COVID-19 Return to School Plan – Fall 2020


Fall 2020 Return to School Plan (as of 9.14.20)

MSB will begin the 2020-21 school year on September 8, 2020 with virtual instruction. The MSB Return to School Plan will be updated frequently as the COVID-19 situation evolves. The current plan can be downloaded below as a Microsoft Word document or PDF or the live version with the most current information can be viewed in this Google Doc .

The cover page includes a photo of a teacher and a student.

2020 COVID-19 Return to School Plan

August 14, 2020

Revised August 28, September 14  

Collaboration and Consultation

We are thankful for the consultation and advisement of Dr. Anamaria Bulatovic, MSB’s Medical Director, the MSB medical team and other medical experts as well as collaboration and consultation with other stakeholders including the MSB senior management team, supervisors, our parents and staff, the MSB board members, PK Law, the Baltimore City Public Schools Superintendent, the Superintendent of the Maryland School for the Deaf, and the other schools for the blind Superintendents through the Council of Schools and Services for the Blind (COSB).

Communication and Community Feedback

MSB held weekly town hall meetings for staff shortly after the campus closed on March 13.  The purpose of the meetings was to keep staff informed of important information regarding COVID-19 and the beginning of the return to school plan. MSB wanted a broad range of feedback from and to provide opportunities for input and to ask questions. The meetings were held on 4/8, 4/22, 4/29, 5/6, 5/13, 5/20, 5/27, 6/4, 6/10, 6/12 (end of school). The most recent staff meeting was held on August 4.  Parent town hall meetings were held on July 8 and August 4.  Staff and parent surveys were conducted throughout this time period and the results have been used to help formulate this plan and were taken into consideration in the decision making process. Future town halls and surveys will assist the MSB leadership team as we gradually reopen school in the months ahead.

Factors in Decision Making

Determining when it is safe to reopen school is complex. The health and safety of staff and students depend on a well-reasoned approach for when it is safe to return to on-campus instruction, particularly for those who are vulnerable to severe COVID-19 illness.

Generally, the virus poses the greatest risk to adults over the age of 65 (1) and to those with underlying health conditions. However, there are risks to people of all ages–including children, especially those with other health conditions. (2)

In the case of the Maryland School for the Blind, there are many students with underlying health conditions that put them at increased risk. In fact, ⅓ of the 200+ students enrolled at MSB, have underlying conditions that qualify them as at risk for severe COVID-19 disease. Because we also operate a residential program, there is more time for disease to spread. (revised September 14, 2020).

Some children, regardless of whether they have other risk factors, have developed multisystem inflammatory syndrome in children (MIS-C) after having been exposed to COVID-19.  MIS-C is a condition where different parts of the body can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. We do not yet know what causes MIS-C. MIS-C can be serious, even life threatening, but most children who were diagnosed with this condition have gotten better with medical care. We don’t know why some children have gotten sick with MIS-C and others have not. We also do not know if children with certain health conditions are more likely to get MIS-C.(3)

Prevalence

A primary consideration to reopen school is to determine the prevalence of COVID-19 and the level of transmission in the local community. The lower the prevalence and transmission, the less likely someone will bring the virus on campus.

Assuming a community is implementing comprehensive mitigation strategies including face coverings and social distancing, understanding whether local community transmission is being suppressed depends on a variety of interdependent factors including:

  • Sufficient testing (indicated by <5% positivity rate)
  • Declining case counts over 14 days
  • Isolating those with COVID-19 and their contacts through adequate contact tracing
  • Low number of active cases per capita (7 day moving average)

The testing positivity rate is helpful in understanding whether enough people are being tested. A high positivity rate suggests that there is insufficient testing.  A lower positive test rate <5% is generally agreed upon as an indication that enough people are being tested.

14 days of declining new case counts based on a 6 day moving average is another common metric. Declining trends in positivity rate and new cases can be interpreted as stable or improving conditions.

Contact tracing and isolation is crucial to break infection chains. Without it, the virus can quickly spread through a community. Each infected person can pass the virus to 2-3 others or more. Influenza has a similar reproduction rate of two to three while measles(4) 12 or more.

