce violence, particularly against women and children. Officials involved in outbreak planning and response efforts should be prepared for the possibility that specific populations may be targeted as being the cause of the outbreak or provoking transmission; strategies should be proactively designed to protect members of such groups from a heightened risk of violence. WHO Ethics in an Outbreak

Recommendations and practices

Emerging concerns

  • Remote learning may place disproportionate hardships on undocumented children. National Public Radio, March 4, 2021.
  • Students in the highest-poverty districts are the most likely to start the fall academic year remotely. Center on Reinventing Public Education, August 2020.
  • Remote education has varying levels of success and is widening the class divide in the United States. New York Times, June 5, 2020.
  • Millions of students lack consistent access to home computer and internet access. New York Times, April 23, 2020.
  • Children experiencing homelessness, children from low-income families, and children who receive special education face additional challenges with remote and hybrid learning models. New York Times, September 21, 2020; Parents Together Survey.
  • Privacy breaches, online harassment, and technical failures occurred due to remote learning in the spring. Washington Post, July 12, 2020.
  • Virtual learning is associated with lower class attendance, greater student disengagement with teachers. New York Times, September 22, 2020.
  • There are global supply chain shortages for laptops and other technology to assist in remote learning. New York Times, October 12, 2020.

Ethical principles

  • Ensure that resulting interventions do not have a disproportionately negative impact on minority or otherwise vulnerable populations (including children and elders) and that there is an effort to enhance the resilience of populations and ecosystems to prevent future harm.  APHA Code of Ethics, 4.2.9.
  • Ensure that reasonable alternative options are considered and evaluated and that final public health policies and plans are designed to most effectively accomplish stated goals while minimizing the potential for harm. APHA Code of Ethics, 4.5.9.

Recommendations and practices

  • “Special considerations and accommodations to account for the diversity of youth should be made, especially for vulnerable populations, including those who are medically fragile or complex, live in poverty, have developmental challenges, or have disabilities, with the goal of safe return to school.” COVID-19 Planning Considerations: Guidance for School Re-Entry, AAP
  • Organizations such as Springboard Collaborative are using innovative approaches to bolster virtual learning. New York Times, October 6, 2020.
  • Consider using social media to engage students, implement quality improvement tools over the course of the school year, and work to bridge the digital divide in communities. JAMA
  • Miami-Dade Public County Schools increased access to internet for remote learning in the spring by distributing more than 80,000 mobile devices and 11,000 smartphones to students. New York Times, April 6, 2020.
  • Seattle’s Highline Public Schools will use CARES Act coronavirus relief funds to provide internet access to families that cannot afford it. JAMA

Emerging concerns

  • Black, Latinx, and low-income parents are disproportionately likely to be hesitant to return to in-person instruction. New York Times, February 1, 2021; Global Strategy Group, August 20, 2020.
  • Only one third of principals were confident in their school systems’ ability to preserve the health of staff and students as schools physically reopen in the fall. Washington Post, July 8, 2020.
  • A recent survey suggests more than 25% of parents express hesitancy in vaccinating their children against COVID-19 after a vaccine has received Emergency Use Authorization by the FDA. The Cap Times, April 5, 2021.

Ethical principles

  • Public engagement and involvement of relevant stakeholders should be part of all aspects of planning. WHO Ethics in Pandemic Flu
  • Responsiveness involving the willingness to address the concerns of the public and of health care professionals is essential. Indiana University

Recommendations and practices

Emerging concerns

  • Proposed in-person and remote hybrid school models are not feasible for working parents. New York Times, July 8, 2020; New York Times, July 8, 2020.
  • Local economies are unable to fully recover unless parents send their children to school. New York Times, August 5, 2020.
  • Working women are particularly vulnerable to long-lasting, negative impacts of the pandemic on their careers. New York Times, June 30, 2020.

Ethical principles

  • Promote policies that enhance community health and well-being and collaboratively respect the privacy, dignity, and civil liberties of individuals and communities affected by the policies and plans. APHA Code of Ethics, 4.5.4.
  • When making such decisions, leaders will need to balance individual freedoms against the common good of society, fear for personal safety against the duty to treat the sick, and economic losses against the need to contain the spread of a deadly disease. University of Toronto
  • Portray risk in a variety of ways. APHA Code of Ethics, 4.3.4.

Recommendations and practices

  • Employers should incorporate flexible policies to support working parents and potential disruptions due to school closures in the upcoming academic year. USA Today, July 16, 2020.

Page last updated April 10, 2021.