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Teaching in person

Emerging concerns

  • Low virus community spread is key to minimizing the risk of sending children back to school. Washington Post, July 1, 2020.
  • Few school districts meet public health guidelines recommended average daily infection rate for reopening. New York Times, August 6, 2020.
  • Reopening of schools hinders nationwide efforts to slow spread of the virus. Washington Post, July 8, 2020.
  • Notification policies for COVID-19 infections at school vary widely across the nation. New York Times, August 22, 2020.

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

Recommendations and practices

Emerging concerns

  • Significant lack of funding, resources for schools to reopen. New York Times, July 29, 2020.
  • An estimated $116 billion is needed to safely reopen schools nationwide. New York Times, July 8, 2020.
  • 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.
  • Federal messaging urges nationwide reopening of schools but offers no financial or other support for schools. Washington Post, July 8, 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

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.
  • Teachers are tasked with enforcing social distancing requirements, mask wearing among students, in addition to regular duties. Washington Post, July 9, 2020; New York Times, July 23, 2020.
  • Districts are developing plans to reopen based on the preference of parents, not teachers. WBUR, July 6, 2020; Washington Post, July 12, 2020.
  • Schools lack isolated spaces for staff when not working with children. Washington Post, July 3, 2020.

Ethical principles

  • 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.
  • Public engagement and involvement of relevant stakeholders should be part of all aspects of planning. WHO Ethics in Pandemic Flu
  • 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

Emerging concerns

  • COVID-19 tests for children are not widely available. New York Times, September 15, 2020.
  • Young children and adolescents are unable or unlikely to comply with mask wearing and social distancing. Washington Post, July 3, 2020.
  • It is difficult to enforce social distancing among students. Washington Post, July 11, 2020.

Ethical principles

  • Requirements for mandatory liberty-limiting and social distancing interventions should be imposed only in cases where voluntary actions seem unlikely to be effective. CDC Ethics in Pandemic Flu

Recommendations and practices

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Emerging concerns

  • Full reopening of schools is categorized as the highest risk, but is the preferred federal policy. The Importance of Reopening America’s Schools this Fall, CDC, July 23, 2020.
  • Trump administration pressured the CDC to downplay risk of sending children back to school. New York Times, October 23, 2020; Washington Post, July 8, 2020.
  • Federal officials threatened to revoke funding to districts that do not reopen. Washington Post, July 8, 2020.
  • Absence of clear federal and state policies for reopening have resulted in a patchwork of policies across the nation with varying levels of success in containing COVID-19 outbreaks in schools. New York Times, October 22, 2020.

Ethical principles

  • Avoid conflicts of interest that could interfere with the willingness to acknowledge public health threats. APHA Code of Ethics 4.2.2.
  • Ensure data validity, account for the limitations of available data, determine statistical thresholds for defining significance, and take steps to assist others who use the data, including the media and policymakers, so they will not draw inappropriate conclusions regarding cause and effect. APHA Code of Ethics 4.2.4.
  • 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
  • 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

Recommendations and practices

Emerging concerns

  • All countries that successfully reopened schools achieved near zero case incidence and low community transmission rates prior to reopening. Washington Post, July 16, 2020.
  • No country has attempted to send students back to school with virus transmission at levels equal to the United States. New York Times, July 11, 2020.
  • School closures across the globe have prompted a surge in child labor. New York Times, October 8, 2020.
  • High rates of absenteeism have been observed among England’s school-aged children to COVID-19, demonstrating the difficulty of children physically remaining in school. The Guardian, October 20, 2020.
  • International reopening of schools has been met with mixed success. New York Times, June 12, 2020; Washington Post, July 8, 2020.
  • Many countries that reopened schools have been unable to prevent subsequent COVID-19 outbreaks. Washington Post, July 8, 2020.

Ethical principles

  • Consider the experiences of designing and implementing these types of policies and plans within the community in question, as well as in other similar communities, and incorporate lessons learned from these experiences in future design and implementation efforts. APHA Code of Ethics 4.5.3.
  • When closure of public venues is being considered, determination must be made of which public venues are more essential in maintaining the functioning of society and may need to remain open with some constraints on the level of access. CDC Ethics in Pandemic Flu
  • Greater restrictions should be imposed only when there are strong grounds to believe that less restrictive measures are unlikely to achieve important public health goals. WHO Ethics in an Outbreak

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.
  • Children are already at risk of falling behind normal academic growth by as much as a year due to school closures in the spring. JAMA, June 1, 2020.
  • 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

  • “While concern over higher rates of COVID-19 among certain racial/ethnic groups may amplify consideration of closing a school that educates primarily racial minority students, there should also be consideration that these may also be the schools most heavily relied upon for students to receive other services and support, like nutrition and support services.” Preparing a Safe Return to School, CDC
  • “Plans should be made prior to the start of the school year for how students participating in free- and reduced- meal programs will receive food in the event of a school closure or if they are excluded from school because of illness or SARS-CoV-2 infection.” COVID-19 Planning Considerations: Guidance for School Re-Entry, AAP
  • Springfield, Massachusetts public schools will pilot an evening meal program to increase food access. Mass Live, July 22, 2020.

Emerging concerns

  • 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. Protecting the Health of Vulnerable Children and Adolescents During COVID-19–Related K-12 School Closures in the US, 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
  • Fairfax County, VA Public Schools state: “plans must account for the disproportionate health and economic impact of COVID-19 on certain communities, including how this affects students’ ability to equitably participate in online learning, potentially widening achievement gaps.” Reopening Schools Plan – Lessons Learned, FCPS

Emerging concerns

  • Black, Latinx, and low-income parents are disproportionately likely to be hesitant of reopening New York public schools. 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.
  • Parents and school officials are hesitant to send children back to school. ABC News/IPSOS Poll, May 15, 2020.

Ethical principles

  • 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 October 29, 2020.