Why a Hybrid Model for School Reopening is our Best Hope
COVID-19 has cast a pall on educational programs at all levels. Questions with too many variables and too few answers make it difficult to balance the benefits of in-person education against predictions of how many will get sick because schools reopen. A hybrid model, blending small classes for in-person training coupled with online remote learning, is the best option to address the challenges of COVID today, and is a durable educational model for tomorrow.
The most immediate challenge to reopening school is keeping students and teachers safe. The surest way to stop the spread of COVID is to stay shut down until everyone is vaccinated. Anything short of a shut down generates additional risk for transmission of COVID and increases the number of people who will subsequently become sick and die. We need to acknowledge that there will be additional cases as a result of having students return to school. It doesn’t make it easier, but as a society, we already make these grim decisions such as when we decide how many parts per million of a carcinogen is acceptable in our water supplies, balancing the risk of cancer deaths against the cost of further purifying our drinking water.
Proponents on both sides of the school reopening debate point to data on transmission and sickness in children. We know that children are much less likely to die than the elderly, and their transmission rates may be less than adults. But children do get sick and even die, and they do transmit the virus to others. Bringing together children will inevitably result in additional cases of COVID. What we don’t know is how many.
What we do know is that there are ways to reduce transmission of COVID. Everyone should know the basic principles by now, wear masks, socially distance, and wash your hands. Our schools can and should reinforce these principles. All school-aged children except those with medical contraindications should be expected to wear a mask at all times. Having hand sanitizers at all entrances and commonly used locations can be readily addressed.
Just as important is social distancing. This can be accomplished by keeping students at least six feet apart, which also limits class size dramatically. Limiting the size of gatherings is a sensible first step in a gradual reopening process. For example the California Interscholastic Federation in their return to training document, limits workouts to pods of 5–10 students in their Phase-1 plan.
All the prevention in the world may not be enough when rates of community transmission are high and rising. For this reason, many advocate for not reopening schools. As adults, we need to model the behaviors we know stop the spread and teach them to our children to give schools a chance to reopen successfully. Children should not have to suffer because we did not do a good job of controlling the virus.
Preparing for students in schools during a pandemic is a risky undertaking, is it worth it? All of us can relate to the disruption in our lives and the isolation and strain that distancing from others has created. Isolation seems particularly cruel for our young, who are learning to interact with others in their formative years. Schools are a venue for students of all ages to learn with and from each other in a supportive environment. It is this type of difficult to quantify benefit along with the other emotional and psycho-social advantages of in-person schooling that we must balance against the added risk of COVID.
There are other reasons to support targeted classroom training. Some courses are difficult to replicate online. Simulations, group activities, and science labs may need to be taught in-person. We want to ensure that all individuals have equal access to a good education and to the full range of services that a school can provide. Students who lack the equipment or the expertise for online learning need computer labs. Essential services such as emergency response and emergency medical services include hands-on activities as part of their training. We can avoid bottlenecks in education by prioritizing targeted high-yield in-person educational experiences that cannot be replicated online.
In-person education is dependent on a robust online education system. Smaller class sizes will drive dependence on remote learning for the remaining students, and for those classes and activities that don’t benefit as much from in-person education. It is inevitable that there will be students who get sick with COVID. This will lead to isolation of the student or teacher who is sick for 10 or more days, as well as close contacts for 14 more days. Anyone in these categories will need to continue their schooling while they are away- online learning is again the answer.
We are also seeing many facets of our society benefiting from digital solutions that increase online access. In the health care field, there has been a huge uptick in virtual visits. This transformation is unlikely to disappear even after there is a vaccine for COVID because it is so beneficial in improving the efficiency of patient care. There are similar opportunities in education. We should encourage digital innovations in online education to customize programs tailored to the unique needs of each student.
Because online learning increases the time children are home, it may increase the time children are unsupervised. Remote learning puts more parents and families in the impossible bind of choosing between going to work or watching your child. Families with less income will need access to subsidized child care. This has a cost, but it would have multiple benefits not only for the children who receive child care services, but also for their caregivers who can now go to work and contribute to our economy. Additional support for child care will also generate child care jobs that can’t be replaced by machines and are a good match for those who are struggling the most in this job market-the young and those who don’t necessarily have expensive college degrees.