The goal of contact tracing is to find people who have spent more than 15 minutes within six feet of an infected person and ask them to quarantine at home for two weeks monitoring themselves for symptoms during that time.

These efforts eventually lead to a lower number of active cases in the community when it is safer to reopen.

What is considered a low number of case counts isn’t universally agreed upon. Minnesota has set specific criteria for reopening schools:

“Schools could consider full returns to in-person classes if they are in counties with fewer than 10 COVID-19 cases per 10,000 residents over a 14-day period.

Schools in counties with higher case counts could attempt to reopen on a more limited basis for full- or part-time classes, with younger students getting priority for in-person instruction. Schools in counties with more than 50 cases per 10,000 residents, meanwhile, would likely have to be fully remote.”

Alternatively, in the briefing, “Pandemic Resilient Schools,”(5)  the Harvard Global Health Institute proposes that schools could reopen if there are fewer than 25 cases of COVID-19 per 100,000 people, more optimally <10 cases per 100,000 people.

As many MSB students come from counties across the state, low case count is important not only statewide, but also in the particular communities in which the students live.

So far, there is no specific guidance prevalence rate metric that is acceptable for reopening school.

COVID-19 Testing on Campus

One of the questions that has been frequently asked by the MSB parent and staff community is whether there will be routine COVID-19 testing as part of the return to on-campus instruction.

Initially and to this date testing has not been widely available, has not had the accuracy or turnaround time that would be needed to mitigate campus outbreaks. Additionally, minimally invasive testing (such as saliva tests) would be an essential component of a testing program since many of our students will not be able to tolerate deep nasal swabs.

With continued advancements in access, accuracy and turnaround time, testing could be a game-changer.  MSB will advocate for frequent, rapid tests as this would be invaluable in MSB’s ability to safely reopen the campus more quickly.

In this fast-moving environment, Governor Hogan announced (the first week of September) that Maryland is taking a lead role in an Interstate agreement for purchase of rapid antigen tests which will be deployed to nursing homes, assisted-living facilities, correctional and juvenile detention centers. In response to this, Superintendent Rob Hair wrote immediately to the State Health Department that MSB would be included in the provision of these tests. We have received a positive response and will continue to advocate that MSB be included as these tests come online in the coming weeks/months. (revised September 14, 2020)

As we make decisions to bring students and staff back to the campus, the school will actively monitor statewide prevalence, community monitoring, advocate for testing and consult with local health authorities.

(1)https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

(2)https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#children-underlying-conditions

(3)https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html#:~:text=Your%20Health-,For%20Parents%3A%20Multisystem%20Inflammatory%20Syndrome%20in%20Children%20(MIS%2D,C)%20associated%20with%20COVID%2D19&text=Multisystem%20inflammatory%20syndrome%20in%20children%20(MIS%2DC)%20is%20a,%2C%20eyes%2C%20or%20gastrointestinal%20organs.

(4) https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30307-9/fulltext

(5)https://globalepidemics.org/wp-content/uploads/2020/07/pandemic_resilient_schools_briefing_72020.pdf

Research and Guidance

Presently there are only public health measures available to prevent the spread of COVID-19.  These include personal protective equipment (PPE), physical distancing, handwashing and sanitation, as well as active case findings, contact tracing and quarantine.

When MSB reopens the campus for in-person instruction, evidence-based preventative procedures to promote safety will be implemented.  The elements are by now familiar: hygiene, health screening, distancing, limiting group sizes, personal protective equipment, and immediate response to positive cases of COVID-19 and contact tracing.  Each element is limited in its benefit. However, when fully implemented as part of a comprehensive plan, they can help mitigate the threat of the virus.

Though the body of research on this virus is nascent, our plan draws on current, credible research by leading experts and will change as new information becomes available including resources and recommendations from the CDC, OSHA and the Maryland State Department of Education (MSDE).

Overview of COVID-19

Novel Coronavirus Disease 2019 (COVID-19)

A new coronavirus was first identified in December 2019 in Wuhan, Hubei, China (1), and has resulted in an ongoing pandemic. The first confirmed case has been traced back to November 17, 2019 in Hubei. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold.

