Filling in the Blanks: National Research
Needs to Guide Decisions about Reopening
Schools in the United States
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 2
Authors
Anita Cicero, JD
Deputy Director, Johns Hopkins Center for Health Security
Visiting Faculty, Johns Hopkins Bloomberg School of Public Health
Christina Potter, MSPH
Analyst, Johns Hopkins Center for Health Security
Research Associate, Johns Hopkins Bloomberg School of Public Health
Tara Kirk Sell, PhD, MA
Senior Scholar, Johns Hopkins Center for Health Security
Assistant Professor, Johns Hopkins Bloomberg School of Public Health
Caitlin Rivers, PhD, MPH
Senior Scholar, Johns Hopkins Center for Health Security
Assistant Professor, Johns Hopkins Bloomberg School of Public Health
Monica Schoch-Spana, PhD
Senior Scholar, Johns Hopkins Center for Health Security
Senior Scientist, Johns Hopkins Bloomberg School of Public Health
Published May 15, 2020
Copyright © 2019 Johns Hopkins University
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 3
Contributors
Annette Campbell Anderson, PhD
Assistant Professor, JHU School of Education
Deputy Director, Johns Hopkins Center for Safe and Healthy Schools
Carolina I. Andrada
Analyst, Johns Hopkins Center for Health Security
Research Assistant, Johns Hopkins Bloomberg School of Public Health
Megan E. Collins, MD, MPH
Assistant Professor
Johns Hopkins Wilmer Eye Institute and Berman Institute of Bioethics
Sara B. Johnson, PhD, MPH
Associate Professor of Pediatrics
Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health
Diane Meyer, RN, MPH
Managing Senior Analyst, Johns Hopkins Center for Health Security
Research Associate, Johns Hopkins Bloomberg School of Public Health
Lucia Mullen, MPH
Analyst, Johns Hopkins Center for Health Security
Research Associate, Johns Hopkins Bloomberg School of Public Health
Jennifer Nuzzo, DrPH, SM
Senior Scholar, Johns Hopkins Center for Health Security
Associate Professor, Johns Hopkins Bloomberg School of Public Health
Joshua M. Sharfstein, MD
Professor of the Practice in Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Elizabeth A. Stuart, PhD
Professor, Departments of Mental Health, Biostatistics, and Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Eric Toner, MD
Senior Scholar, Johns Hopkins Center for Health Security
Senior Scientist, Johns Hopkins Bloomberg School of Public Health
Rachel A. Vahey, MHS
Graduate Research Assistant, Johns Hopkins Center for Health Security
Kelsey Lane Warmbrod, MS, MPH
Analyst, Johns Hopkins Center for Health Security
Research Associate, Johns Hopkins Bloomberg School of Public Health
Crystal Watson, DrPH, MPH
Senior Scholar, Johns Hopkins Center for Health Security
Assistant Professor, Johns Hopkins Bloomberg School of Public Health
Tom Inglesby, MD
Director, Johns Hopkins Center for Health Security
Professor, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 4
Executive Summary
Most elementary schools, middle schools, and high schools across the United States
have been closed since March in an eort to reduce the spread of COVID-19. Schools
that are able to do so have replaced classroom education with remote learning, using a
range of tools and approaches. As of the publication of this report, governors from most
US states have recommended or ordered that schools remain closed for the remainder
of this academic year, aecting more than 50 million public school students. While
a few schools may reopen before the end of the current school year, most schools,
students, and their families in the United States are now facing uncertainty about
whether or how schools will resume for in-class learning in the fall.
The White House issued guidelines for Opening Up America Again on April 16, 2020;
many states have already nalized or are developing their own plans and taking steps
toward reopening businesses, communities of faith, and other settings. Not all states
that are now relaxing physical distancing restrictions have met the gating criteria set
out in the White House guidelines, but they are motivated to reopen in order to blunt
economic losses resulting from shut-down orders. School closures will have a direct
impact on the ability to reopen the economy. Realistically, it will be dicult for many
adults to return to work in person if their children are not back in school in the fall.
Likewise, closures of summer camps, daycare centers, and aer-school activities also
aect the ability of many adults to return to work.
A host of guidance documents related to COVID-19 mitigation strategies for schools
have recently been issued by various government and nongovernment organizations
at the national and international levels. And a number of countries in Europe and
Asia are now implementing a variety of approaches for returning K-12 schoolchildren
to school. This report includes a summary and detailed Appendix on a selection of
country approaches to school reopening. It is important to track these eorts and the
implementation of the various guidances closely. Still, it will be dicult to tease out
lessons learned absent rigorous study, since many adults will be returning to work,
and physical distancing restrictions will be eased contemporaneously with schools
reopening.
There is an urgent need to understand the evidence that would support how students
could safely return to school. This is an extremely dicult decision, because of the
uncertainties relating to risk. While published studies to date indicate that children
with COVID-19 are less likely than adults to suer severe illness, there is only limited
scientic evidence, models, and anecdotal accounts attempting to gauge whether
children with COVID-19 in school can eciently transmit the virus to other children,
teachers, school sta, and family members. Unanswered questions include: How
vulnerable to severe illness are students who have underlying health conditions, such
as asthma, diabetes, or severe obesity? How safe is it for adults who themselves have
serious underlying health conditions to send their children back to school without
fear of those children bringing the virus home and infecting others in the family?
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 5
How safe is it for teachers, administrators, and other school sta, especially those
who are medically vulnerable, to return to school and interact with students who
may be asymptomatic but infectious? Are certain school communities at greater risk
than others relative to exposure, and should each school community be evaluated
independently to determine level of risk?
We need a national mandate to prioritize and quickly fund research to answer
these scientic questions about children and COVID-19 so that governors, schools,
teachers, and guardians can have greater certainty about the potential consequences
related to reopening schools and can make informed decisions. While some studies
are getting under way, the US government (as well as other national governments,
nongovernment organizations, and philanthropies) should fund additional studies
aimed at understanding the role of children in transmission of COVID-19. As schools
reopen, models are not sucient to determine the actual risk to school-aged children
and the teachers and caregivers in their lives, given that available scientic evidence is
not conclusive and continues to evolve.
Transmissibility studies, especially epidemiologic investigations using contact tracing
and other data, are needed to understand COVID-19 transmission dynamics in school-
aged children. We should also closely track the experience in countries where schools
are starting to reopen during the pandemic and in those places in the United States that
decide to open schools this spring or summer. For countries where schools have opened
recently, formal case studies and cohort studies comparing whether transmission is
occurring in families of students or in teachers or sta in those schools will be very
important. Support for this critical research is now needed to ll in the blanks of our
knowledge as much as possible as schools in the United States decide how and under
what conditions they will open their doors during the 2020-21 school year. To help
maintain momentum and focus, a national advisory group composed of pediatric,
public health, and education researchers should be established to regularly review
the state of the science and provide coherent updates on key questions, including
recommendations supported by data.
Overview and Scope of This Report
Although data should be central to decisions about how to reopen schools, evidence
related to the burden of COVID-19 in children and children’s role in COVID-19
transmission dynamics has been slow to come for many reasons. In general, data
gathered to date indicate that children with COVID-19 do not typically get as severely ill
as adults, with only a small percentage suering serious complications or death. This
makes it more likely that asymptomatic and mild COVID-19 cases in children have gone
undetected. This is likely to have been especially true since limited diagnostic testing
has been used primarily for hospitalized patients and those presenting with more severe
illness. In this report, we briey summarize key ndings of a selection of published
pediatric COVID-19 literature, and we provide recommendations for areas where
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 6
additional study and expedited research are needed. Recognizing that many countries
are opening schools now, we summarize the approaches and plans of several countries
in their eorts to resume in-classroom education, as it will be important to observe
whether and how these measures ultimately aect disease transmission.
This report focuses primarily on research needed to improve the evidence base relating
to children, teachers, and other sta in daycare and in schools serving pre-K through
12th grade. This report does not include a focus on boarding schools, colleges, or
universities because the congregate living arrangements common to these settings
present dierent challenges. Those settings are outside the scope of this report and
deserve their own strategies and lines of research.
The Importance of Schools for Classroom-Based
Instruction and Resources
The closure of schools across America occurred quickly in the setting of a rapidly
worsening pandemic, and schools did not have much time to plan for remote education
and other services typically provided in many school settings (eg, food, health care).
Because of the uncertainty surrounding the spread of COVID-19, many schools
assumed that classroom education would resume aer a period of a few weeks. Most
online programs were put together quickly, and the transition from classroom-based
instruction to remote learning was dicult. Challenges were particularly severe for
many students and teachers who have limited access to technology and technical
support.
Schools provide much more than academic instruction for children. Schools also
aord opportunities for social development and are settings for the delivery of critical
resources such as physical and mental health services, special education, gied
instruction, developmental assessments and services, and social support services, and
they are sometimes a haven for children subjected to abuse in the home. Schools also
provide meals for low-income students, including free or discounted lunches to more
than 20 million. School-based health centers are an essential part of the healthcare
system, particularly as safety net providers. Decisions to close or reopen schools need to
take these factors into account, in addition to academic considerations.
The longstanding digital divide raises concerns regarding the resources students
have in place to facilitate remote learning. Schools have made noble eorts to quickly
convert to online learning systems, but equity issues are abundant. Not all families
own a laptop, let alone enough laptops for each of their children. Not all children have
equal access to the internet or access to soware needed for class. For instance, a recent
survey conducted by the Public School Superintendent’s Association of Maryland found
that as many as 25% of students in some school districts in Maryland either had not
signed on to the internet to do lessons or had not picked up a paper-based learning
packet to complete since schools closed. These types of inequities may be widening the
socioeconomic status achievement gap.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 7
Certain students, such as those who are marginalized, vulnerable, or have special
needs, are likely to suer the most from school closures given that, in many cases,
these students may have required additional in-person support to meet academic
standards before the arrival of COVID-19. Schools serving populations of students with
greater needs may also have fewer resources and greater challenges than other schools,
making the transition to remote or online learning even more dicult. Because of these
inequities, COVID-19–related school closures may increase the likelihood of a widening
learning loss among our most vulnerable students as the pandemic extends through the
end of the academic year and potentially into next year.
Equity is a key factor to consider in any discussions about school closure and reopening.
Lessons from previous school closures show us that children who are more vulnerable
require more services and assistance to successfully transition back to learning in
school. Equity issues aside, remote learning requires more adult supervision for young
learners, and, in general, remote learning is more challenging for younger school-age
children, a fact oen cited by countries that are reopening rst for primary school–aged
children.
State of Scientific Understanding
Coronavirus disease 2019 (COVID-19) is an illness caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2). Information about children with COVID-19 is
limited but growing. Below we provide an overview of key ndings from a number of
published studies. This information is not a comprehensive literature review but is
intended to provide a general summary of the current state of the literature as it relates
to the incidence of COVID-19 in children, the frequency of severe illness, and the role of
children in transmission of SARS-CoV-2.
Incidence
It is important to note that children of all ages are susceptible to infection with SARS-
CoV-2, but there is also an apparent reduced incidence of disease in children compared
to adults. For example, in the United States, the Centers for Disease Control and
Prevention (CDC) has reported that less than 2% of COVID-19 cases reported by April 2,
2020, were in children under 18 years of age, while children make up approximately 22%
of the US population. In Italy, by March 15, 2020, 1.2% of identied cases were 18 or
younger. While these ndings provide evidence that there may be reduced susceptibility
to the disease in children, mild or asymptomatic cases—which may make up the bulk of
infections in children—are less noticeable and may go undetected and untested.
