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World Health Organization and UNICEF Up-to-Date Guidelines on School-Related Public Health MeasuresOn September 14, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) issued a 10-page document entitled "Considerations for school-related public health measures in the context of COVID-19" that provides guidance on public health measures related to elementary and high schools in the context of the COVID-19 pandemic, at a time when schools in the northern hemisphere are reopening in one form or another. It replaces a previous document issued on May 10. It gives the following general principles for reopening schools to prevent and minimize COVID-19 transmission: - Ensuring continuity of safe, adequate and appropriate educational and social learning and development of children. - Minimizing the risk of SARS-CoV-2 transmission within school and school-associated settings among children, teachers and other school staff. - Guarding against the potential for schools to act as amplifiers for transmission of SARS-CoV-2 within communities. - Ensuring school-related public health and social measures are integrated into and support the wider measures implemented at the community level. Among other information it provides the following measures on prevention and control of COVID-19 transmission. Physical Distancing at SchoolThe guidelines given for physical distancing in outdoor school areas are to "Maintain a distance of at least one metre for both students (all age-groups) and staff, where feasible." Within school buildings, physical distancing guidelines are based on the epidemiological situation in the community: - where community-transmission is occurring, a distance of at least one metre should be maintained between all individuals (students of all age groups and staff) for any schools remaining open. - where transmission is occurring based on clusters, the new guidelines state that "A risk-based approach should be applied to maintain distance of at least one metre between students. The benefits of adhering to physical distancing of at least one metre inside a classroom should be weighed against the social, emotional, developmental and mental health gains from interactions between children." Teachers and support staff "should keep at least one metre from each other and from students. When maintaining at least one metre distance is not practical or hampers support to students, teachers and support staff should wear a mask." - where there are sporadic cases, it is advised that children under the age of 12 years should not be required to keep physical distance at all times. Where feasible, children aged 12 years and over should keep at least one metre apart from each other. Teachers and support staff should keep at least one metre apart from each other and from students. When keeping at least one metre distance is not practical or hampers support to students, teachers and support staff should wear a mask. - in areas where there are no cases of transmission, the guidelines are the same as when there are sporadic cases. While not explicitly stated, the last guideline indicates the need to err on the side of caution and not to become complacent even if no cases have been detected, as new cases could easily arise in the context of a global pandemic where some people are asymptomatic carriers of COVID-19 and could cause infections to spread quickly in a school environment. Physical Distancing Between Groups Within SchoolsThe WHO/UNICEF document also provides guidance on how to limit the spread of COVID-19 between groups of students within a school. It suggests that schools can consider: - Limiting the mixing of classes and of age groups for school and after-school activities. - Alternative class modalities to limit contacts between different classes when space and resources are limited. For example, the start and end times of different classes can be staggered. - Modifying high school timetables, so that some students and teachers attend school in the morning, others in the afternoon, others in the evening. The same can be done for meal and break times. - Increasing the number of teachers or having recourse to volunteer support, if possible, to allow for fewer students per classroom (if space is available). - An organized approach to school or day-care drop off and pick up periods to ensure crowd control, including clearly identified entry and exits, with directions marked for foot traffic, as well as considering restrictions for parents and caregivers entering school campus and premises. - Educating students to not gather in large groups or in close proximity when in lines, when leaving the school and in their free time. VentilationThe WHO/UNICEF guidelines state school authorities should: - Consider using natural ventilation (i.e., opening windows if possible and if it is safe to do so) to increase dilution of indoor air by outdoor air when environmental conditions and building requirements allow. - Ensure adequate ventilation and increase total airflow supply to occupied spaces, if possible. - If heating, ventilation and air conditioning (HVAC) systems are used, they should be regularly inspected, maintained and cleaned. Rigorous standards for installation and maintenance of ventilation systems are essential to ensure that they are effective and safe. The same applies to monitoring the condition of filters. If feasible, increase central air filtration to the highest level possible without significantly diminishing design airflow. - For mechanical systems, increase the total airflow supply and the percentage of outdoor air, such as by using economizer modes of HVAC operations (potentially as high as 100 per cent). First verify compatibility with HVAC system capabilities for both temperature and humidity control as well as compatibility with outdoor/indoor air quality considerations. - Disable demand-control ventilation (DCV) controls that reduce air supply based on temperature or occupancy. - Consider running the HVAC system at maximum outside airflow for two hours before and after times when the building is occupied, in accordance with the manufacturer's recommendations. Hygiene and CleaningConcerning hygiene and cleaning, the guidelines start by pointing out the need to ensure all staff and students are educated about preventative measures, COVID-19 symptoms and what to do when feeling sick, use of masks, and the need to provide regular updates on the situation and counter misleading information. In terms of practical measures, the guidelines recommend that schools: - Create a schedule for frequent hand hygiene, especially for young children, specifically at school arrival and at certain key moments of the school routine. - Provide sufficient soap and clean water or alcohol-based rub at school entrances and throughout the school and in classrooms where feasible. - Ensure physical distancing when students wait at hand hygiene/washing points using signage on the ground. - Increase the frequency of regular scheduled cleaning of the school environment, and provide custodial staff with checklists to ensure all daily hygiene tasks, and with all necessary cleaning and personal protective equipment. - Assess what can be done to limit risk of exposure, or direct physical contact in all school settings, including physical education classes, sports, music or other physical activities and playgrounds, pools, change rooms, science and computer labs, libraries, washrooms and dining areas. - Provide hand hygiene stations at entrances and exits, establish one-way circulation of athletes through sports facilities and limit the number of persons allowed in lockers rooms at one time; display clear information as to the number of people allowed at the entrance of individual school facilities. - Put in place respiratory and hand hygiene and physical distancing measures in transportation such as school buses. Screening and Management of Sick Students or StaffWhen staff and students (and their parents) are screening themselves as to whether they are sick and should not attend school, the guidelines emphasize erring on the side of caution. Schools are recommended to "Enforce the policy of 'staying at home if unwell' for students, teachers or school staff with potential COVID-19 infection and connect them with local health care providers for assessment, testing and care." To that end, it is recommended that schools provide a screening checklist for parents/students/staff to decide whether they can go to school, with due consideration for the local epidemiology of COVID-19. The checklist should include: underlying medical conditions and vulnerabilities, to protect the student/staff; recent illness or symptoms suggestive of COVID-19, to prevent spread to others; special circumstances in the home environment, to tailor support as needed. The guidelines also state that the requirement for a doctor's note to excuse absences should be waived when there is community transmission of COVID-19. Those who have been in contact with a COVID-19 case should go into quarantine for 14 days. In
the event of a positive COVID-19 case among students or staff, school
officials should notify Other InformationThe September 14 WHO/UNICEF document also provides information and guidelines on the following areas: - Communication with parents, students, teachers
and school staff The document concludes by saying, "Considering that most countries are only slowly lifting restrictions on activities and social gatherings, the longer-term effects of keeping schools open on community transmission are yet to be evaluated. This underscores the importance of rigorous implementation of preventive measures when SARS-CoV-2 is circulating in the community." To see the full 10-page document, click here.
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