On February 11, 2020 (2) the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV”.

There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses. COVID-19 is a new disease, caused by a novel (or new) coronavirus that has not previously been seen in humans.

COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats.  Rarely, animal coronaviruses can infect people and then spread between people. This occurred with MERS-CoV and SARS-CoV, and now with the virus that causes COVID-19. The SARS-CoV-2 virus is a betacoronavirus, like MERS-CoV and SARS-CoV. All three of these viruses have their origins in bats. The genetic sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir. However, the exact source of this virus is unknown.

 

Transmission

It is thought that the primary mode of transmission of COVID-19(1) occurs from airway water droplets that are expelled from an infected person’s mouth and nose. These droplets form in greater concentrations when someone coughs, sneezes, uses a loud speaking voice or sings.

Transmission through fomites, or surfaces in the environment that are likely to carry infection, is thought to be a less significant source of transmission; however, transmission from frequently touched surfaces to a person’s eyes, nose or mouth continues to be a concern and frequent, thorough handwashing is essential for reducing the risk of infection.

There is a clear association that close physical contact with others who have this disease increases the likelihood of transmission. For COVID-19, close contact (2) is defined as anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the infected person began feeling sick until frank illness. People are still considered a close contact even if they were wearing a mask while around someone with COVID-19.

It has long been known that coughing and sneezing (3) can propel airway droplets farther than 6 feet (4) but generally, 6 feet is regarded as a safe distance, especially when people are masked and are in open, well-ventilated spaces.

There is also evidence that risk of transmission increases within enclosed environments. To decrease the likelihood of transmission, people should actively avoid enclosed environments with poor air ventilation(5).

(1) How COVID-19 Spreads, June, 2020 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

(2) CDC FAQ updated August, 2020 https://www.cdc.gov/coronavirus/2019-ncov/faq.html

(3) The New Yorker, May, 2020 https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry

(4) The New Yorker, https://media.newyorker.com/photos/5ebaf6cefb47a95f08dba5d7/master/w_1600%2Cc_limit/Gawande-rerelease-spot.gif

(5) EPA,Ventilation and Coronavirus (COVID-19)  https://www.epa.gov/coronavirus/ventilation-and-coronavirus-covid-19

Environmental Transmission

While environmental transmission does contribute to infection rates, one study (1) suggests that it may be as little as 6% that may be attributed to environmental transmission. However, there is risk. Virus can be transferred from environmental surfaces (known as fomites) to the nose, mouth, and eyes–areas where respiratory viruses can cause infection.

Science has shown that hand washing with soap and water is an essential part of reducing the risk of infection. Research (2) on the 2002 sars coronavirus outbreak found that washing hands more than ten times a day reduced the infection rate by more than 45%.

Frequent sanitizing of high touch surfaces is important, but the key to avoiding environmental transmission is frequent, thorough hand washing.

Hand sanitizing gel (containing a concentration of 60% or more of ethyl alcohol) is useful when hand washing, the preferred method of hand cleaning, is not accessible.

(1) https://science.sciencemag.org/content/368/6491/eabb6936

(2) https://www.bmj.com/content/336/7635/77

 

Respiratory Droplets

The majority of transmissions seem to come through respiratory droplets emitted from infected people when they breathe, talk or sing. Loud talking has been shown (1) to emit significantly more droplets than soft talking.

Singing too seems to produce more droplets. There was an early case (2) on March 10th, 2020 in the COVID-19 pandemic at a choral practice at a church in Washington State. The group employed what were at the time considered to be appropriate safety practices to prevent the spread of COVID-19. They avoided hugs and handshakes and sat farther apart than usual.

According to an investigation by the County Public Health department, fifty-two of the sixty-one choir members in attendance fell ill. Thirty-two choir members tested positive for covid-19. Two died.

(1)  Exhaled particles and small airways https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-019-0970-9

(2) Attack Rate Following Exposure at a Choir Practice https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm

Facial Coverings are Essential

Consistent use of facial coverings is highly protective and will be required at MSB.