Incidence may also vary across the pediatric age spectrum, with a general increase
in numbers of cases as children get older. In the United States, where data collection
has been limited, among 2,572 pediatric COVID-19 cases, 15% occurred in children
who were under 1 year old, 11% occurred in children ages 1 to 4 years, 15% occurred
in children ages 5 to 9 years, 27% occurred in children ages 10 to 14 years, and 32%
occurred in children ages 15 to 17 years.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 8
In Iceland, testing of 6% of the population showed that children under 10 years of age
were less likely to be positive than people who were over the age of 10 (6.7% vs 13.7%).
In South Korea, which also conducted extensive testing, 1% of cases were found in
children ages 0 to 9, while 5.2% of cases were found in the 10 to 19 age group. In a
preprint (not yet peer reviewed) study, it was reported that in Vo, Italy, at the beginning
of that city’s lockdown, a large fraction of the city’s population was tested, and the
prevalence of COVID-19 across all ages was found to be 2.6%. Those tested included 217
children between the ages of 1 and 10 (none of whom tested positive) and 250 people
aged 11 to 20 (1.2% of them tested positive). At the end of the lockdown, the prevalence
of COVID-19 across all ages tested was 1.2%. None of the 157 tested between the ages of
0 and 9 was positive, and only 1% of the 210 people tested between the ages of 11 and 20
tested positive. Notably, 43% of all people (adults and children) tested in Vo across the 2
surveys were asymptomatic.
Several studies have shown that attack rates—that is, the proportion of people in an
initially uninfected community who become ill—are lower in children as compared to
adults. However, evidence is mixed. In a study of 105 index cases and 392 household
contacts near Wuhan, China, the attack rate in children in the household was 4% as
compared to 17% in adults and 27% for spouses specically. Another study of 2,541
contacts reported from 1,193 cases in Wuhan and Shanghai showed that children who
were in households with a COVID-19 case were a third as likely to become infected with
SARS-CoV-2 compared to adults, whereas individuals over 65 were nearly 1½ times as
likely as younger adults to become infected. In a third study of 770 exposed household
members in Guangzhou, China, those less than 20 years of age had a lower attack rate of
5.3% compared to an overall attack rate of 12.6%. In contrast, a dierent study of 1,286
contacts of 391 cases in Shenzhen showed that children in households were equally
likely as adults to be infected. As a result, although there are indications that children
may be less susceptible to the disease, this conclusion cannot be made with condence.
Severity
While much is unknown about COVID-19 in children, studies have provided fairly
denitive and reassuring information on severity in children compared to severity in
adults. Healthy children are much less likely than adults to develop severe disease from
COVID-19—meaning that they are unlikely to be hospitalized in such numbers as to be
contributors to healthcare system overload. In particular, children are more likely to
develop asymptomatic infection or mild disease. Of 2,143 pediatric cases reported to
China CDC by February 8, 94.1% were considered asymptomatic, mild, or moderate.
Reports that a substantial percentage of diagnosed pediatric cases have been
hospitalized should be viewed in the context of limited testing. In Madrid, of the 4,695
COVID-19 cases diagnosed by the middle of March, 41 were children and (60%) of
those 41 were hospitalized. Early data collected on cases in the United States were not
uniformly detailed enough to know hospitalization status of all pediatric cases. But for
the subset of pediatric cases diagnosed between mid-February and early April, where
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 9
hospitalization status was known, 5.7% of infected children were hospitalized. It is
important to take into account that due to the need to conserve limited tests, severely
ill patients are prioritized for testing, which likely results in an overestimation of
hospitalization rates for COVID-19 cases.
Severe outcomes from COVID-19 are rare in children. Of the rst 44,672 cases reported
from China, no deaths were reported in children under the age of 10, and 1 death was
reported in a child between the ages of 10 and 19. Data from 149,082 COVID-19 cases
in the United States occurring between February 12 and April 2 showed only 3 pediatric
deaths. Complications are rare, but they have been reported. A study in China (with 14
children) found substantial lung injury in children whose clinical symptoms were mild.
A pediatric multisystem inammatory syndrome recently observed in at least 100
children in New York (including 3 who died) has raised concerns that it may be linked to
COVID-19. The presentation of disease in these children, many of whom tested positive
for COVID-19 or had its antibodies, appears similar to Kawasaki disease, which causes
inammation in the walls of blood vessels, including those that supply blood to the
heart. Although the current incidence of this outcome is quite low, any association with
COVID-19 should be further explored in order to better understand the risk factors and
how its potential spread might aect plans to reopen schools.
Pre-existing underlying health conditions in children seem to be an important factor
for children who have COVID-19 and require admission to pediatric intensive care
units (PICUs). Out of 48 children admitted to 46 PICUs in North America across a
3-week period this spring, 83% of them were found to have signicant pre-existing
comorbidities and 4% died.
Transmission from Children
Since adults experience more severe illness and death than children, knowing the
risks of asymptomatic spread from children to adults is a central question. Studies
to improve understanding of the role of children in transmission of COVID-19 are
beginning to emerge. One study involving 3,712 COVID-19 patients showed that viral
loads of SARS-CoV-2 are similar in children as compared to adults. This means that
infected children have a similar amount of virus particles in testing samples as adults.
Although it is not a given that viral load is a primary indicator of transmissibility in
COVID-19 cases, this nding could support the idea that children are as infectious and
able to transmit the disease as easily as adults. However, case investigations conducted
to date suggest that transmission is not particularly frequent. Research conducted in the
Netherlands (which has been summarized but not yet shared) to determine the ages of
primary COVID-19 cases and their contacts suggests that children have a much smaller
role in transmission than the elderly and adults. Still, in a study in China of 10 pediatric
cases of COVID-19, a 3-month-old child likely passed the infection to at least 1 adult in
her household, indicating that transmission from children to adults is possible.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 10
One limitation in the understanding of how children may spread COVID-19 is that
children have been sequestered more than adults in this outbreak, so they are less likely
to initiate disease transmission chains. Another important limitation in interpreting
the studies to date is that they were almost all done when children were out of school
and not around other children, so children were not in conditions that would resemble
school settings.
Data on the potential transmission of COVID-19 in the school setting is limited because
of the widespread closure of schools across the world. Studies that have been conducted
to date provide mixed data on likely settings for transmission of COVID-19. In Australia,
735 students and 128 sta who were close contacts of 18 initial COVID-19 cases were
followed prior to school closures. One child from a primary school and 1 child from a
high school may have contracted COVID-19 from the initial cases at their schools. No
teacher or sta member was found to have contracted COVID-19 from the initial school
cases. A systematic review of available literature and media reports showed only a small
number of case clusters linked to schools. In these reports, the COVID-19 cases were
most oen in teachers or other sta.
Another systematic review of the eectiveness of school closures in other coronavirus
outbreaks, such as for SARS, showed that school closures did not contribute to the
control of those outbreaks. However, it should be noted that SARS was transmitted
frequently in hospital settings and rarely spread in the community outside of hospitals,
decreasing the likelihood that it would appear in schools in the rst place. One
contrasting study in France showed that infection attack rates were higher in a high
school setting (40.9%) than in community households (10.9%), suggesting that, in this
case, the school might have been an important setting for disease transmission.
Models
While modeling studies can be useful, the predictive nature and accuracy of models
can vary widely. There have been a number of modeling groups that have drawn on
existing data to attempt to project out the impact of reopening schools on community
spread of COVID-19. Epidemiologic modeling of the eectiveness of school closure
has shown that lower and delayed disease peaks may result from school closure. One
comparison of interventions indicated that school closures may result in a 2% to 4%
relative decrease in numbers of deaths from COVID-19. Another study analyzing the
eectiveness of social distancing measures and school closures found that school
closures were unlikely to entirely inhibit disease transmission but were likely to reduce
the infection attack rate and peak incidence of the outbreak. The authors concluded
that school closures alone are not sucient to prevent outbreaks from growing,
but they can help atten the curve to avoid overwhelming critical infrastructure. In
another modeling study, Dutch researchers determined that primary schools will have
little impact on disease transmission, whereas secondary schools were more likely to
contribute to transmission, in large part because secondary schools, unlike primary
schools, tend to draw students from a larger number of regions and communities.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 11
Current Guidance and Country Approaches
Although many gaps remain in our understanding of COVID-19 transmission risk
factors associated with reopening schools, much may depend on how vigilant schools
will be in maintaining social distancing among students, teachers, and sta when
they open. As the United States looks forward to the 2020-21 school year, leaders and
stakeholders should review existing guidance on the subject and closely track any
clusters of cases that may result from the reopening of schools in the United States and
elsewhere.
Notable Existing Guidance
Various organizations at the national and international levels have released guidance
on how to proceed with opening schools and childcare programs during the COVID-19
pandemic. Guidelines published to date cover a wide variety of topics, including how
to reduce the chances of transmission in these settings (through infection control
practices and physical distancing), what to do if a case is identied, contingency
planning for continuity of learning if community spread is identied, mental health
support services, communication and engagement within the community, and support
for vulnerable populations, including children with disabilities and those who are
economically disadvantaged. There has not yet been enough time for the guidance
documents to be evaluated for eectiveness, practicality, or feasibility, but across these
guidance documents, recommendations seem to be based on the assumption that
children are at risk of both infection with COVID-19 and onward transmission of the
disease to their peers and the adults in their lives.
Guidelines will be helpful for schools that are preparing to reopen, but it will be
necessary for schools to contextualize the guidelines to their specic circumstances.
It is likely that schools will encounter logistical challenges in operationalizing many
recommendations—in particular, as they relate to ensuring physical distancing between
students, especially young students. A selection of guidance documents includes:
• American Federation of Teachers, Plan to Safely Reopen America’s Schools and
Communities
• UNICEF, WHO, IFRC, Key Messages and Actions for COVID-19 Prevention and
Control in Schools
• UNESCO, UNICEF, the World Bank, the World Food Programme, Framework for
Reopening Schools
• WHO, Considerations for School-Related Public Health Measures in the Context of
COVID-19
• CDC, Interim Guidance for Administrators of US K-12 Schools and Child Care
Programs
• CDC, Interim Guidance for Child Care Programs [dra, unocial release]
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• National Association of Independent Schools, Coronavirus (COVID-19) Guidance
for Schools
Emerging Approaches to School Openings and Closures
A patchwork of approaches and timetables is evident when looking across countries
and state plans for resuming classroom-based education. Strategies from 11 countries
have been reviewed and summarized in this report’s Appendix in order to display
variations in the landscape of school-related national policies. It should be noted
that the examples provided below and in the Appendix do not cover all countries or
all mitigation measures planned or under consideration. While 11 countries does
not constitute a denitive sample size to fully document the scope of all educational
policies and practices currently being used during the COVID-19 pandemic, it provides
an overview of dierent measures being taken. While success in mitigating community
transmission cannot be ascribed to any of these school approaches yet, it will be
important to monitor the eectiveness of these and other policies from countries that
could be translated to the US education landscape.
Remote and Blended Learning
Throughout the pandemic, a vast majority of countries and areas have restricted
classes to an online, remote format in one way or another. In Australia, the Australian
Capital Territory is teaching all classes remotely from late April through at least early
July. France and New South Wales in Australia were also continuing remote learning
until mid-May. Singapore has conducted classes remotely for all schools since early
April through at least early May. South Korea has conducted classes remotely since
April. Some schools in Sweden remain open, while others are only conducting learning
remotely, depending on municipality or school discretion.