Online learning does not mean fewer teachers. We already will need more teachers for our socially-distanced, small-pod classes. We will see many scenarios play out when schools reopen, but polls suggest that around 2/3 of parents want their children to return to the classroom, while 1/3 prefer online education. Assuming a normal size classroom of 30 students- that means 10 will opt for remote education, while the remaining 20 could be placed into two socially distanced pods of 10 each. It would be extremely challenging for a single teacher to manage essentially three different groups of students, but with a teachers assistant, they would have a chance. Hiring additional teachers assistants would come with a cost, but again it would pay off by giving students a second teacher to turn to, supporting our valued teachers, and increasing job opportunities for laid off workers.
Many states including California make school openings contingent on lower COVID rates. Whatever the prevalence is in the community, there will be situations where students or teachers test positive for COVID, or even more commonly, have symptoms of COVID. These symptoms; fever cough, and shortness of breath along with a handful of other relatively common symptoms, overlap with the symptoms of the colds students and teachers are sure to experience in the winter. We will be faced with difficult decisions about when to close a classroom or school if there are 1,2, 3 or more infections on a campus.
One important distinction will be determining if a positive case resulted from exposure at school or somewhere else. If the exposure was elsewhere, you can isolate the involved student or teacher. If your classroom is socially distanced you may be able to limit the number of students who are quarantined. A person is quarantined if they are a close contact. A close contact is defined by the CDC as being within 6 feet of someone who tests positive for 15 minutes or more. A socially distanced classroom may not have any students who meet the definition of a close contacts, while schools that have 20–30 students per class may have to close down the classroom because students are spaced closer than six feet.
We should work to reduce the number of individuals who require quarantining because quarantining itself can have negative consequences. Quarantining means no work and no social interaction for 14 days. These consequences disproportionately effect those who are poor. At the same time, we allow essential workers to continue to work rather than make them quarantine. even if they meet the criteria for a close contact. Before addressing this inconsistency, we can limit the number of individuals and families impacted by quarantining by limiting the size of classrooms.
However, we must be prepared for the number of students and teachers who will be sick, particularly during cough and cold season. This means having a well thought out approach to isolating and quarantining students and teachers who test positive or have symptoms of COVID, and it means that caregivers must screen their children everyday before they go to school to make sure they are not sick. At the same time, our communities must support caregivers who are required to stay at home when their child cannot go to school.
Our schools should also be screening- both for symptoms of COVID, and by checking temperatures. We should collect data on how many elevated temperatures are discovered, but checking temperature is the only objective measure of COVID we have short of testing, and fever is the most common symptom of COVID. These are good arguments for including temperature checks in school reopening plans by using the entrances to the first class of the day for screenings.
As we look to the future, it’s hard to imagine a world where online communication and learning doesn’t continue to grow and improve. At the same time, the need for in-person education and hands-on experiences are not going away. A hybrid model brings us the best of both worlds and the flexibility to adjust such as during the rapidly changing pandemic we find ourselves in right now.
We should consider resuming schools when COVID rates begin decreasing in our communities. The hybrid model is the best option because it optimizes opportunities to build in key COVID preventive strategies including social distancing and small class sizes. It also incorporates online education which can serve as an alternative educational format for all students if there are too many cases when schools reopen. We should utilize remote online education whenever possible, but we should retain in-person education for key classes so that bottlenecks in training do not occur and so that children can have the stimulation of living and learning with others.
A hybrid model for school reopening gives us the best chance in our fight against COVID now, and in a future that rewards efficiency and effectiveness. We should provide adequate funding to support enough teaching staff to begin in-person education in our elementary schools and selected classes in other grades that are difficult to provide online while creating a robust online presence. As a complement to the hybrid model, our caregivers must have access to a strong cohesive daycare system that incorporates the same attention to public health best practices as our schools. Funding will be required, but it will be money well spent, not only for children, but for caregivers and families, and for the additional adults who will be hired for expanded childcare and schoolroom positions that will be needed to make the hybrid model a success.
Dr John Zweifler is a family physician with decades of experience in medical director roles, patient care, medical education, and managed care. He now works part-time as a medical consultant with the Fresno County Department of Public Health. He is also a physician consultant with The Terry Group, and is the author of the e-books, “Tipping Health Care in the Right Direction” and “Pop Health”
He can be contacted at The Terry Group John.zweifler@terrygroup.com
