By Anne Blythe

Once school resumes next month, North Carolina’s 1.5 million public school children will have the opportunity for some in-class instruction across the state while some kids might continue with remote learning only.

Gov. Roy Cooper announced on Tuesday that he had selected his “Plan B,” a hybrid model for instructing children in kindergarten through high school as a new school year begins amid the COVID-19 pandemic that has obliterated traditions and routines since early March.

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“In the spring, when this pandemic first broke out, we made the difficult but necessary decision to close in-person learning at K through 12 schools and move to remote learning,” Cooper said during an afternoon press conference. “March feels like a long time ago given everything that we’ve been through. And that was just the beginning of a series of tough decisions to slow the spread of COVID-19 that have helped our state cope and prevented our hospitals from being overwhelmed.”

Simmering, not boiling

North Carolina has not seen the tsunami of cases that recently have forced some states to reverse reopening plans because hospital beds have filled with COVID-19 patients.

Nonetheless, there has been a sharp rise in the number of lab-confirmed cases in recent weeks throughout North Carolina that cannot be explained simply by more testing. The percentage of tests coming back positive hovers at 9 to 11 percent, double what health care experts would like to see before opening society up further. These high numbers of positive tests indicate community spread of the virus continues.

Even as North Carolina has seen record hospitalizations there continues to be capacity for more patients as hospitals adjust their routines, adopt plans to add beds and learn better how to care for patients with COVID-19.

But recently, concerns about testing supply shortages have grown. Shortages of equipment and chemicals have created long waits for lab results across the country, putting contact tracers further behind in trying to contain the spread of the virus.

“We continue to simmer,” Mandy Cohen, secretary of the state Department of Health and Human Services, said Tuesday. “We’ve avoided boiling over as many states are doing now.

“If we see indications that we’re changing quickly or there’s new scientific data that emerges, we will not hesitate to act.”

Cohen said planning for the coming school year has been full of difficult decisions.

She and her public health team helped Cooper come to the decision he announced on Tuesday after examining research showing that elementary school-aged children and preschoolers seem to be at lower risk for COVID-19 infection and less likely to transmit it to others.

They weighed that research and medical data against evidence that school is critical to a child’s education, health, emotional and social well-being, as well as advice from pediatricians that missing school is harmful to children.

“With any decision like this it is necessary to weigh the risks and the benefits and there are no easy answers,” Cohen said.

Tailoring plans district by district

Though individual school districts across the state may tailor attendance plans that work best for the areas their students come from, face masks, temperature checks and screenings at the door will be required for any in-person instruction.

For instance, Wake, Durham and Forsyth counties have already developed plans with a priority to bring elementary school children back to in-classroom instruction first. The Chapel Hill-Carrboro district is postponing the return of high school students until mid-September, weeks after the start of the school year.

There’s no one-size-fits-all plan.

The few hard and fast requirements that public health leaders have pushed throughout the pandemic have been the wearing of face masks, social distancing and hand-washing.

Students and teachers will each be issued five cloth face masks, one for each day of the school week, that can be washed and reused. The state also has distributed personal protective equipment and other supplies to school nurses.

Cooper called the state’s baseline plan “a measured, balanced approach,” but acknowledged that some teachers, school staff and families might not be as enthusiastic about being inside school buildings.

“As a part of this plan, we want local districts to provide for remote options for any child that chooses it,” Cooper said.

Eric Davis, chairman of the state Board of Education, said districts are surveying teachers and staff to gauge how many will be willing to teach and work inside school buildings even as COVID-19 continues to spread, and which staffers feel like they need to stay away.

“We certainly anticipate that some teachers and staff members will not be able to return to school for a variety of reasons, where others, as the governor mentioned, are energetically awaiting the day that they can get back with their students and move forward,” Davis said. “We’re confident in the work that our districts have underway to care for the needs of our staff and teachers and we will continue to send them the support and the assistance that they need, including revised policies or other things needed to continue to meet the needs of our teachers.”

Working parents, more home schooling and child care

If a district chooses, Cooper added, it can opt out of any in-classroom instruction and solely provide remote teaching that will require parents or others to help with home schooling children.

That option, as well as plans calling for children to have in-classroom instruction for one week and then two weeks of remote learning, have working parents struggling to figure out what they’ll do about child care in the weeks and months ahead.

Volunteers help children read their books in the Read and Feed van.
In many instances, parents don’t have the ability to suspend their work day to instruct their children. Photo credit: Hyun Namkoong

Not everybody can work from home, and as parents who have that ability will attest, it can be difficult to help with school lessons while also attempting to work.