Certain countries and areas are using both remote and in-person methods for students
in a blended learning approach. For example, New South Wales in Australia is using
a phased approach to return to in-person classes. Students have begun attending in-
person classes on 1 assigned day per week since mid-May, with a preference given to
students in the same household attending on the same day. As control of the outbreak
improves in the future, students will attend an additional day per week until nally
transitioning fully back to all in-person classes. The Netherlands has also begun using
a phased blended learning approach, in which primary school students will attend
in-person classes for half the week and use remote learning the other half of the week
starting in mid-May.
In-Person Classes for Select Groups
Some countries and areas are conducting the majority of classes online, with a
select group of individuals being allowed to learn in person at school. In Australia,
Queensland is allowing only vulnerable students and children of essential workers
to attend in-person classes during its second term, which runs through late May. The
United Kingdom has followed a similar policy since late April. Since April, Victoria in
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Australia has allowed vulnerable students, some students requiring in-person learning
in order to graduate, and children of guardians who cannot make other arrangements
to attend in-person classes. Denmark allowed autism spectrum disorder classes and
classes of particular age groups to resume in mid-April prior to in-person classes
resuming for all students in early May. The Netherlands has a similar policy that allows
special education students to attend in-person classes for the entire week, while other
students must continue blended or remote learning until early June.
In-Person Classes and Activities for Particular Age Groups
Some countries are beginning the process of reopening their schools by specically
only allowing students in particular age ranges to attend in-person classes, while other
age groups are still required to learn remotely. Some countries promote older children
learning in person, due to exam or graduation requirements, while other countries have
decided to start with younger children learning in person. For example, in mid-April
Denmark gradually resumed in-person classes with primary school students, some
secondary students, and nal year vocational students, while other secondary school
students remained remote until early May. Starting in mid-May, France has allowed
primary and middle school students to return to in-person classes on a voluntary basis,
while high school students cannot return to in-person classes until at least late May
and only aer districts are considered largely free of transmission. Starting in late April,
certain states in Germany provided in-person classes only for older students preparing
for exams. In Iceland, students from preschool age until age 16 have been attending
classes in person since mid-March, while older students continued remote learning
until early May. In the Netherlands, primary schools began conducting blended classes
with in-person and remote components, while secondary school students will continue
remote learning until early June, with the exceptions of students who must sit for nal
exams in person. In late May, Tasmania in Australia will allow all K-12 students, except
for years 7 through 10, to return to in-person classes.
Daycare, Early Childhood Services, After Care, and Child Supervision
Services
Some countries are ensuring continued access to services that supervise children, such
as daycare, aer care, or other early childhood services. However, countries dier in
who is allowed access to these services. Australia has strongly encouraged all daycare
centers and early childhood services to remain open, even providing additional funding,
and Iceland preschools have been open since mid-March. Other countries, including
Denmark, the Netherlands, Sweden (preschool only), and France, are also beginning
to reopen daycare facilities or daytime child supervision services with various levels of
mitigation measures. Some countries, such as the Netherlands, are providing additional
services, such as before-school care and aer-school care.
In contrast, Germany has a policy of providing emergency childcare for children of
hospital workers and police, with other daycare services being closed. Sweden provides
daycare for children of guardians in certain essential professions. South Korea provides
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emergency childcare with mitigation measures in place for certain early childhood and
primary school students. Similarly, before-school care and aer-school care specically
for vulnerable children or children of essential workers has continued to be available
in the United Kingdom. Other areas, such as New South Wales in Australia, have a “no
child turned away” policy so that any child can be supervised who needs it during the
school day, regardless of age. Some countries such as Singapore have suspended daycare
and other child supervision services entirely.
Universal In-Person Classes with a Remote Opt-Out Option
Some countries and areas are already transitioning to in-person classes but allowing
guardians or children to opt out if they chose and to learn remotely. Western Australia,
South Australia, and Northern Territory in Australia are currently following this strategy.
Some schools in Sweden are using remote learning at the discretion of municipality and
school ocials.
Considerations for Vulnerable Populations
Countries have also recognized that certain vulnerable populations require additional
special measures or considerations. Below is a sampling of some of these measures and
considerations.
• Who is considered vulnerable? Countries have varying denitions of students
they would consider vulnerable, and they have diering mechanisms by which
individual students are classied as vulnerable and able to receive additional
protections or accommodations. Some countries or areas make provisions for
students on a case-by-case basis, as determined by educators or school ocials.
Other countries or areas have dened groups of students who are automatically
considered vulnerable. See Appendix for examples of dened groups considered
vulnerable by various countries.
• In-person classes. Some countries specically provide in-person classes for
vulnerable students.
• In-person supervision. Some countries specically allow for in-person supervision
for vulnerable students.
• Continuation of existing services and protections. Some countries have worked
to ensure that services or protections normally available to vulnerable children
continue, including processes to protect children from abuse or domestic violence
as well as services typically provided to children with disabilities or lunch for
students from low-income families.
• Ensuring access to remote learning materials. Some countries are adding
provisions for students who are engaging in remote learning but lack devices
or sucient internet access. Some measures taken include providing devices or
providing alternative hard copy materials to students who need them.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 15
Considerations for High-Risk Populations (adults and children)
Some countries are enacting specic policies to protect students, teachers, sta, and
household members of students who are at a higher risk of severe disease or death
if infected by SARS-CoV-2. Below are examples of policies currently used by various
countries related to accommodations and protections for these individuals.
• Defining high-risk status. Some countries have specic denitions of high-risk
groups, while other denitions are more exible or require only self-identication
in order to receive accommodations. Some also use a combination of denitions.
For example, in Australia high-risk status is inclusive of individuals over the age of
70; individuals over the age of 65 who have a chronic medical condition; individuals
over the age of 50 who are aboriginal and have a chronic medical condition; and
individuals with a compromised immune system. However, individual states and
territories in Australia also allow for individuals to self-identify as high risk and
discuss potential accommodations with school leaders in consultation with their
medical care providers and other stakeholders on a case-by-case basis.
• Accommodations for students. Some countries allow, encourage, or mandate
various accommodations and protections for students at high risk of severe
disease or death. One measure of protection is the option of remote learning. Some
countries are allowing students to opt out of in-person classes and learn remotely
even if they do not identify as belonging to a high-risk group.
• Accommodations for teachers and staff. Countries may allow, encourage, or
mandate work accommodations for school teachers and sta. For example,
Australia encourages sta and teachers to discuss potential work from home or
other accommodations with school principals. France species that teachers
considered to be at high risk are allowed to work from home.
Mitigation Measures for In-Person Interactions
Countries adopting any in-person component to coursework or supervision of children
are oen also adopting various measures in an eort to reduce viral transmission within
schools and their associated communities. Examples of mitigation measures used are
listed below. (See the Appendix for greater detail on specic country measures.)
• Physical distancing. Countries are introducing various measures to encourage or
maintain physical distancing among students and sta. Approaches range from
the promotion of distancing behavior to strict enforcement of distancing. Some
countries require modication of classroom furniture arrangements. Others
promote the use of electronic submission and feedback on assignments to avoid
exchanging hard copies of schoolwork. Countries have also maintained strict
teacher:student ratios to ensure physical distancing is maintained in classrooms.
• Reducing the number of potential contacts. Some areas have taken measures
that may assist in reducing the number of potential contacts of students. These
measures include canceling student gatherings such as sporting events and
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 16
assemblies, minimizing class sizes, reducing queueing, and canceling aer-school
activities including extracurricular activities and sports. Schools in some countries
have also closed common areas where students may congregate, promoted walking
or biking to school instead of using public transportation, or allowed only take-out
from school cafeterias.
• Avoiding mixing between groups. Some countries provide measures that place an
emphasis on keeping individuals from dierent groups separate. This includes
strategies to keep the public away from students, to keep dierent age groups
of students apart, to keep students and adults separate, or to keep classroom
groups or students of dierent schools separate. Measures to implement these
strategies include canceling student eld trips or excursions, canceling interschool
gatherings, reducing public access to school grounds, and staggering times between
class transitions.
• Increasing ventilation. Some countries advocate for classes or activities being
conducted in outdoor spaces or in classrooms with open windows when possible.
• Enhancing hygiene and cleaning. Several countries are using measures to enhance
hygiene and cleaning and reduce possible transmission of the virus on surfaces.
These measures have included promoting handwashing, supplying hygiene
products, supplying additional rubbish bins, disposing of waste frequently, and
reducing mobile phone use in school settings. Measures also include frequent
cleaning, particularly of high-touch surfaces such as playground equipment and
toys.
• Reducing access to high-touch surfaces. Various countries are employing policies
to reduce access to high-touch surfaces, such as closing playgrounds or communal
water fountains, to reduce transmission of the virus on surfaces. Additional
measures used include closing school swimming pools or not allowing children to
share toys or equipment they touch with bare hands.
• Identifying and isolating symptomatic students and staff. Some countries are
taking extra steps to identify sick students early to keep them from transmitting to
others. Measures include monitoring the health of sta and students throughout
the day visually or through temperature checks. Mandatory regular diagnostic
testing for students is also being piloted in 1 country.
• Promoting influenza vaccination. Some countries are promoting seasonal inuenza
vaccination among guardians, sta, and students to avoid the potential for co-
infection.
• Using personal protective equipment. Countries have diering guidance on the use
of personal protective equipment by sta and students. Some countries generally
advise against mask use, while others specically require secondary school students
and sta to wear masks if learning in person. Others recommend gloves for physical
care of children, such as rst aid activities or care of children aected by physical
disabilities.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 17
• Varying mitigation for different age groups. Not all countries apply mitigation
measures equally across age groups. For example, Iceland requires older students
in noncompulsory education to use stricter physical distancing and classroom
size measures than their younger counterparts in compulsory education. The
Netherlands also specied strict physical distancing between students aged 13
to 18 for outdoor activities but did not specify the same strict physical distancing
between younger students engaged in outdoor activities.
Applications and Next Steps
While 11 countries is not a large enough sample size to allow us to fully understand
the scope of all educational policies and practices currently being used during the
COVID-19 pandemic, these countries illustrate many of the priorities and measures
being taken. Within-country variation in how these policies are implemented may
provide important lessons. Within this small sample may be examples of policies
that states in the United States should consider when deciding on how to reopen
schools. Factors to consider before enacting any of the above measures should include
similarities and dierences between populations, unique considerations for vulnerable
or high-risk groups, dierences in culture and education needs, and the overall success
of the communities at mitigating community transmission as they reopen. It is also
important to consider the potential success of country approaches in context. For
instance, holding in-person classes may largely be successful in some regions because
of factors outside of the education system, such as how well the country has responded
to its COVID-19 outbreak thus far and the associated severity and scope of the outbreak
at the time of reopening.
It is conceivable, if not likely, that many schools that attempt to implement mitigation
measures (eg, maintaining social distance between students and between teachers and
students) will struggle from operational, logistics, and funding perspectives. While
implementing public health–informed measures to protect students, their families, and
school teachers and sta is crucial, school districts will also have to think strategically
about how to ensure adequate stang in schools, especially given teacher shortages
in some parts of the United States (with an overall shortage of approximately 100,000
teachers) as well as the potential for 300,000 possible teacher layos in the fall. School
nurse shortages may further hamper implementation challenges.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 18
Recommendations for Research Needed to Inform
Decision Making About School Reopening
It has been well established that children are less likely than adults to develop severe
illness from COVID-19, but it is not clear what role they play in transmission. While
the scientic evidence to date suggests that children do not play as dominant a role
in SARS-CoV-2 transmission as they do in seasonal inuenza, there are still many
important open questions. How eciently and frequently do children who are
asymptomatic or mildly symptomatic spread the virus to other children? To adults in
the school? To family members at home? Since adults are at greater risk of severe illness
and death than children, the possibility of asymptomatic spread from children to adults
poses a risk to guardians and adult family members, school sta, and other caretakers.
