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Schools Can Reopen Safely If They Follow Protocols, According to UCSF Study

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A masked teacher sets up an activity on a table.
Chris Johnson, a teacher at Bryant Elementary School in San Francisco, prepares to welcome 16 kindergarteners to class on April 9, 2021. (Justin Sullivan/Getty Images)

Researchers with UCSF say a safe return to schools in-person this fall depends a lot on how well those schools stick to an array of COVID-19 mitigation measures.

In a study published in the journal Pediatrics on Thursday, researchers cited new evidence from looking at how staff from San Francisco’s learning hubs kept kids ages 5 to 12 safe while they were gathering inside makeshift classrooms over the winter months when the city was experiencing high rates of COVID-19.

“The children and families that were served by the hubs represented the highest risk that San Francisco as a city experienced,” said Dr. Sunitha Kaiser, a UCSF pediatrician and the study’s lead author. “The delightful surprise was the shockingly low level of in-hub COVID transmission.”

Researchers said the study is important because many parents from parts of the Bay Area that were most devastated by the coronavirus have expressed fear over returning their unvaccinated children to school campuses this fall.

The study comes at a time when Gov. Gavin Newsom has been pushing for all schools to fully reopen in-person this fall. Earlier this week, the state launched an initiative to build confidence among parents who remain concerned about sending their unvaccinated young children back inside schools.

San Francisco's learning hubs served students largely coming from families more at risk of contracting the virus, including children of essential workers and from low-income families, as well as students living in foster care or experiencing homelessness.

There were a total of 36 positive COVID-19 cases in the hubs during the study’s time frame, but only one of them proved to be a hub-based transmission, according to the city’s Department of Public Health. The 85 hubs served a total of 1,738 students with 295 supervising adults, and offered services from 8 a.m. to 5 p.m. The study focused on 54 of the hubs.

When the hubs were established after schools shuttered last year, Kaiser saw it as an opportunity to fill a gap in the body of research on in-school transmission. Two large studies out of North Carolina and Wisconsin found low rates of in-school transmission, but neither study had focused exclusively on an urban school district.

“The studies that have been done to date haven't really honed in on those most disadvantaged neighborhoods. And that was really the advantage that the San Francisco community has provided,” Kaiser said. “Their goal was to support those kids that were really getting left behind in the remote learning environment that just weren't showing up.”

Kaiser’s team observed how well staff were able to get children to follow protocols such as keeping 6 feet apart and keeping masks on, especially after eating together. And they noted what worked, such as staff using hula hoops to help kids understand the radius of safety or using pool noodles when children would play tag to prevent kids from touching one another.


The researchers also collected data on hand washing, symptom screening and what ventilation measures were in place. What struck Kaiser about the relative lack of in-hub transmission is that this happened despite the fact that a lot of kids weren’t always wearing masks or staying properly distanced and vaccinations had yet to fully be available to adults.

What worked, she said, is that enough of these protocols were being followed that they created a sort of layering effect; if one piece of prevention isn’t perfect, that’s OK.

“What we show is that when they are trying on all fronts,” like symptom screening, having adequate masks and hand hygiene supplies and maximizing ventilation, then in-person learning “can be done safely," she added.

The message to parents hesitating to return their young, unvaccinated children to school buildings full time this fall, Kaiser said, is that it is safe.

Take masks for example, Kaiser said. “There's times that we're going to have to take them off for eating. But if we do it in that same stable cohort of kids, then we're not mixing multiple groups together.”

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The study's findings are information both parents and schools can use, said Dr. Naomi Bardach, a co-author of the report. Bardach also heads the California’s Safe Schools for All initiative, the state’s framework to support schools’ return to in-person instruction.

“It’s nerve-wracking for families to send their kids back to school when they've been so personally affected by COVID,” Bardach said. But the other piece, she said, is that some families have gone through most of the year doing distance learning and “they actually have some system that works really well.”

A recent EdSource analysis found that as of April, 55% of parents across the state were still keeping their children in distance learning. Parents and teachers have blamed some of that on the inconvenience of the hybrid schooling model, which requires caregivers to drop off and pick up children in the middle of their work day.

Bardach said she's working with schools to make campuses safer and keep parents informed, with hopes they’ll feel empowered to ask questions about a school’s safety plans.

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