As more state guidance becomes available and some school districts start transporting students again for summer school, health experts express concern regarding school transportation operations while also providing potential solutions going forward.
Laurie Combe, president of the National Association of School Nurses (NASN), was a school nurse for 12 years and works closely with school nurse administrators in the greater Houston area. She said she is acutely aware of the normal challenges that transportation departments already face on a daily bias.
However, with social distancing guidelines now recommended by the Centers for Disease Control and Prevention (CDC), she said the financial impacts on districts are changing the game.
She went on to explain that one of her colleagues is working with a school district in Texas that has opened for in-person summer school as of June 1, per Gov. Abbott’s approval. She said over the course of a two-week span, one busload of 13 students is estimated to cost the district an extra $1,000.
“That is huge, if you think about the school populations and how many buses it will take,” Combe said.
However, she said another concern is the limited number of school buses available to districts. She questioned how long it will take to get the student population to school with social distancing in place.
“How do you transport those students in a timely manner? The transportation time is going to cut into instructional time in a huge way,” she added.
Dr. Nathaniel Beers, president of the HSC Health Care System in the Washington, D.C, area and a member of the American Academy of Pediatrics (AAP) Council on Children and Disasters, said that including health expertise in the conversations will help alleviate the responsibility of transportation directors to figure out the CDC guidance on their own. He also encouraged looking to guidance released by health professionals.
“All of these are hard decisions,” Beers said. “… [S]chool districts are already going to be strapped for resources because of the economic impact that most districts have experienced.”
He said the AAP posed a set of recommendations and questions that school districts should address as they move toward reopening.
“We do know that pediatricians are a critical part of the child health education systems and need to be armed with the right types of questions to be encouraging school districts to talk about,” Beers said.
The AAP has guidance on its website, “COVID-19 Planning Considerations: Return to School In-Person Education in Schools,” that outlines several factors that school districts should consider.
Meanwhile, Dr. Joseph O’Neil, who specializes in development and behavioral pediatrics at the Riley Children’s Health at Indiana University Health, said the CDC guidelines are well thought out at this time.
“We are basing all of our recommendations on what we have learned about this novel or new virus,” O’Neil explained. “I think there are some challenges that we are facing in terms of sending our children back to school.”
He noted that many of the logistics being discussed today could change before August.
“The good thing about children, is the receptors on their skin are probably not as susceptible to COVID-19 as adults or older individuals are,” O’Neil advised. “And I think that is the good news. The bad news is they could pick it up and take it home. And if they have an older caregiver or live with their grandparents, that could be an issue.”
He said there is no easy solution to any question being posed by student transporters, but he has had regular conversations regarding school transportation with Michael LaRocco, state director of the Office of School Transportation at the Indiana Department of Education.
“I work with Mike quite closely, and we have been going through these discussions about how you handle buses. Do you need to establish more school bus stops so that there are fewer gatherings? How do you do so when kids are congregating. Do they all conjugate together, or do you have a stop per family?” O’Neil questioned. “It’s a very difficult situation, and how are you going to do that in congested and busy areas like urban settings? And then do you have more frequent stops when you are in rural areas? It’s not an easy answer.
“There is just no good answer to this.”
However, the concerns don’t stop there, Combe said she is worried about the health of school bus drivers amid their onboard proximity to students. Plus, she noted, how do you address students walking past the driver while loading and unloading the school bus.
“They really shouldn’t be driving with face shields, those are not meant for driving, as they can fog up, so we can consider that a safety issue,” Combe said.
She also discussed concerns regarding social distancing at a bus stop. “Have you been to student bus stops before? I laugh when I read the CDC guidelines that there should be social distancing at the bus stop. They are children. I mean, especially the young kids, they run and play and tackle. All of those students participate in close bodily contact. How do you social distance at a bus stop? I mean that is out of a school district’s control.”
She said one thing transportation departments can do is encourage proper hygiene and handwashing for students upon leaving the bus and entering the school setting.
“I certainly had that experience in my school district, where the health department required, for certain diseases, that students must wash their hands when they enter the school, and when they exit the schools, so they are not bringing anything in or bringing anything home,” Combe explained.
O’Neil agreed, noting that inside the bus there is less worry about the students and more for the transportation personnel.
“Oftentimes, if a bus driver has a medical problem, it might preclude them from being able to transport a child,” O’Neil explained. “And that is going to be a real strain on the personnel needs of a school district for transportation.”
The Importance of Children Attending School
Another concern felt by many is the idea that a school bus is an enclosed box, with little ventilation.
“I understand that not all weather will accommodate [opening the windows on the bus],” Combe said. “But there should be an attempt on every day on every ride to open the bus windows as much as practically possible.”
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Combe said the best thing school districts can do now is to seek guidance from international partners. For example, she noted that European countries are opening schools back up. While not much data is currently available, she cited a Switzerland school that has been open for longer than the typical incubation period of 14 days, without any student cases or any increased cases.
Regardless of the concerns, bringing students back to school is happening, and several studies have been released indicating that school is important, especially for younger children.
“I think many people have a different plan, but internationally and within the U.S. I have heard a lot of discussions that it is important to bring pre-kindergarten through fourth grade back every day,” Combe said. “So how would we do that? Maybe bring half of them in the morning, clean the school, and the other half in the afternoon? I think teachers have to be engaged in cleaning and that sort of thing. Especially for those younger grades, social distancing is going to be difficult, because of the nature of children.”
She noted that the school community believes it’s in the best interest of students to give them that sense of normalcy that attending school provides, and she encourages districts to lean on resources put out by the National Association of School Nurses and the John Hopkins University.
Beers noted that this is only the beginning of the recommendations regarding opening schools. “I think we will continue to be modifying recommendations all summer long. And that is a challenge for schools, but I think they are all eager to get as many kids into the schools as possible, safely as possible. So, our hope as medical professionals is to help give them guidance in how they can do that most effectively.”
Beers discussed an article that recently came out in The Journal of Pediatrics, “Re-opening Schools Safely: The Case for Collaboration, Constructive Disruption of Pre-COVID Expectations, and Creative Solutions.” It applies added pressure to reopen schools by pointing out that school positively addresses inequality and inequity issues, impacts mental health, and provides nutrition to many students. The article featured several authors including two doctors at the Children’s National Hospital, Jeffrey Dome, M.D., Ph.D., and Lisa Guay-Woodford, M.D.
“And then to make it even broader, the reality is the rest of the workforce is unlikely to reopen unless schools and childcare can reopen,” Beers added in highlighting the article. “Because the reality is many of us as parents are dependent on schools to provide safe spaces for our families and children to be during the day. And absent of that, we create a huge gap in infrastructure in the ability that people have to be able to return to work. So that article begins to work through some of that, as well as those individuals with chronic illness and what the real risks are for them, as related to the COVID-19 virus.”