This risk may be even greater for adults who are considered high risk for severe disease.
Approximately 527,000 teachers who teach preschool through grade 12 in the United
States are over the age of 61, and that gure does not include other potentially high-risk
sta and volunteers who work in childcare settings and schools.
Studies are getting o the ground to begin to provide answers to some unanswered
scientic research questions. For instance, Boston Children’s Hospital has launched a
study of COVID-19 disease among children across the country, with funding from CDC.
According to press reports, the study will include 35 children’s hospitals and capture
data from 800 patients hospitalized with COVID-19. The investigators plan to enroll up
to 400 of these patients for detailed, prospective observation and periodic collection of
samples. Data on patients’ antibody levels and viral shedding, among other indicators,
will be collected. One of the goals of the study is to ascertain why some children become
seriously ill with COVID-19.
Another example is an NIH study recently launched to help determine the rate of
coronavirus infection in children and their family members in the United States. The
study, called Human Epidemiology and Response to SARS-CoV-2 (HEROS), aims to
determine what percentage of American children who are infected with SARS-CoV-2
develop symptoms. In addition, the study will examine whether rates of SARS-CoV-2
infection are higher in children who have asthma or other allergic conditions. The study
team is enrolling 6,000 individuals from 2,000 US families.
More can and should be done on an expedited basis to better understand the level of
risk to families, teachers, and students when classroom-based instruction resumes
and to inform planning as schools contemplate how to reopen. We recommend the
following:
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 19
1. Conduct epidemiologic investigations
Studies to reconstruct transmission chains using data collected from contact
tracing and case investigations are needed to help pinpoint whether children are a
frequent source of infection or whether they rarely transmit. These studies, which
could be conducted by state and local health departments, could be based on
methodologies used for studying household transmission of inuenza. It would
be most useful if such studies were conducted in settings where children are not
primarily remaining at home—for example, in US states that have reopened this
spring, other countries that have reopened schools recently, or in daycare facilities
that remain open to serve the children of essential workers. If these studies
determine that children are oen a source of infection, either for other children
or for adults, this would suggest that children are an important driver of infection,
as is the case with inuenza. If children are found to rarely be the index case, that
would point to a safer reopening.
Serological studies looking for past evidence of infection would also be helpful to
characterize the burden of COVID-19 in children, teachers, and other school sta.
These studies should be performed in settings where school has reopened already,
and studies should be planned for the future when larger numbers of schools are
likely to be reopened. In the latter case, these studies should still be organized and
prepared to start now, so that they can be conducted in the immediate months
following reopening of schools. Data from schools that are reopening now or that
have reopened recently could be used to inform decisions about reopening this
summer or fall. Collecting data this fall will be too late to aect fall reopening
decisions, but it would still facilitate a better understanding of transmission risks
of COVID-19 in the school setting, which could inform future policymaking.
2. Undertake case studies and cohort studies
Although published case series suggest that it is primarily infants and children
with underlying health conditions who develop severe disease, more information
is needed on risk factors for children. If mild health conditions (eg, well-controlled
asthma, repaired or low-complexity congenital heart defects) are associated with
severe disease in children, the risk assessment for reopening schools will be
dierent than if it is primarily medically fragile children who are experiencing
severe COVID-19 infection.
Likewise, it is critical to better understand the role of comorbidities in COVID-19–
positive adults who suer severe outcomes. This line of scientic inquiry is
especially important for families with school-age children who live with 1 or more
adult family members who suer from an underlying health condition that makes
them more vulnerable to severe outcomes of COVID-19. The US CDC cautions that
children can pass the virus on to others who may be at a higher risk of negative
outcomes and recommends that children be separated in the household from
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 20
other individuals who have a high risk of severe illness from COVID-19. This
recommendation is likely dicult, if not impossible, to follow, especially in high
poverty and multigenerational households, so more data are needed to better
ascertain the risk of children transmitting the virus to adults in the household.
The pathogenesis of SARS-CoV-2 in young children is not well understood.
Clinical studies could explore whether children have specic immune-regulatory
mechanisms that contribute to milder disease, whether past infections with other
types of coronaviruses that circulate among young age groups may confer some
level of protection against COVID-19, or whether there is some other explanation(s)
for the dierences from adults. We should seek to understand whether there are any
physiological reasons why children are so infrequently reported among cases and
severe illness.
In addition, studies assessing viral load in infected children and the relationship
between viral load and transmission may also be helpful in understanding the role
children play in transmission—particularly those with mild and asymptomatic
infection.
3. Evaluate effectiveness of policies
As schools adopt and follow various guidelines and bring students back to
classrooms, we should be closely evaluating the eectiveness and outcomes of
dierent approaches. Studies can estimate the eects of various policy approaches,
using strong nonexperimental designs. These might include rigorous comparison
group designs, which aim to compare groups that were or were not exposed to
some policy but that were as similar as possible on a large set of background
characteristics. For policy evaluation, a common strategy is to use both a
comparison group and longitudinal data on key outcomes before and aer the
policy change, known as a dierence-in-dierences approach.
With data on policy implementation dates, localities that implement
dierent policies can be compared across time to examine whether the policy
implementation was associated with changes in disease transmission or other
outcomes in the community; they can also be compared to trends over time in
locations that did not change their policies. These studies will be challenging,
given the multitude of factors inuencing disease transmission, but carefully
done studies may be able to tease apart the dierent factors, using statistical and
econometric models, as is being done for some examinations of stay-at-home
policies.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 21
4. Conduct surveillance and epidemiologic studies specific to
daycare
The United States and many other countries, although they have closed schools,
have sustained childcare services to some extent throughout the pandemic. It
would therefore be greatly advantageous to conduct disease surveillance and
epidemiologic studies specically with childcare facilities in mind. Surveillance
systems and contact tracing eorts should include queries about any connections
of infected individuals to childcare providers. These data can help identify and ag
clusters of disease that are related to childcare facilities if they are occurring.
Childcare centers, as compared to elementary schools, generally have fewer
children, as they are governed by state childcare licensing ratios. That being said,
childcare for infants, toddlers, and preschool-aged children is characterized by
close contact between children and childcare providers, with frequent exposure to
respiratory droplets and other bodily uids. One daycare center in Quebec reported
a COVID-19 outbreak in 4 of its sta and 12 of the 27 children. Children of these
ages are unable to observe physical distancing measures or maintain personal
hygiene or mask wearing with any consistency. So, if surveillance and epidemiologic
studies show that transmission is not occurring at high rates in these facilities, it
would usefully inform policies and could serve to incentivize closed facilities to
reopen.
5. Perform studies to assess psychosocial impacts to increase
chances for successful reentry into school
The continued presence of contagion reasonably dictates that priority be given to
the physical health of schoolchildren and sta. At the same time, for students to
resume their studies successfully, more research is needed on the psychosocial,
developmental, and psychological impacts of COVID-19 on children and
adolescents. An ad hoc research response, with small-scale and localized initiatives,
will not produce the kind of insights that decision makers, educators, and
guardians require so that school-age children can have the conditions they need to
learn eectively. The pandemic is occurring at a time of rising mental health issues
in adolescence and childhood. Thus, schools need to be doubly prepared to reopen
and to serve their charges well.
An immediate priority is the collection of high-quality data on the mental health
and psychological eects of the pandemic for school-age children. Among the
stresses that may be prompted by the novel coronavirus are an interrupted
education, exposure to substance misuse, domestic violence and child abuse, food
insecurity, overcrowded accommodations, economically displaced guardians,
disrupted social networks and social isolation, and, for some, bereavement. Of
urgent concern are identifying and mitigating the eects of school closures on
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 22
youth with mental health needs, because education settings are where children and
adolescents oen seek out help. A majority of mental health disorders emerge in
childhood and adolescence, making it critical to identify and treat concerns early.
School closures, too, may disrupt the provision of mental health care for some
youth more than others. Adolescents in racial and ethnic minority groups, with
lower family income, or with public health insurance rely disproportionately on
school settings for mental health services.
More research into the pandemic’s eects on educational outcomes of children
from dierent population groups is needed. The gap in math and reading skills
between children from lower and higher socioeconomic backgrounds oen
widens during school holiday periods; with unequal home learning environments,
school closures may similarly expand the learning gap. Research, too, into factors
that strengthen the capacity of children and adolescents to overcome pandemic-
induced distress and to demonstrate resilience could prove useful when school sta
welcome returning students.
6. Establish a national advisory group to synthesize study results
and make evidence-based recommendations
The US government should support the establishment of a national advisory
group to regularly review the state of scientic research as it relates to the
reopening of schools. The advisory group should provide regular status updates
on research aimed at addressing key scientic questions and, as appropriate, issue
recommendations supported by the data. The group should include pediatric,
public health, and educational researchers, as well as parents, teachers, and
clinicians. The National Academies of Sciences, Engineering, and Medicine would
be well positioned to convene this advisory group and issue periodic reports. As
additional research studies commence and all eyes are on the fall, updates on
existing and emerging evidence will help to inform risk assessments and decisions
pertaining to schools reopening.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US 23
Conclusion
Determining the risk of infection in school for children and discerning whether children
infected with COVID-19 can eciently transmit the virus to others (especially high-risk
adults) must be prioritized. Sending children back to learn in classrooms in the fall
would greatly benet them from educational, mental health, social development, and
general well-being perspectives. It would also free up their adult caregivers who need
to return to work, whether inside or outside of the home. Funding and immediately
pursuing the research described above will assist families, schools, and political leaders
to make better-informed choices about reopening schools. What we need now is reliable
information and rigorously designed studies that could lead to more peace of mind
about sending our children back to learn and thrive in schools. This research should be
funded and begun as soon as possible so that preliminary data can be available before
the start of the fall school year. Research should continue aer schools open to answer
these important questions about the role of children in transmission of COVID-19.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-1
Appendix: Existing approaches used by other
selected countries
The appendix describes overarching school-related policies used by 11 selected
countries. This is not a comprehensive analysis of all existing education policies to
mitigate COVID-19 transmission, but rather a selection of varying approaches by a
subset of countries. Success in mitigating transmission is not being ascribed to any of
these measures at this time, but these approaches should be evaluated and considered
in future research in order to better inform the upcoming fall school year in the United
States.
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-2
Australia
Summary Reopening and closing of schools varies signicantly by state/territory, including
the use of remote learning, in-person classes, in-person classes for select groups, in-
person classes for particular age groups, and blended learning. Those that do reopen
oen use national guidance to mitigate risks of transmission. Considerations are
also included to maintain services for vulnerable students and protect high-risk
individuals.
Decision-making & policy
implementation
“State and Territory Governments and non-government sector authorities are
responsible for managing and making operational decisions for their schools.
Decisions regarding the response to COVID-19 in the schooling sector must
continue to be informed by expert, ocial, national and state-based public health
and education advice, consistent with [COVID-19 National Principles for School
Education].”
Use of in-person classes and
remote learning
• Victoria: Starting on April 14, in-person classes have been conducted for select
groups, with remote learning for all other students. Select groups include
vulnerable students, children of guardians who cannot make other arrangements,
and some students in years 11 and 12.
• Queensland: Starting on April 20, in-person classes have been conducted for select
groups, with remote learning for all other students through at least May 22. Select
groups include children of guardians who are essential workers and vulnerable
students.