Not just a place for teaching and learning

Over the decades, schools have become far more than places where children from kindergarten through high school go to learn.

They have become places where children from low-income families have access to food. They provide safety and security for children from abusive homes. They provide a set number of hours of child management for working parents.

Lisa Gennetian, an economist at Duke University, noted these realities in a panel discussion Tuesday morning before Cooper made his announcement.

“When we think about school openings and closings, we should really think hard about the function of schools in these communities,” said Gennetian. “They’re not just environments for learning.”

One in five children, according to Gennetian, are poor in America, a number that is likely to grow during the pandemic.

In many households, one or both parents may have lost jobs or suffered income losses that force them to choose between putting food on the table, paying monthly bills and keeping up economically.

Economists and others are predicting a tsunami of evictions that will make providing shelter even more difficult for some families barely making ends meet.

“The U.S labor market is not designed well to absorb formal care,” Gennetian said, adding that it could be child care for preschool children or for the older ones who still need the supervision of an adult. “This intersects super closely with the question of school closings.

“The U.S. lacks a strong safety net for reaching vulnerable people, and again, schools have played an important role in filling that gap.”

For that reason and others, Gennetian and two pediatricians from Duke agreed that opening schools in a safe way would be beneficial to the children.

Developing COVID-19 research on children

The three offered their thoughts during a panel discussion on Tuesday before Cooper announced his decision.

“There’s a really strong case for trying to reopen schools because there are so many benefits both for children, not only their academic benefits, but also their health and well-being and social, emotional health … and also for families, many of whom are trying to get back to work and reopen the economy,” said Charlene Wong, a Duke pediatrician who specializes in care for adolescents and teens.

“We really need to proceed with caution and care and avoid broad, sweeping mandates about requiring schools to open,” she added. “We are certainly very early in learning about the experience of children and their experiences, particularly in schools and other congregant settings.”

Image by Editor B, flickr creative commons
The classroom experience could be very different this year, with children staying with one cohort and teacher for their entire school day, eating at their desks, wearing masks and social distancing. Image by Editor B, Flickr Creative Commons

Wong suggested that scientists and medical researchers should start including children in broader studies about the impact of COVID-19 that could help guide school decisions and others ahead.

“While we’ve seen an explosion of COVID-19 research and we’re learning something new every day, a relatively small proportion of that research has been on children,” Wong said.

The data show that high school students and elementary school children should be considered in a different light for several reasons.

There is evidence of teens becoming infected and transmitting the virus, as well as acknowledgement that high school students are better suited for remote learning than younger children.

“We are seeing a difference in the way in which the infection presents itself,” said Ibukun Christine Akinboyo, a Duke pediatrician and infectious disease specialist. “It seems to be milder in younger kids.”

Develop a quarantine plan

Nonetheless, that does not mean they are immune, Akinboyo said.

“Particularly in our area, we have had child care settings that have been open … until recently we have not seen rapid clusters around spread in those settings,” she said. “As the community prevalence has gone up, we have seen some clusters of spread among staffers, among children. And that is not unexpected.

“I’m in full support of making decisions based on local data,” Akinboyo added. “That may be on the state level, that may be on the county level. We have to ensure resources are available across the board, so counties that historically have not had adequate access to resources have them.”

Whether a district chooses in-person instruction or remote learning, Wong suggested that families develop quarantine plans that anticipate lab-confirmed cases in a school and the disruption that would come at home and work.

“In many ways these unpredictable two-week quarantines for individual children or classrooms … can sometimes cause more chaos for families than what we saw with the blanket closures in the spring when all of us who were working parents were mostly in the same boat as we tried to juggle our personal and professional obligations,” Wong said.

She said people need to prepare for the inevitable disruptions.

“Preparation now will help ensure that families will be able to follow these quarantine guidelines so that we can slow the spread of the virus and so schools can remain open for learning,” Wong said.

What happens if students, teachers or staff test positive?

If a student or teacher contracts a lab-confirmed case of COVID-19, Cohen said contact tracers will work to find close contacts and encourage those people to get testing and isolate themselves while awaiting results.

Schools or classrooms wouldn’t necessarily be closed down, even if a student were to test positive for the virus.

“We would do what we would do now related to somebody being positive,” Cohen aid. “If it was in elementary school it is likely that they would have been cohorted and with the same number of students and one teacher throughout the day and would only have come into contact with the students.”

