A call to bring students back into classrooms and school buildings around Maryland does not include guidance to parents and educators on what the academic year would look like when the first positive cases are diagnosed in children, teachers or staff.
Gov. Larry Hogan and his top advisers on education and public health have dangled a $10 million carrot to “strongly encourage” schools systems to move to in-person learning based on two health metrics described as “general guidance.”
But that guidance doesn’t specify what should happen if and when positive cases are diagnosed, something top public health experts say is important.
“I’m not sure who the doctor is at (Johns) Hopkins that you’re talking to but the health department has given a good deal of thought to that,” Hogan told a reporter Thursday when asked about guidance for schools that reopen and then have positive test results.
Dr. Jinlene Chan, acting deputy health secretary and a key leader in the state’s ongoing COVID-19 response, said questions about guidelines for schools that diagnose cases are “critically important” but said it will develop those plans on a case-by-case basis.
“So the metrics we laid out are very general guidance for school systems and schools to be able to make decisions,” said Chan. “However, if there are instances where there is a case or an outbreak, that would be part of the partnership or discussion with the local health officers to make decisions on whether or not there may be a need for additional mitigation measures if in fact it is more widespread — whether a classroom may need to be shut down or in certain circumstances, an individual school.”
That “very general guidance” is based on two statistics.
The first is the positivity rate for each of the 24 jurisdictions in Maryland. Of those jurisdictions, only Worcester is above the 5% mark with Prince George’s and Charles counties slightly below. Other tracking sites, including CovidActNow.org, which is cited by a number of local health officials, lists seven Maryland jurisdictions at 5% or higher and three more at 4.5% or more.
Jurisdictions with a positivity rate below 5% for seven days and who have a seven-day positivity rate below 5 new cases per 100,000 in population could reopen schools for in-class instruction. Jurisdictions with new cases higher than 5 per 100,000 could use a combination if in-person and virtual classes.
Maryland reports its new case rate at 9.3 per 100,000 people. Only five jurisdictions meet the below-5-cases threshold. Nineteen others report new cases at rate of 5.6 -14.5 per 100,000 people.
Last week, experts at the Johns Hopkins Bloomberg School of Health said states need to expect to see cases in schools as students return to classrooms, even with social distancing, mask rules and other mitigation efforts.
“Plan for cases,” said Dr. Jennifer Nuzzo, an associate professor and senior scholar at the Johns Hopkins Center for Health Security. “Even if these safety measures are in place, we have to think about what we do to further limit the spread. Schools should plan to reduce the numbers of people that any one person interacts with to reduce the probability that if an infection comes it will result in a school outbreak.”
Because of the inevitability of positive tests within the school population, there also needs to be clear guidance on what it means if a student or group of people within a school test positive including triggers for closing classrooms, schools and what a reopening would look like.
“If all you’re getting from your school system is here’s everything that we’re doing to reduce the chance of infection, that’s not enough,” Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins, told reporters during an online discussion of reopening schools. “People should also know what should happen, when and if there’s a case of coronavirus in the schools.”
Local health officers and county leaders in larger jurisdictions, such as Montgomery County and Baltimore city, have called for more state guidance and a uniform set of standards that would apply to every county and to Baltimore.
Chan said it is those same health officers who will be consulted to determine how to handle cases in schools if and when they are diagnosed.
“It’s hard to give specific guidance to say yes, if there’s X number of cases we shall do this,” said Chan. “Every circumstance is unique and every school is unique and so we would certainly look at the situation and to identify how widespread the contact might be to determine what the most effective measures might be to mitigate additional spread.”