• New South Wales: Previously, students were allowed to attend in-person classes,
but remote learning was strongly encouraged. Starting on April 29, classes were
conducted remotely until May 11. Starting May 11, students have engaged in
blended learning, attending classes in person for part of the week and learning
remotely for the rest of the week. Students will start with learning in person 1
day per week with additional in-person learning days per week added over time,
depending on COVID-19 outbreak control in the area.
• Western Australia: Previously, students were allowed to attend in-person classes,
but remote learning was strongly encouraged. Starting April 28, students could
continue to attend classes in person, with an opt-out option for those who prefer
to continue learning remotely.
• South Australia: Starting April 27, classes have been conducted in person with an
opt-out option for those who prefer to continue learning remotely.
• Tasmania: Children are currently learning remotely. Starting May 25, kindergarten
to year 6 students, as well as year 11 and year 12 students, will attend in-person
classes, while students in years 7 through 10 will continue to learn at home.
Beginning on June 9, students in years 7 through 10 will return to in-person
classes.
• Australian Capital Territory: Previously, in-person classes were used. Starting April
27, classes have been conducted remotely for all students.
• Northern Territory: Starting April 20, classes have been conducted in person, with
an opt-out option for those who prefer to continue learning remotely.
Child supervision services such as
daycare & aer school care
Strongly encouraged to remain open, additional funding for providers available
through at least June 28.
Mitigation measures: physical
distancing
Physical distancing strongly encouraged but not strictly enforced when impractical.
Emphasis on distancing between adults, such as restricting community access
to school grounds. Maintain strict teacher-to-student ratios, such as the 1-to-8
ratio Victoria uses. Environmental modications such as closing common areas,
avoiding queueing, and modifying furniture arrangements may be done to promote
distancing. School cafeterias may allow only takeout. Physical distancing promotion
Appendix: Existing approaches used by other selected countries Australia
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-3
overall may be modied by age range. Consider using electronic options for
submission and feedback of assignments.
Mitigation: reducing the number
of potential contacts
Gatherings including aer school extracurricular activities or sports may not be
allowed. Class size should be minimized. School swimming pools may be closed.
Mitigation: avoid mixing between
groups
Individuals from outside the school may be restricted from school grounds or
gatherings. Students and sta should not go on eld trips or excursions. Transition
times should be staggered so classes of dierent years do not mix.
Mitigation: increased ventilation Conduct activities outdoors. Conduct activities in large, enclosed spaces such as
gymnasiums. Open windows during instruction.
Mitigation: enhanced hygiene and
cleaning
Cleaning and handwashing supply products and rubbish bins should be provided.
Cleaning should be done frequently, particularly for high-contact surfaces. Waste
should be disposed of frequently. Handwashing and hygienic behavior should be
promoted. Communal water fountains may be closed. Mobile phone use should be
discouraged.
Mitigation: reduce access to high
touch surfaces
Playgrounds and other high-touch equipment may be closed. Group separation may
also be used on playgrounds.
Mitigation: identify and isolate
symptomatic students and staff
Do not allow symptomatic students or sta to participate in in-person classes
or activities. Monitor for potential symptoms in students and sta throughout
the day, particularly at daycare centers and early childhood facilities. Large-scale
temperature checks are discouraged due to limited evidence of ecacy. Individual
schools may be closed if an outbreak in the school warrants the measure.
Mitigation: personal protective
equipment
Masks are not needed, but gloves should still be used when giving direct physical
care of children, such as during rst aid.
Mitigation: other Promote vaccination for seasonal inuenza among students, sta, and parents.
Considerations for vulnerable
students
• Defining vulnerability: Varies state by state, but generally includes certain dened
groups with latitude by schools to include other students they identify. In New
South Wales, these dened groups include those aected by disability, children
with high support needs, children who are in residential care, students who are
young carers, students at risk for signicant harm, students who are homeless,
students of families supported by social and family support programs, and
students aected by domestic violence. In Queensland, these groups include
children identied by schools or who are currently receiving services from
Child Safety, including children who are subject to a child protection order
or are subject to a youth justice order and children in designated indigenous
communities. In Victoria, these groups include any children in out-of-home care,
children deemed by Child Protection and/or Family Services to be at risk of harm,
children identied by the school as vulnerable (including via referral from a family
violence agency, homelessness, or youth justice service or mental health or other
health service, and children with a disability).
Considerations for vulnerable
students
• In-person classes for vulnerable students in certain states
• In-person supervision of vulnerable students in certain states, including daycare,
aer care, before school care, or other similar services
• Continuation of existing services and protections for students aected by
domestic violence, students with disabilities, or other vulnerable students
• Ensuring access to remote learning materials: Schools may provide devices or
hard copy learning materials to students who lack access to remote learning, if
needed.
Appendix: Existing approaches used by other selected countries Australia
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-4
Considerations for high risk
populations
Note: Measures listed are inclusive of all reported by states and territories, but not
all measures are necessarily used in each state and territory.
• Defining high-risk individuals: 70+, 65+ with chronic condition, 50+ and
Aboriginal with chronic condition, those with a compromised immune system
• Accommodations for students: Guardians, medical providers, and principals
should identify best precautionary actions, including remote learning.
• Accommodations for teachers and staff: Sta and school principals should work
out arrangements, such as potential work from home.
Notes • Mitigation measures listed are inclusive of all reported by states and territories,
but not all measures are necessarily used in each state and territory.
• Funding: The national government is providing assistance of up to $100,000 to
help eligible small and medium-sized businesses and for-prot organizations,
including nongovernment schools.
• Testing: Specic guidance on April 7 states that students can earn their high
school diploma this year in order to allow for university admission/employment,
and related assessments will be available and altered if needed to accommodate
COVID-19. On March 20 it was announced that in-person standardized testing for
literacy and other basic skills (NAPLAN) scheduled for May would not be occurring
this year.
• International students: On February 22, it was announced that Chinese-based
students were allowed to attend their nal 2years of high school in Australia as an
exemption to travel restrictions.
• Interesting note on transmission: April 25 AHPPC guidance states, “the greatest
risk of transmission in the school environment is between adults.”
• Communications: April 25 AHPPC guidance promotes use of newsletters, social
media, SMS, TVs, posters, factsheets, and web links for schools to raise awareness
with guardians and children
• Boarding schools residential facilities in certain states and territories are closed.
• Western Australia on reopening schools: “We have considered the benets of
schools remaining open over the last 2 months and, in the context of our wider
public health strategies, determined schools should stay open and that they are
safe for sta and students. With increased testing and low rates of infection in
Western Australia, I am condent that school sta and children are not at an
increased risk of COVID-19 by physically attending school. Even when we had
higher rates of disease in WA, only 1.5% of cases were in school students (8 cases)
and one case was in a teacher, which were mostly related to travel, all of whom
had mild illness and have fully recovered. Furthermore, there have been no cases
of student-to-student transmission in WA and no cases of student-to-teacher
transmission. Other Australian jurisdictions have had similar experiences. In
reviews of cases in South Australia and New South Wales, there has been only
one case of student to student spread and no student to teacher spread. Adult
sta (teachers) appear to play a role in both the introduction and, to a greater
extent than children, transmission of the virus in educational settings, which is
why social distancing among adults remains important. There remains no good
international evidence of signicant transmission between children, or between
children and teachers, in schools. The downside of keeping schools closed is
the potential to signicantly adversely impact the cognitive, psychological and
physical development of children.”
Appendix: Existing approaches used by other selected countries Australia
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-5
References
1. Government of South Australia, Department for Education. COVID-19 (coronavirus). https://www.education.sa.gov.au/
supporting-students/health-e-safety-and-wellbeing/covid-19-coronavirus. Accessed May 8, 2020.
2. Tasmanian Government, Department of Education. Novel coronavirus (COVID-19). https://www.education.tas.gov.au/
parents-carers/novel-coronavirus-covid-19/. Accessed May 8, 2020.
3. Australian Government, Department of Education, Skills and Employment. Back to school dates 2020. https://www.
education.gov.au/school-term-dates-2020. Accessed May 5, 2020.
4. Victoria State Government, Education and Training. Coronavirus (COVID-19) advice for schools. April 29, 2020. https://
education.vic.gov.au:443/school/Pages/coronavirus-advice-schools.aspx. Accessed May 3, 2020.
5. Victoria State Government, Education and Training. Communicating with parents and carers. April 18, 2020. https://www.
education.vic.gov.au:443/school/teachers/teachingresources/Pages/communicatingwithparentsandcarers.aspx. Accessed
May 3, 2020.
6. Andrews D. Statement from the Premier. Premier of Victoria. March 22, 2020. https://www.premier.vic.gov.au/statement-
from-the-premier-32/. Accessed May 3, 2020.
7. Victoria State Government, Health and Human Services. Education sector - coronavirus disease (COVID-19). April 23, 2020.
https://www.dhhs.vic.gov.au/information-education-sector-coronavirus-disease-covid-19. Accessed May 3, 2020.
8. Victoria State Government, Health and Human Services. Family violence crisis response and support during coronavirus.
April 15, 2020. https://www.dhhs.vic.gov.au/family-violence-crisis-response-and-support-during-coronavirus. Accessed May
3, 2020.
9. Victoria State Government, Health and Human Services. Information for community services - coronavirus disease
(COVID-19). May 1, 2020. https://www.dhhs.vic.gov.au/information-community-services-coronavirus-disease-covid-19.
Accessed May 3, 2020.
10. Victoria State Government, Health and Human Services. Stay at home restrictions. April 22, 2020. https://www.dhhs.vic.gov.
au/stay-home-restrictions-coronavirus. Accessed May 3, 2020.
11. Victoria State Government, Health and Human Services. Your coronavirus (COVID-19) questions answered. May 2, 2020.
https://www.dhhs.vic.gov.au/your-coronavirus-covid-19-questions-answered#what-activities-are-already-restricted. Accessed
May 3, 2020.
12. Northern Territory Government. Coronavirus (COVID-19). Schools. April 22, 2020. https://coronavirus.nt.gov.au/community-
advice/schools. Accessed May 3, 2020.
13. Northern Territory Government, Department of Education. Information for parents and carers about NTG schools for Term
2, 2020. April 22, 2020. https://education.nt.gov.au/publications/information-for-term-2-2020. Accessed May 3, 2020.
14. Queensland Government, Department of Education. Frequently asked questions for parents. April 16, 2020. https://qed.qld.
gov.au/aboutus/newsandmedia/Pages/faqs-for-parents.aspx. Accessed May 3, 2020.
15. Queensland Government, Department of Education. COVID-19 service information. April 29, 2020. https://earlychildhood.
qld.gov.au/news/covid-19-information/service-information. Accessed May 3, 2020.
16. Queensland Government. Staying home — coronavirus (COVID-19). April 26, 2020. https://www.qld.gov.au/health/
conditions/health-alerts/coronavirus-covid-19/protect-yourself-others/social-distancing. Accessed May 3, 2020.
17. Queensland Government, Department of Education, Early Childhood Education and Care. COVID-19 frequently asked
questions. April 16, 2020. https://earlychildhood.qld.gov.au/news/covid-19-information/frequently-asked-questions.
Accessed May 1, 2020.
18. Queensland Government, Department of Education. Coronavirus (COVID-19). April 29, 2020. https://qed.qld.gov.au/
aboutus/newsandmedia/Pages/Novel-coronavirus.aspx. Accessed May 1, 2020.
19. Australian Government, Department of Education, Skills and Employment. Coronavirus (COVID-19) information for
early childhood education and care providers and services from 6 April 2020. April 2, 2020. https://docs.education.gov.au/
documents/coronavirus-covid-19-information-early-childhood-education-and-care-providers-and-services. Accessed May 1,
2020.
