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With Safety Measures in Place, In-School COVID-19 Transmission Is Extremely Limited

children doing schoolwork wearing masks

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Key Takeaways

  • A new study says schools can reopen safely during the COVID-19 pandemic, provided they adhere to specific science-based preventive measures.
  • Out of almost 100,000 students and staff from North Carolina schools, researchers noted only 32 cases of in-school COVID-19 transmission.
  • Experts stress that it's never been more important to stick to the "rule of three"—mask wearing, social distancing, and hand washing.

A recent study, published in Pediatrics on January 8, 2021, makes a case for schools reopening safely if they comply with specific steps to prevent COVID-19. Researchers from Duke University and the University of North Carolina at Chapel Hill found only 32 cases of in-school COVID-19 transmission out of almost 100,000 students in North Carolina schools. 

The work began before the beginning of the 2020-21 school year, when the research team created the ABC Science Collaborative to help school districts follow science-based measures throughout the course of the pandemic. Later, the team looked closely at 11 of the districts that kept schools open at partial capacity for at least nine weeks, following a hybrid model that included twice-weekly in-person classes. 

In North Carolina, schools must adhere to COVID-19 mitigation strategies, including face coverings for children age 5 and older, social distancing, regular hand-washing, and daily temperature checks and symptom monitoring. 

Study Details

Over the nine weeks, the 11 districts reported 773 community-acquired infections, but only 32 in-school transmissions. Of these cases, four were in schools that included kindergarten through 12th grade, six were in pre-kindergarten, 11 were in elementary schools, six were in middle schools, and five were in high schools. Notably, none of the cases involved a child infecting an adult. 

The numbers are impressive—but they came after some serious hard work. “These districts had detailed plans on how to achieve more than 90% masking at all times, by all people on school property,” says study author Daniel Benjamin Jr., MD, PhD, co-chair of the ABC Science Collective. “The target is 99% of people in the mainstream curriculum, 99% of the time with masks over their nose, mouth, and chin.”

Daniel Benjamin Jr., MD, PhD

Success requires attention to detail. It’s not enough to say ‘masking.’ Schools need high compliance with masking, distancing, and hand hygiene.

— Daniel Benjamin Jr., MD, PhD

With these measures in place, the districts used walk-through inspections by school staff, district leadership, and sometimes video documentation to show that they were meeting their target, Benjamin adds. This enabled them to capture in-school acquired infections and make the necessary corrections when those occurred. 

The North Carolina model is being replicated in other parts of the country, but Benjamin acknowledges that the work isn’t easy. “If any of the above is not done, failure is much more likely,” he warns. “Success requires attention to detail. It’s not enough to say ‘masking.’ Schools need high compliance with masking, distancing, and hand hygiene.” 

Benjamin was surprised by the numbers of in-school transmission. “We are missing some because of lack of testing,” he says. “But even if we are missing 50%, the numbers are still strikingly low.” 

Carol Winner, MPH, public health expert and founder of social distancing brand Give Space, praises the efforts of the North Carolina school districts. “The researchers designed a public-health winning combo by implementing a multi-faceted approach, securing federal NIH funding, and collaborating with state and local health departments and school administrators,” Winner says.

“This provided the foundation for the planning and implementation, but most importantly, the key to its success was the enforcement of the well-known practice of three—physical distancing, masking, and regular hand washing,” says Winner.

What's the Future for Our Schools?

Winner believes it's possible that the success in the North Carolina schools can be recommended by the Centers for Disease Control and Prevention (CDC) as a best practice for returning school kids to in-person learning. The release of more detailed information by those involved and the provision of state-level guidelines and technical assistance from the CDC also help.

"Having worked with the CDC on the implementation of state-level best practices, I know that defining what may be possible to duplicate within communities can result in highly successful outcomes," she says. 

Carol Winner, MPH

Children must be required within schools to practice mask-wearing, social distancing, and hand washing. Teachers and administrators must be required to do the same and enforce these practices.

— Carol Winner, MPH

The increasing numbers of COVID-19 cases and deaths are down to one thing, Winner adds—the lack of adherence to guidelines and simple public health practices of wearing a mask, social distancing, and hand washing.

"The added politicization of the virus and 'COVID-19 fatigue' or boredom has also resulted in the spread of the virus through non-essential outings and travel," Winner says.

"There's no disagreement that identifying successful practices to return children to in-person learning should and can be the first step in returning to our new normal. The combination of knowing what works in public health behavior practice, with the support of the incoming administration’s commitment can result in getting our children back to school safely."

Winner also points out that the researchers in North Carolina said the success of mitigation of COVID-19 in public schools was due to the “enforcement” of the public health practices. "Asking politely for people to change their behavior when trying to protect our children and teachers from the death grip of COVID-19 is like trying to negotiate with a rabid dog," Winner says.

The Centers for Disease Control and Prevention has detailed guidelines for the best COVID-19 hygiene and safety practices, which are updated regularly.

She believes that for successful in-person learning, policies need to be clearly defined, communicated, and enforced at the federal, state, and local levels. "Children must be required within schools to practice mask-wearing, social distancing, and handwashing," says Winner.

She further emphasizes her belief that teachers and administrators must be required to do the same and enforce these practices. If faculty and students don't adhere to the mandated public safety measures, then there should be consequences of suspension from in-person learning environments until it is determined they are no longer a safety threat to others.

At this time, with more infectious COVID-19 strains doing the rounds, Winner says the most important thing is to keep your attention "razor-focused" on yourself and your family. "We cannot control the virus, but we can work to protect ourselves, and this is done solely by wearing our masks, social distancing, and washing our hands, before and after having received the vaccine," she says.

What This Means For You

Even if your kids still can't return to school, you can implement healthy behavior practices—mask wearing, social distancing, and regular hand washing—to help protect them (and their teachers) when they do go back to classroom learning.

If your children are spending time learning in school, ensuring they adhere to these practices will help keep COVID-19 transmission to a minimum—and their school open.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Zimmerman KO, Akinboyo IC, Brookhart MA, et al. Incidence and secondary transmission of SARS-CoV-2 infections in schools. Pediatrics. 2021;147(4):e2020048090. doi:10.1542/peds.2020-048090 

  2. Centers for Disease Control and Prevention. COVID-19: How to protect yourself and others. Updated December 31, 2020.