In such a case, contact tracers would alert people who were within six feet of that person for longer than 10 minutes, telling them to get tested. Public health officials also would work with schools on cleaning protocols outlined in their guidelines and recommendations.

“It doesn’t mean immediately that a school needs to close,” Cohen added. “They may want to go beyond our protocols and do that. Again, it depends on the situation, what was the age of the kid, how those contacts were arrived at.”

“We don’t want to have a one-size-fits-all,” Cohen added. “We really do need to tailor to what the situation is, what kind of student, how long were they in school, what were their contacts. That’s why we really need local health departments involved in each one of those situations.”

First five days of school year

The protocols for the coming school year are included in an updated StrongSchoolsNC public toolkit created by DHHS.

“In-person education is important for children, and it happens in the context of a community,” said Theresa Flynn, a Wake County pediatrician who serves on the board of directors of the North Carolina Pediatric Society. “This plan strikes the right balance between health and safety, and the benefits of having children learn in the classroom. We must all continue with proven measures to reduce COVID-19 transmission like wearing a face covering, keeping distance between people, and frequent hand and surface cleanings so we can move closer to safely re-opening public schools.”

Cooper, an advocate for higher salaries for teachers who has pushed for more state spending for public schools by the Republican-led General Assembly, said he would be asking for more to be allocated from both the state and federal government to address increased school needs.

Phil Berger, the Republican from Eden at the head of the state Senate, and Cooper were in a budget stand-off for much of last year in large part over the school budget.

During the session that just ended, Berger added an additional twist to how schools would open next month when he failed to put forward a requested lifting of a law that requires North Carolina school children to spend the first five days of a school year in classrooms.

During the Duke panel discussion, the pediatricians and economist said such a mandate could cause health and safety problems.

“Certainly that could cause a spike in spread,” said Wong, whose practice focuses on  adolescents and young adults. “It’s my opinion there shouldn’t be such a broad sweeping mandate to say that every child must attend in person at any point during the semester and certainly not during the first week when everyone’s going to be trying to work out the kinks of the new systems that have been put together over the summer time. … There should always be a remote learning option.”

Cooper said Tuesday that Josh Stein, a fellow Democrat and the state attorney general, had provided the Cooper administration with a letter saying that his office thought it was OK to proceed with a hybrid model.

“We’re in a state where we’re rethinking everything. We’re rethinking how we eat, how we buy groceries, how we go to the restaurants, gyms, how we take public transit,” said Akinboyo.

“Now more than ever, we need to rethink how we go to school and how kids go to school. So I’m not sure that mandating in-person appearance for every kid allows each administrator, each group, each parent and staff — they’re trying to figure out the best thing for a child —  to be flexible in those options.”

Coronavirus by the numbers

According to NCDHHS data, as of Tuesday afternoon:

  • 1,552 people total in North Carolina have died of coronavirus.
  • 89,484 have been diagnosed with the disease. Of those, 1,109 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
  • 67,124 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious.
  • To date, 1,254,846 tests have been completed. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
  • Most of the cases (45 percent) were in people ages 25-49. While 12 percent of the positive diagnoses were in people ages 65 and older, seniors make up 79 percent of coronavirus deaths in the state.
  • 264 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
  • There are 3,374 ventilators in hospitals across the state and 921 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

Fayetteville hospital system gets COVID-19 diagnostic equipment

Cape Fear Valley Health, the state’s eighth largest health system, is now using lab equipment that can diagnose inpatients for the coronavirus in an hour.

The health system, which is based in Fayetteville, bought the $140,000 equipment through a donation from its foundation. The equipment allows Cape Fear Valley to test inpatients suspected of having COVID-19 by performing a Respiratory Pathogen Panel test. The tests can simultaneously check for dozens of potential targets, including bacteria, parasites, yeast, antimicrobial resistance genes and viruses such as COVID-19.

Cape Fear Valley no longer will have to send inpatients’ test kits out of state for testing.    Patients admitted during weekends who are suspected of having COVID-19 previously waited up to three days for results, hospital officials said in a news release.

“We get the results in real time now,” said Chris Tart, Cape Fear Valley’ vice president of professional services. “That helps us place COVID-19 patients on the appropriate unit.”

BioFire Diagnostics, the equipment manufacturer, says its system can run up to 264 samples a day. Faster diagnosis means faster treatment for the correct condition, according to the news release. — Greg Barnes

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Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.