20. New South Wales Government. FAQs for services and providers. April 15, 2020. https://education.nsw.gov.au/early-
childhood-education/coronavirus/advice-for-services-and-providers.html. Accessed May 1, 2020.
21. New South Wales Government. Managed return to school - A guide for families. April 24, 2020. https://education.nsw.gov.au/
covid-19/advice-for-families/managed-return-to-school-guide-for-families.html. Accessed April 30, 2020.
Appendix: Existing approaches used by other selected countries Australia
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-6
22. New South Wales Government. NSW students to transition back to the classroom in Term 2. April 21, 2020. https://
education.nsw.gov.au/news/latest-news/nsw-students-to-transition-back-to-the-classroom-in-term-2.html. Accessed April 30,
2020.
23. New South Wales Government. Advice for families. April 28, 2020. https://education.nsw.gov.au/covid-19/advice-for-families.
html. Accessed April 30, 2020.
24. Government of Western Australia, Department of Education. Coronavirus (COVID-19). April 1, 2020. https://www.education.
wa.edu.au/coronavirus-school-update. Accessed April 30, 2020.
25. Robertson A. Novel Coronavirus (COVID-19), teachers, educators and support sta. Government of Western Australia,
Department of Health. April 22, 2020. https://www.education.wa.edu.au/dl/m76l3x. Accessed April 30, 2020.
26. Robertson A. Novel Coronavirus (COVID-19), parents and carers. Government of Western Australia, Department of Health.
April 22, 2020. https://www.education.wa.edu.au/dl/3xlgo1. Accessed April 30, 2020.
27. Government of Western Australia, Department of Education. Term 2 schooling arrangements. https://www.education.
wa.edu.au/term-2-schooling-arrangements. Accessed April 30, 2020.
28. Western Australia Department of the Premier and Cabinet. COVID-19 coronavirus: education and family advice. April 30,
2020. https://www.wa.gov.au/organisation/department-of-the-premier-and-cabinet/covid-19-coronavirus-education-and-
family-advice. Accessed April 30, 2020.
29. Australian Capital Territory Government. Children’s Education and Care Assurance. Information on novel coronavirus
(COVID-19) for education and care. https://www.education.act.gov.au/early-childhood/information-on-novel-coronavirus-
covid-19-for-early-childhood. Accessed April 30, 2020.
30. Australian Capital Territory Government. Education Directorate. Term 2 in ACT public schools. April 24, 2020. https://www.
education.act.gov.au/about-us/all-news-and-news-alerts/news-items/april-2020/term-2-in-act-public-schools. Accessed April
30, 2020.
31. Australian Capital Territory Government. Public health (non-essential gatherings) emergency direction 2020. March 31,
2020. https://www.legislation.act.gov.au/View/ni/2020-202/20200331-73578/PDF/2020-202.PDF. Accessed April 29, 2020.
32. Australian Government, Department of Health. Australian Health Protection Principal Committee (AHPPC) advice on
reducing the potential risk of COVID-19 transmission in schools. April 16, 2020. https://www.health.gov.au/news/australian-
health-protection-principal-committee-ahppc-advice-on-reducing-the-potential-risk-of-covid-19-transmission-in-schools.
Accessed April 29, 2020.
33. Australian Government, Department of Health. Australian Health Protection Principal Committee (AHPPC) advice on
reducing the potential risk of COVID-19 transmission in schools (24 April 2020). April 25, 2020. https://www.health.gov.
au/news/australian-health-protection-principal-committee-ahppc-advice-on-reducing-the-potential-risk-of-covid-19-
transmission-in-schools-24-april-2020. Accessed April 29, 2020.
34. Hunt G, Tehan D, Merlino J, Murphy B. Facilitating Chinese-based students to attend Year 11 and 12. Australia Ministers
Department of Health. February 22, 2020. https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/facilitating-
chinese-based-students-to-attend-year-11-and-12. Accessed April 29, 2020.
35. Australia Education Council. Communique: Senior secondary arrangements and university admissions. April 7, 2020.
http://www.educationcouncil.edu.au/site/DefaultSite/lesystem/documents/EC%20Communiques%20and%20media%20
releases/2020/Education%20Council%20Communique%20%20-%207%20April%202020%20.pdf. Accessed April 29, 2020.
36. Australian Government, Department of Education, Skills and Employment. COVID-19 National Principles for School
Education. April 16, 2020. https://www.dese.gov.au/covid-19/schools/national-principles-for-school-education. Accessed
April 29, 2020.
37. Australian Government, Department of Education, Skills and Employment. Coronavirus (COVID-19) information for schools
and students. https://www.dese.gov.au/covid-19/schools. Accessed April 29, 2020.
38. Australian Government, Department of Health. Limits on public gatherings for coronavirus (COVID-19). https://www.health.
gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-
covid-19/limits-on-public-gatherings-for-coronavirus-covid-19. Accessed April 10, 2020.
39. Australian Government, Department of Health. Social distancing for coronavirus (COVID-19). https://www.health.gov.au/
news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/
social-distancing-for-coronavirus-covid-19. Accessed April 10, 2020.
Appendix: Existing approaches used by other selected countries Australia
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-7
Denmark
Summary Reopening is slowly occurring at the national level, with younger students, some
vulnerable students, and last-year students coming back rst. Mitigation measures
strongly focus on hygiene, distancing, and reduction of potential contacts.
Decision-making & policy
implementation
Decision making on reopening has been made mostly at the national level, with
districts having exibility to make some local decisions on reopenings as well.
Use of in-person classes and
remote learning
Schools have been closed since March 12. Some districts have been gradually
reopening schools since April 15, starting with elementary (K-5th grade), secondary
(2nd-3rd grade), nal-year vocational students, and autism spectrum disorder
classes. All other students will remain in remote learning until May 10.
Child supervision services such as
daycare & aer school care
Daycare facilities are reopening beginning April 15.
Mitigation measures: physical
distancing
Physical distancing has been implemented.
Mitigation: reducing the number
of potential contacts
Classroom size is limited to 10 students per classroom. Large gatherings and events
are banned until at least August. Smaller gatherings of more than 10 people will
remain banned until May 10. Common spaces, such as club premises and libraries,
will be closed through at least May 10.
Mitigation: avoid mixing between
groups
No further information identied
Mitigation: increased ventilation No further information identied
Mitigation: enhanced hygiene and
cleaning
Hygiene rules have been implemented, with handwashing promoted throughout
the day. Signage and handwashing-hand sanitizer stations will be available. Schools
must have a hygiene plan in place prior to opening in-person classes.
Mitigation: reduce access to high
touch surfaces
No further information identied
Mitigation: identify and isolate
symptomatic students and staff
No further information identied
Mitigation: personal protective
equipment
Mask use is not recommended at this time.
Mitigation: other See National Board of Health guide for administrators, sta, and pupils for
management
Considerations for vulnerable
students
Continuation of existing services is a priority. Ministry of Social Aairs and the
Interior eorts remain open to serve those with disabilities, the homeless, other
vulnerable populations. Housing assistance, social educational assistance, and
professional help are also being coordinated. There is a coordinated eort with
Ministry of Children and Education for youth concerns.
Considerations for high risk
populations
Written guidance is in development
Notes No further information identied
Appendix: Existing approaches used by other selected countries Denmark
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-8
References
1. Coronavirus. Denmark lets young children return to school. BBC News April 15, 2020. https://www.bbc.com/news/world-
europe-52291326. Accessed April 30, 2020.
2. UNESCO. COVID-19 educational disruption and response. https://en.unesco.org/covid19/educationresponse. Accessed April
30, 2020.
3. Denmark Prime Minister’s Oce. The rst phase of a reopening of Denmark [press release]. Regeringen.dk. April 6, 2020.
https://www.regeringen.dk/nyheder/2020/pressemoede-i-statsministeriet/. Accessed April 30, 2020.
4. Denmark Ministry of Social Aairs and the Interior. If you have a disability or are socially disadvantaged (e.g., homeless or
disabled). Danish Police. https://politi.dk/coronavirus-i-danmark/hvis-du-er-socialt-udsat-eller-paaroerende. Accessed April
30, 2020.
5. Denmark Ministry of Children and Education. Reopening information. https://www.uvm.dk:443/aktuelt/i-fokus/
information-til-uddannelsesinstitutioner-om-coronavirus-covid-19/spoergsmaal-og-svar/genaabning. Accessed April 30,
2020.
6. Denmark National Board of Health. Pamphlet: Advice on New Coronavirus for You Who Are a Risk Group (translated into 9
languages). https://www.sst.dk/da/udgivelser/2020/pjece_gode-raad-om-coronavirus-til-dig-i-risikogruppe. Accessed April
30, 2020.
7. Denmark National Board of Health. Guidance and materials for reopening schools and leisure facilities. https://www.sst.dk/
da/udgivelser/2020/genaabning-af-skoler. Accessed April 30, 2020.
8. Denmark Ministry of Children and Education. This is how daycare, schools and education institutions open up in the
rst phase. April 6, 2020. https://www.uvm.dk:443/global/news/uvm/2020/apr/200406-saadan-aabner-dagtilbud-skoler-og-
uddannelsesinstitutioner-i-foerste-fase. Accessed April 30, 2020.
Appendix: Existing approaches used by other selected countries Denmark
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-9
France
Summary Reopening has begun in mid-May with younger students returning to in-person
classes rst. Mitigation measures include reduction of potential contacts, hygiene,
and mask usage.
Decision-making & policy
implementation
Decisions on reopening have been made mostly at the national level, with districts
having exibility to make some local decisions on reopenings as well.
Use of in-person classes and
remote learning
Remote learning will continue until at least May 11. Elementary and middle school
will resume in-person classes on May 11. High school will not resume in-person
classes until at least May 18 and will be allowed only in districts considered “green”
or largely free of transmission. Decisions on when high schools will open will be
made by the end of May. Students are also allowed to opt-out of in-person classes
and continue remote learning.
Child supervision services such as
daycare & aer school care
Nurseries will open May 11 with classroom size restricted to 10 or fewer.
Mitigation measures: physical
distancing
No further information identied
Mitigation: reducing the number
of potential contacts
Classroom size is limited to 15 students per classroom.
Mitigation: avoid mixing between
groups
No further information identied
Mitigation: increased ventilation No further information identied
Mitigation: enhanced hygiene and
cleaning
Hand sanitizer gel will be distributed to students and sta.
Mitigation: reduce access to high
touch surfaces
No further information identied
Mitigation: identify and isolate
symptomatic students and staff
No further information identied
Mitigation: personal protective
equipment
Secondary school students and all sta are required to wear masks.
Mitigation: other No further information identied
Considerations for vulnerable
students
No further information identied
Considerations for high risk
populations
Teachers who are considered high risk are allowed to remain working from home.
Notes No further information identied
Appendix: Existing approaches used by other selected countries France
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-10
References
1. UPDATE: How France’s plan to reopen schools has changed. The Local April 29, 2020. https://www.thelocal.fr/20200421/
what-we-know-about-frances-plan-to-reopen-schools. Accessed April 30, 2020.
2. Coronavirus: France mandates masks for schools and transport. BBC News April 28, 2020. https://www.bbc.com/news/
world-europe-52459030. Accessed April 30, 2020.
3. French Government. Coronavirus Information. https://www.gouvernement.fr/info-coronavirus. Accessed April 30, 2020.
Appendix: Existing approaches used by other selected countries France
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-11
Germany
Summary Reopening plans are still being nalized, with prioritization of graduating students.
Some older students are attending in-person classes. Emergency childcare for
essential workers is currently being provided.
