In March, I wrote an open letter to the community expressing my view that COVID-19 may be the greatest public health threat of our lifetime. Now, almost 150 days later, we are working, parenting, educating, eating, shopping, exercising and socializing in a completely different manner. Franklin County has lost more than 500 of our friends, relatives, and neighbors to this disease. As individuals and as a community we will grieve those losses and hold a space for those who are suffering both as a direct and indirect result of this pandemic. While there is no easy way forward, your willingness to prioritize hand washing, social distancing and the use of face coverings shows a fierce determination to save lives. Likewise, Franklin County Public Health (FCPH) has been tirelessly working to meet our mandate to control the spread of this disease in our community.
On July 29, FCPH issued guidance to all public and private K-12 schools recommending they begin the 2020-2021 school year using a virtual/online learning model and discontinue extracurricular activities. FCPH made this science-based, data-driven recommendation after a thorough analysis of key statistics, multiple conversations with state and federal public health experts, and utilizing the guidance from the Centers for Disease Control and Prevention (CDC). It’s our belief that while starting the school year at home is less than ideal, it will ultimately slow the spread of COVID-19, expedite containment and save lives.
Since announcing this guidance, our office has received hundreds of emails, phone calls, and text messages. This feedback, some full of heartfelt gratitude, others with anxious uncertainty and a few with outright anger have confirmed the unique and widespread impact of our pandemic mitigation efforts. We thank everyone for their input. We will read each message we received with humility and an openness to better understand the impact and significance this recommendation may have on those we serve. And although we cannot respond to each message separately, this letter intends to collectively provide more context to help parents and community members better understand our rationale for and purpose of the recommendations.
Recommendations vs. Orders
When circumstances dictate, the Franklin County Board of Health has legal authority in the form of a board order to immediately compel action either by an individual or an operator to protect the public’s health. Other times, it’s more appropriate for our office to issue guidance or recommendations for individuals or organizations to consider for the same purposes. The intent of our memo regarding school openings is an example of the latter. The recommendations we put forth last week and any we issue in the future are simply that, recommendations. We stand by them and will continue to objectively offer guidance based on the latest science and information. However, these recommendations are not board of health orders. The recommendations are intended to inform the decisions schools deem appropriate for their individual communities.
In looking at the data, we see worrying trends in our community. Franklin County is experiencing the highest sustained rate of transmission since the pandemic started. As of July 30, our seven-day rolling average of daily new cases was 234. More broadly, the average number of daily new cases of COVID-19 tripled between mid-June and mid-July. Our weekly positivity rate of testing is hovering above 10%. With daily new case and positivity rates significantly over recommended levels we advise schools consider opening remotely at this moment in time.
The literature suggests younger kids (10 and under) appear to spread the virus at about half the rate of adults while older kids spread the virus at rates similar to adults. FCPH has already identified clusters of cases associated with sports and extracurricular activities and have done extensive contact tracing as needed. And though the disease burden thankfully for this age group is quite low, it’s the possible transmission of the virus to others more at-risk, either in the school or at home, that is of concern.
Overall the absolute risk level in the community gives us the best predictive indication as to if we can reopen schools safely. Quoting the CDC Director, Dr. Robert Redfield, in a press interview July 24, “So when you look at the hot spots, I think most of us right now are looking where the percent positivity rate within the community is greater than 5%…to be more cautious (when opening schools) particularly in those areas that have prevalence rates of percent positive more than 10%.” Dr. Redfield continues by saying that it is in the best interest of public health to bring students back into the classroom. FCPH agrees with that risk assessment and the goal of bringing kids back to school. Unfortunately, we cannot ignore the conditions in the community including positivity rates above 10%. So, our recommendation currently is to ask our schools consider starting the school year in a remote fashion and discontinue extracurricular activities until such time as those conditions improve.
Working with Schools
Though our recommendation for schools is to consider beginning the year remotely and discontinue extracurricular activities, it is the school’s governing body’s decision to do so. Our job is to provide guidance and information. FCPH will work with our schools in whatever capacity and environment in which they choose to open. In anticipation of that, the health department would recognize a few areas that are of interest to which we would like to offer specific guidance.
- Special Education, Intervention, and Social Emotional Learning Needs: We recognize all students learn more effectively in the classroom. However, some student’s educational and social/emotional needs necessitate those services be delivered in person. In those specific cases during a remote learning environment, schools may have small, in-person groups of students no larger than nine in a classroom/learning area with one staff member in attendance.
- Extracurricular Activities: If these activities are held, FCPH advises schools to cohort groups of no more than nine students with one staff member. All sports-related decisions should follow guidelines from OHSAA and the state.
- Classroom Teaching: If schools choose to be in a remote learning setting, it is acceptable for teachers to teach from their classroom which, in the absence of students, affords substantial and appropriate social distancing opportunities.
- Return to School Plans: FCPH will continue to review and provide technical assistance to all schools as they prepare their plans in whatever capacity their governing body decides is appropriate.
Future Public Health Recommendations
Going forward, we are committed to adjusting our recommendations based on the data and the science. We will maintain an ongoing and active dialogue with our schools to ensure we make new recommendation when appropriate. In considering any future change to this recommendation, here are the factors we would consider allowing for us to have that opportunity:
- Decline in cases- ideally four weeks
- Positivity rates below 10% but preferably closer to 5%
- Improvement in the risk level as defined by the state advisory system (i.e. orange)
We recognize schools have put in significant time and effort in planning for return to school following the state’s guidance. Furthermore, we also understand from a public health perspective, the importance schools have in the social and emotional well-being of students, their safety, nutrition and other support needs. To that end FCPH is in active partnership with other county government and non-profit agencies to assure our children and families have the support they need.
The issue of back to school though certainly a highly visible issue is one part of a complicated puzzle as we work to respond to COVID-19. Our recommendations for schools come with the understanding this virus continues to spread rapidly in our community. We thank the community for their continued efforts to minimize the impact the pandemic is having on our community. Lives are at stake, and it is our job to do what we can to protect them. That is our mission and we will continue to work every day to achieve it.
- Park YJ, Choe YJ, Park O, Park SY, Kim YM, Kim J, et al. Contact tracing during coronavirus disease outbreak, South Korea, 2020. Emerge Infect Dis. 2020 Oct [date cited]. https://doi.org/10.3201/eid2610.201315