The science continues to show that face coverings protect other people from the wearer’s respiratory(1) droplets—as has been shown with influenza virus aerosols.

However, experts noting a variety of evidence in a new paper(2), slated to be published in the Journal of General Internal Medicine, suggests that both medical grade and cloth masks(3) also protect the people wearing them. They posit that masks lessen the inhalation of airway droplets, the amount of virus and, it seems, the severity of symptoms when infections do occur, possibly warding off infection entirely especially when used in conjunction with other hygienic and physical distancing strategies.

The amount of virus that someone is exposed to seems to correspond to the severity of COVID-19 illness. There have been studies(4) on other viruses with mice dating back to the 30s to try to determine how much viral dosing is required to cause infection. Even recently, there have been human experiments(5) of blowing different doses of influenza virus into human noses, the outcome of which suggested that higher doses lead to greater sickness.

Experiments using COVID-19 on humans would be unethical, but from observational data, and some limited animal experiments, wearing masks seems to be correlated to asymptomatic, or mild cases of illness, suggesting that dosing plays a role. The reason, proposed in this University of California, San Francisco paper(6) is that masking seems to decrease the amount of virus that enters the nose and mouth, decreasing the severity of infection.

Numerous articles and videos have emerged since the pandemic began on how to construct high filtration cloth masks. However, a review of research(7) suggests that even simple homemade fabric masks are effective in reducing the spread of COVID-19.

Atul Gawande, a leading physician and expert, said(8) that if at least 60% of the population wore simple two-layer fabric masks that were even 60% effective at blocking respiratory emissions,it could greatly reduce the spread of the Covid-19, and even stop the epidemic.

  1. Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1003205
  2. Masks Do More than Protect Others during COVID-19: Reducing the Inoculum of SARS-CoV-2 https://ucsf.app.box.com/s/blvolkp5z0mydzd82rjks4wyleagt036
  3. Effectiveness of surgical masks against influenza bioaerosols https://pubmed.ncbi.nlm.nih.gov/23498357/
  4. A SIMPLE METHOD OF ESTIMATING FIFTY PER CENT ENDPOINTS https://academic.oup.com/aje/article-abstract/27/3/493/99616
  5. Validation of the wild-type influenza A human challenge model H1N1pdMIST: an A(H1N1)pdm09 dose-finding investigational new drug study. https://doi.org/10.1093/cid/ciu924
  6. Masks Do More than Protect Others during COVID-19: Reducing the Inoculum of SARS-CoV-2 https://ucsf.app.box.com/s/blvolkp5z0mydzd82rjks4wyleagt036
  7. Face Masks Against COVID-19: An Evidence Review https://www.preprints.org/manuscript/202004.0203/v1
  8. How The Widespread Mask Use Could Slow The Coronavirus Pandemic https://www.npr.org/2020/06/11/875311079/how-the-widespread-mask-use-could-slow-the-coronavirus-pandemic

For all student facing staff we are using medical procedural masks which provide a higher level of protection.  Properly used procedural masks (as part of a plan that includes physical distancing, hand washing and sanitizing) have been shown to help prevent the transmission of COVID-19 for medical workers. In some hospitals where practices of masking, handwashing, health screening etc. were adopted early, it has been reported that few nosocomial (hospital) infections have been documented, including the Brigham and Women’s Hospital (1).

Another study(2) found that, when worn properly and with a good fit, surgical masks can block 99% of respiratory droplets expelled by those with influenza, coronaviruses and rhinoviruses. Laboratory research has also found that surgical masks reduce inhalation of respiratory-droplet-size particles by about three-quarters (3). 

Most of the filtration in procedural masks is from an electrostatic charge (4) applied to the fiber. The static electricity captures viral particles and allows the material to breathe more freely.

Preserving PPE, keeping masks clean and properly stored for reuse, is an essential part of our plan. Whenever possible, staff should reuse their procedural masks until they are soiled or wet. If a mask gets wet, the electrostatic charge is lost and it becomes less effective and should be discarded.