Decision-making & policy
implementation
Decisions on reopening have been made mostly at the national level, with districts
having exibility to make some local decisions on reopenings as well.
Use of in-person classes and
remote learning
Since April 24, some in-person classes have been open for older students preparing
for exams in certain states, but overall remote learning is still occurring. Overall
reopening plans are still being nalized, with prioritization of graduating students.
Child supervision services such as
daycare & aer school care
Most daycare facilities are closed, except for emergency child care being provided for
children of hospital workers and police.
Mitigation measures: physical
distancing
No further information identied
Mitigation: reducing the number
of potential contacts
No further information identied
Mitigation: avoid mixing between
groups
No further information identied
Mitigation: increased ventilation No further information identied
Mitigation: enhanced hygiene and
cleaning
No further information identied
Mitigation: reduce access to high
touch surfaces
Note: Playgrounds are being reopened, date TBD.
Mitigation: identify and isolate
symptomatic students and staff
One school in northern Germany is also piloting a testing program in which
students must collect a sample for testing. If a student tests positive, he or she must
stay home for 2 weeks. If the test is negative, the student receives a green sticker that
allows travel throughout the school.
Mitigation: personal protective
equipment
No further information identied
Mitigation: other No further information identied
Considerations for vulnerable
students
No further information identied
Considerations for high risk
populations
No further information identied
Notes No further information identied
Appendix: Existing approaches used by other selected countries Germany
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-12
References
1. Bennhold K. As Europe reopens schools, relief combines with risk. New York Times May 10, 2020. https://www.nytimes.
com/2020/05/10/world/europe/reopen-schools-germany.html. Accessed May 10, 2020.
2. Coronavirus: Latest updates. April 30, 2020. https://www.deutschland.de/en/news/coronavirus-in-germany-informations.
Accessed April 30, 2020.
3. Coronavirus in Germany. https://www.deutschland.de/en/corona-virus-germany-overview. Accessed April 30, 2020.
4. Telephone conference between the Federal Chancellor and the Heads of Government of the Länder on 15 April
2020: Restrictions to public life in order to curb the spread of the Covid-19 epidemic. April 15, 2020. https://www.
bundesregierung.de/resource/blob/973812/1744550/4e256a620f61e3154bf8b2bf310837c2/2020-04-15-beschluss-bund-
laender-eng-data.pdf?download=1. Accessed April 30, 2020.
Appendix: Existing approaches used by other selected countries Germany
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-13
Iceland
Summary Classes are operating in person, with younger students allowed to do in-person
learning rst. Mitigation measures focus on physical distancing, reduction of
potential contacts, hygiene ,and reducing mixing between groups. Some aer-school
activities are allowed with mitigation.
Decision-making & policy
implementation
Decisions regarding opening and closing of schools are occurring at the national
level.
Use of in-person classes and
remote learning
Majority of schooling is occurring in person, with some classes for certain age
groups still occurring remotely. All preschools and compulsory education has been
operating in-person classes since March 13, with mitigation measures in place, and
will be allowed to operate normally starting May 4 (uncertain if this means with or
without mitigation). Noncompulsory education will continue remotely until May 4,
when in-person classes will resume with mitigation.
Child supervision services such as
daycare & aer school care
Preschools have been open with mitigation measures since March 13, and starting
May 4 will be open normally (uncertain if that means with or without mitigation).
Mitigation measures: physical
distancing
Two-meter social distancing in place for noncompulsory education students
and outdoor sports starting May 4. Preschool students should stay as separate as
possible from other groups. If children are mature enough to obey instructions on
reduced contact with friends, then they can play together without physical touching
or sharing toys/equipment that they touch with bare hands.
Mitigation: reducing the number
of potential contacts
Minimization of classroom size: small groups only for preschool, 20 students per
classroom for compulsory education, and 50-student limit for noncompulsory
education and outdoor sports, starting May 4.
Mitigation: avoid mixing between
groups
Groups and classrooms must avoid mixing.
Mitigation: increased ventilation Starting May 4, outdoor sports are allowed.
Mitigation: enhanced hygiene and
cleaning
Cleaning should occur at least daily for the building. Handwashing should be
promoted, particularly aer activities with other students.
Mitigation: reduce access to high
touch surfaces
If children are mature enough to obey instructions on reduced contact with friends,
then they can play together without physical touching or sharing toys/equipment
that they touch with bare hands.
Mitigation: identify and isolate
symptomatic students and staff
No further information identied
Mitigation: personal protective
equipment
No further information identied
Mitigation: other No further information identied
Considerations for vulnerable
students
No further information identied
Considerations for high risk
populations
No further information identied
Appendix: Existing approaches used by other selected countries Iceland
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-14
Notes Specic to households with some members under quarantine: If the children are
mature enough to maintain hygiene and social distancing, they are allowed to
attend school. The entire household must quarantine if any child in the partially
quarantined house cannot maintain quarantine instructions.
References
1. Iceland Department of Civil Protection and Emergency Management, Iceland Directorate of Health. Children and teens.
https://www.covid.is/sub-categories/children-and-teens. Accessed May 5, 2020.
2. Directorate of Health, Iceland Department of Civil Protection and Emergency Management. Iceland’s response. Updated
April 3, 2020. https://www.covid.is/categories/icelands-response. Accessed April 10, 2020.
3. Iceland Directorate of Health, Iceland Department of Civil Protection and Emergency Management. Re: Children and
the ban on gatherings. March 20, 2020. https://www.ahs.is/wp-content/uploads/2020/03/Children-and-the-ban-on-
gatherings-20.03.2020.pdf. Accessed April 10, 2020.
4. Iceland Department of Civil Protection and Emergency Management, Iceland Directorate of Health. What is ban on public
events? Updated March 24, 2020. https://www.covid.is/categories/what-is-ban-on-public-events. Accessed April 10, 2020.
Appendix: Existing approaches used by other selected countries Iceland
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-15
Netherlands
Summary Blended learning is being used for primary school students beginning May 11.
In-person classes are allowed for students who attend special education classes.
Secondary school students are using remote learning until at least June 1.
Decision-making & policy
implementation
Decisions regarding opening and closing of schools are being made at the national
level.
Use of in-person classes and
remote learning
Primary school students will attend blended classes beginning May 11, with 50% of
time dedicated to in-person classes and 50% of time dedicated to remote learning.
Secondary students will use only remote learning until at least June 1. However,
secondary schools may reopen for students to sit nal exams.
Child supervision services such as
daycare & aer school care
Daycare facilities will reopen on May 11. Daycare centers and childminders for ages
0-12 will open with their regular hours, but aer-care supervision is allowed only on
days when students attend school.
Mitigation measures: physical
distancing
Physical distancing of 1.5 meters between students must be maintained in classes.
Outdoor activities such as sports have been allowed from April 29; children between
the ages of 13 and 18 must stay 1.5 meters apart.
Mitigation: reducing the number
of potential contacts
School occupancy is reduced, with blended learning. Guardians are asked to walk
or bike their students to school whenever possible to avoid public transportation.
Outdoor activities such as sports have been allowed from April 29, but matches and
competitions will not be allowed.
Mitigation: avoid mixing between
groups
No further information identied
Mitigation: increased ventilation Outdoor activities such as sports have been allowed from April 29. Matches and
competitions will not be allowed. Children between the ages of 13 and 18 must stay
1.5 meters apart.
Mitigation: enhanced hygiene and
cleaning
Handwashing, cough etiquette, and other hygienic behavior is being promoted.
Mitigation: reduce access to high
touch surfaces
No further information identied
Mitigation: identify and isolate
symptomatic students and staff
No further information identied
Mitigation: personal protective
equipment
No further information identied
Mitigation: other No further information identied
Considerations for vulnerable
students
Primary students who attend special education classes may attend in-person classes
every day.
Considerations for high risk
populations
No further information identied
Notes No further information identied
Appendix: Existing approaches used by other selected countries Netherlands
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-16
References
1. Government of the Netherlands. Dutch measures against coronavirus. https://www.government.nl/topics/coronavirus-
covid-19/tackling-new-coronavirus-in-the-netherlands. Accessed May 1, 2020.
2. Netherlands National Institute for Public Health and the Environment. Children and COVID-19. https://www.rivm.nl/en/
novel-coronavirus-covid-19/children-and-covid-19. Accessed May 1, 2020.
Appendix: Existing approaches used by other selected countries Netherlands
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-17
Singapore
Summary While initially Singapore kept schools and in-person classes open during the
outbreak, as of April 8, all classes have been moved to remote learning.
Decision-making & policy
implementation
Decisions regarding opening and closing of schools are being made at the national
level.
Use of in-person classes and
remote learning
There was a countrywide school closure on April 3, and all schools have been asked
to move to remote learning starting April 8 through at least May 4.
Child supervision services such as
daycare & aer school care
General services are suspended.
Mitigation measures: physical
distancing
Not applicable
Mitigation: reducing the number
of potential contacts
Not applicable
Mitigation: avoid mixing between
groups
Not applicable
Mitigation: increased ventilation Not applicable
Mitigation: enhanced hygiene and
cleaning
Not applicable
Mitigation: reduce access to high
touch surfaces
Not applicable
Mitigation: identify and isolate
symptomatic students and staff
Not applicable
Mitigation: personal protective
equipment
Not applicable
Mitigation: other Not applicable
Considerations for vulnerable
students
Not applicable
Considerations for high risk
populations
Not applicable
Notes Some international schools fall under the Committee for Private Education and
have not been aected by prior decisions made by the Ministry of Education, but
it is unclear if they must follow this decision. It has been announced that some of
these international schools have already closed their campuses or moved to online
learning.
Appendix: Existing approaches used by other selected countries Singapore
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-18
References
1. Which School Advisor. All Singapore schools to close from April 8. April 3, 2020. https://whichschooladvisor.com/uae/school-
news/moe-closes-schools. Accessed May 1, 2020.
2. ISC Research. Coronavirus COVID-19 update. https://www.iscresearch.com/cornavirus-covid-19-update. Accessed May 1,
2020.
3. Ministry of Education Singapore. Press releases. April 3, 2020. https://www.moe.gov.sg/news/press-releases. Accessed May 1,
2020.
Appendix: Existing approaches used by other selected countries Singapore
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-19
South Korea
Summary Aer reassessments, all learning has been conducted remotely since April 9. Limited
in-person provisions are created for certain students, including those who are
vulnerable.
Decision-making & policy
implementation
Decisions regarding opening and closing of schools are being made at the national
level by Ministry of Education and KCDC.
Use of in-person classes and
remote learning
Aer multiple assessments and postponements of the school year opening (which
was supposed to occur on March 2) since the beginning of March, it has been
decided that all courses will move to remote learning as of April 9.
Child supervision services such as
daycare & aer school care
Uncertain, see information regarding vulnerable populations
Mitigation measures: physical
distancing
No further information identied
Mitigation: reducing the number
of potential contacts
Yes, minimization of classroom size to 10 students per class; see information
regarding vulnerable populations.
Mitigation: avoid mixing between
groups
No further information identied
Mitigation: increased ventilation No further information identied
Mitigation: enhanced hygiene and
cleaning
Yes, cleaning and hygiene promotion; see information regarding vulnerable
populations.
Mitigation: reduce access to high
touch surfaces
No further information identied
Mitigation: identify and isolate
symptomatic students and staff
Yes, temperature checks for students and sta; see information regarding vulnerable
populations.
Mitigation: personal protective
equipment
Yes, mask usage; see information regarding vulnerable populations.
Mitigation: other No further information identied
Considerations for vulnerable
students
Services for vulnerable groups, like lunch for low-income households and assistance
for those with disabilities, still continuing throughout, including “Emergency
Childcare Program” for select students of daycare centerss, kindergartens, and
elementary schools that began on March 2; mitigation measures include twice-
daily temperature checks for students and sta, cleaning, mask usage, hygiene
promotion, and max limit of 10 students per class
March 2-April 6: Special ed schools delayed opening
Considerations for high risk
populations
No further information identied
Notes No further information identied
Appendix: Existing approaches used by other selected countries South Korea
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-20
References
1. The government will provide safe solid emergency childcare program
[press release]. February 28, 2020. http://english.moe.go.kr/boardCnts/view.
do?boardID=265&boardSeq=79943&lev=0&searchType=null&statusYN=C&page=1&s=english&m=0301&opType=N. Accessed
April 13, 2020.
2. Republic of Korea Ministry of Education. All schools postpone the new
school year. March 17, 2020. http://english.moe.go.kr/boardCnts/view.
do?boardID=265&boardSeq=80295&lev=0&searchType=null&statusYN=C&page=1&s=english&m=0301&opType=N. Accessed
April 13, 2020.
3. The New School Year Begins with Online Classes [press release]. March 31, 2020. http://english.moe.go.kr/boardCnts/view.
do?boardID=265&boardSeq=80297&lev=0&searchType=null&statusYN=C&page=1&s=english&m=0301&opType=N. Accessed
April 13, 2020.
4. Republic of Korea. Public Advice: Mass facilities for children and seniors. Updated March 19, 2020. http://ncov.mohw.go.kr/
en/infoBoardView.do?brdId=14&brdGubun=141&dataGubun=&ncvContSeq=1197&contSeq=1197&board_id=&gubun=.
Accessed April 10, 2020.
Appendix: Existing approaches used by other selected countries South Korea
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-21
Spain
Summary Fall opening for classes is still being planned, but summer activity reopenings are
occurring, staggered by province or island.
Decision-making & policy
implementation
Decisions on reopening have been made mostly at the national level, with districts
having exibility to make some local decisions on reopenings as well.
Use of in-person classes and
remote learning
All schools have been closed since mid-March. The academic year is set to begin
in September. Some institutions may open earlier for support activities. A phased
reopening (minimum 2 weeks per phase), staggered by province or island, begins
May 4.
Child supervision services such as
daycare & aer school care
No further information identied
Mitigation measures: physical
distancing
Not applicable
Mitigation: reducing the number
of potential contacts
Not applicable
Mitigation: avoid mixing between
groups
Not applicable
Mitigation: increased ventilation Starting May 2, children are allowed to attend outdoor walks or nonprofessional
sports. Time is staggered by age group.
Mitigation: enhanced hygiene and
cleaning
Not applicable
Mitigation: reduce access to high
touch surfaces
Not applicable
Mitigation: identify and isolate
symptomatic students and staff
Not applicable
Mitigation: personal protective
equipment
Not applicable
Mitigation: other Not applicable
Considerations for vulnerable
students
Not applicable
Considerations for high risk
populations
Not applicable
Notes Not applicable
Appendix: Existing approaches used by other selected countries Spain
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-22
References
1. La Moncloa. COVID-19 in Spain. Government of Spain. https://www.lamoncloa.gob.es/covid-19/Paginas/index.aspx.
Accessed April 30, 2020.
2. Spain Ministry of Health. Order SND / 370/2020, of April 25, on the conditions in which displacements by the child
population must take place during the health crisis caused by COVID-19. Government of Spain. Published April 25, 2020.
https://www.boe.es/buscar/act.php?id=BOE-A-2020-4665&p=20200425&tn=0. Accessed April 30, 2020.
3. Spain Ministry of Social Rights and 2030 Agenda. Guide to facilitating access to measures, Annex II: Orientative forecast
for the liing of national limitations established in the state of alarm. Government of Spain. https://www.mscbs.gob.es/ssi/
covid19. Accessed April 30, 2020.
4. Spain Council of Ministers. Government approves de-escalation plan which will gradually be implemented until end
of June. Government of Spain. April 28, 2020. https://www.lamoncloa.gob.es/lang/en/gobierno/councilministers/
paginas/2020/20200428council.aspx. Accessed April 30, 2020.
Appendix: Existing approaches used by other selected countries Spain
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-23
Sweden
Summary School openings vary by locality, and decision making is le to municipality and
school ocials. Certain mitigation measures are recommended for any open
schools.
Decision-making & policy
implementation
“Not part of the National Agency for Education’s task to make the decision” to close
schools; decision up to municipality and principals. Schools are exempt from March
27 ban of more than 50 people.
Use of in-person classes and
remote learning
Some schools are conducting in-person classes for all or some or only using remote
learning, but it varies by locality. Some school reopenings are beginning May 4
in Sando and Revigne. Specic closures on preschool, elementary, SAMI, upper
secondary, and other education activities are at the discretion of the principal.
Healthy students are expected to attend school if open.
Child supervision services such as
daycare & aer school care
Care available for children of guardians in “socially important activities,” contingent
on who imposed closures (government or principal). Some preschools are open and
may operate an extended day or school week.
Mitigation measures: physical
distancing
Modify furniture arrangements in classrooms and cafeterias.
Mitigation: reducing the number
of potential contacts
Minimize gatherings.
Mitigation: avoid mixing between
groups
Stagger start, break, and exit times between classes.
Mitigation: increased ventilation Add outdoor breaks and activities.
Mitigation: enhanced hygiene and
cleaning
Minimum once daily cleaning of tabletops, handrails, tables, and toilets and
emptying of restroom trash. Toys, textbook covers, and keyboards must be cleaned
every day.
Mitigation: reduce access to high
touch surfaces
No further information identied
Mitigation: identify and isolate
symptomatic students and staff
No further information identied
Mitigation: personal protective
equipment
No further information identied
Mitigation: other No further information identied
Considerations for vulnerable
students
No further information identied
Considerations for high risk
populations
No specic guidance is oered by Public Health Agency for high-risk children. Risk
groups are dened for ages 18 to 67.
Notes Country specically mentioned the importance of sharing correct information
and dispelling rumors/conspiracy theories in schools, including addressing source
criticism.
Appendix: Existing approaches used by other selected countries Sweden
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-24
References
1. Sweden National Agency for Education. Coronavirus and covid-19 - questions and answers about preschool, school and
adult education https://www.skolverket.se/regler-och-ansvar/coronaviruset-och-covid-19---regler-for-skolor-och-forskolor/
coronaviruset---fragor-och-svar-utifran-skollagstiningen. Accessed May 1, 2020.
2. Sweden Public Health Authority. Information for school and preschool about covid-19. http://www.folkhalsomyndigheten.
se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/verksamheter/information-till-skola-och-forskola-om-den-nya-
sjukdomen-covid-19/. Accessed May 1, 2020.
3. Sweden National Agency for Education. Opportunities for schools open during the corona pandemic. https://www.
skolverket.se/regler-och-ansvar/coronaviruset-och-covid-19---regler-for-skolor-och-forskolor/mojligheter-for-skolor-som-ar-
oppna-under-coronapandemin. Accessed May 1, 2020.
4. Swedish Civil Contingencies Agency. MSB will resume some local teaching on May 4. April 28, 2020. https://www.msb.se/sv/
aktuellt/nyheter/2020/april/msb-aterupptar-viss-narundervisning-den-4-maj/. Accessed May 1, 2020.
5. Swedish Civil Contingencies Agency. Regulations on care for children with guardians in socially important activities. https://
www.msb.se/sv/amnesomraden/krisberedskap--civilt-forsvar/samhallets-funktionalitet/foreskri-om-omsorg-for-barn-med-
vardnadshavare-i-samhallsviktig-verksamhet/. Accessed May 1, 2020.
6. Sweden Ministry of Education and Research, Sweden Ministry of Employment, Sweden Ministry of Finance. Crisis package
for jobs and transition. Government Oces of Sweden. March 30, 2020. https://www.government.se/press-releases/2020/03/
crisis-package-for-jobs-and-transition/. Accessed May 1, 2020.
7. Sweden Prime Minister’s Oce. Prime Minister’s address to the nation, 22 March 2020. Government Oces of Sweden.
March 23, 2020. https://www.government.se/speeches/2020/03/prime-ministers-address-to-the-nation-22-march-2020/.
Accessed May 1, 2020.
8. Sweden Ministry of Education and Research. The Government’s work in the area of education in response to the
coronavirus. Government Oces of Sweden. March 30, 2020. https://www.government.se/articles/2020/03/the-governments-
work-in-the-area-of-education-in-response-to-the-coronavirus/. Accessed May 1, 2020.
Appendix: Existing approaches used by other selected countries Sweden
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US Appendix A-25
United Kingdom
Summary As of April 28, all schools are “closed” until further notice except for in-person
classes and child supervision for vulnerable students or children of critical workers.
Various mitigation measures for these select groups attending in person are in place.
Decision-making & policy
implementation
Decisions regarding opening and closing of schools are being made at the national
level.
Use of in-person classes and
remote learning
Majority of students are engaging in remote learning. Schools, including state
schools, have been asked to remain open for children of critical workers and
children identied as vulnerable. Extracurricular activities have the same
restrictions.
Child supervision services such as
daycare & aer school care
Only children of critical workers or vulnerable students may attend aer care.
Mitigation measures: physical
distancing
Other national social distancing guidelines should be followed.
Mitigation: reducing the number
of potential contacts
Students should reduce use of public transportation to and from school. Class sizes
should be minimized. Parents and guardians cannot gather at school gates.
Mitigation: avoid mixing between
groups
Lunch and break times are staggered. Movement of pupils around the building is
restricted.
Mitigation: increased ventilation No further information identied
Mitigation: enhanced hygiene and
cleaning
Handwashing and other hygienic behavior should be promoted. Surfaces should be
cleaned frequently.
Mitigation: reduce access to high
touch surfaces
No further information identied
Mitigation: identify and isolate
symptomatic students and staff
Children, guardians, carers, and visitors are told not to enter schools or childcare
settings if they are symptomatic.
Mitigation: personal protective
equipment
No further information identied
Mitigation: other No further information identied
Considerations for vulnerable
students
Vulnerable children, in this context, include children who have a social worker, and
those children and young people with education, health, and care (EHC) plans.
Those who have a social worker include children who have a child protection plan
and those who are looked aer by the local authority. Children may also be deemed
to be vulnerable if they have been assessed as being in need or otherwise meet the
denition in section 17 of the Children Act 1989. Vulnerable children are allowed to
attend in-person classes.
Considerations for high risk
populations
No further information identied
Notes No further information identied
Appendix: Existing approaches used by other selected countries United Kingdom
Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US A-26
References
1. UK Department for Education. Actions for early years and childcare providers during the coronavirus outbreak. GOV.UK
Updated April 24, 2020. https://www.gov.uk/government/publications/coronavirus-covid-19-early-years-and-childcare-
closures/coronavirus-covid-19-early-years-and-childcare-closures. Accessed April 29, 2020.
2. UK Department for Education. Coronavirus (COVID-19): implementing protective measures in education and childcare
settings. GOV.UK May 11, 2020. https://www.gov.uk/government/publications/coronavirus-covid-19-implementing-
protective-measures-in-education-and-childcare-settings. Accessed May 14, 2020.
Appendix: Existing approaches used by other selected countries United Kingdom
Johns Hopkins
Center for Health Security
621 E. Pratt Street, Suite 210
Baltimore, MD 21202
Tel: 443-573-3304
Fax: 443-573-3305
centerhealthsecurit[email protected]
centerforhealthsecurity.org