In addition to procedural masks, face shields are a part of our plan for staff/students where 6 foot physical distancing cannot be maintained. Face shields provide additional protection, a barrier primarily for the eyes, but also a second barrier for the mouth and nose.

(1)The New Yorker, May, 2020 https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry

(2) Respiratory virus shedding in exhaled breath and efficacy of face masks https://www.nature.com/articles/s41591-020-0843-2

(3) Assessment of Fabric Masks as Alternatives to Standard Surgical Masks in Terms of Particle Filtration Efficiency https://www.medrxiv.org/content/10.1101/2020.04.17.20069567v2.full.pdf

(4) The New Yorker, May, 2020 https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry

Children’s Role in Transmission

A primary concern for reopening schools is to what degree children spread the virus.  Early in the pandemic and even into early August, the general consensus was that children do not contract COVID-19 at the same rates as adults, and when they did, their symptoms were mild.

However, more recent studies and reports leave little doubt that in fact Covid-19 may spread more easily among children than previously thought and that children are potentially important drivers in the spread of the virus.  A report by the US Centers for Disease Control and Prevention (CDC) highlights risks of reopening after outbreaks at a camp in Georgia(1) and schools in Israel(2). Other scientific reports(3) also support this.

In Georgia, an outbreak occurred at a summer camp. Although the camp, involving about 600 young people, followed hygiene procedures and staff mask wearing, the campers were not required to wear masks. Groups of children aged between six and 19 slept in communal cabins. After testing 344 attendees, 260 were found to be positive.

A CDC report said: “The findings demonstrate that Sars-CoV-2 spreads efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission.”

Israel’s COVID-19 response had been successful at the start of the pandemic after imposing a strict lockdown in March and flattening the curve. However, with the government motivated to limit the impact on the economy and to get parents back to work, children returned to school in May. But by the end of the month COVID-19 was spreading through classrooms and authorities closed about 100 schools before the summer break, ordering thousands of students and teachers into quarantine.

A report by the American Academy of Pediatrics and the Children’s Hospital Association found that more than 338,000 children have tested positive for COVID-19 since the onset of the U.S. epidemic, with 97,078 new cases reported in the July 16-30 period. This spike in infection among children has upended previous thinking about children’s role in spreading the virus.

Though severe complications have been reported in children of all ages, they appear to be infrequent. According to the CDC, compared to adult patients with COVID-19, there are fewer children with COVID-19 requiring hospitalization. For reasons not completely understood, some children(4), teens, and young adults seem to be at greater risk for severe complications from COVID-19.

Like adults over 65 years of age or who have other medical risk factors, there is concern that youth with underlying health conditions are at greater risk.

( 1) Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020 https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article

(2) SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp, Georgia, June 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6931e1.htm

(3) A large COVID-19 outbreak in a high school 10 days after schools’ reopening, Israel, May 2020 https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.29.2001352

(4)  JAMA Pediatrics, July 30, 2020 https://jamanetwork.com/searchresults?author=Larry+K.+Kociolek&q=Larry+K.+Kociolek

MSB’s Vulnerable Student Population

MSB has a uniquely vulnerable student population whose special needs make it difficult to fully implement the strategies that reduce the risk for transmission compared to other students.

For example, many students are unable to wear masks safely or have the ability to manage their sneezes or coughing effectively. Many cannot report when they are not feeling well. Many students at MSB have complex medical profiles which put them at greater risk for severe complications.

Many students require close and frequent physical contact for things such as positioning and physical management (such as for students with physical disabilities). Deafblind students require tactile sign language, a very intimate form of communication in which language is transmitted directly through physical touch from the staff’s hands to the student’s.  And many students cannot maintain appropriate physical distancing for a variety of reasons.

These factors make it challenging to protect students and staff from spreading the virus to one another.

Therefore, when MSB does reopen, the protocols will be different, by necessity, with a higher degree of precaution and protective equipment (medical masks, face shields and gowns) when compared to most public schools.

Our first goal is to return students to our physical school for instruction safely.  Our current plan is for a gradual, tiered approach to carefully transition back to in-person, on-campus instruction when conditions are safe.

At each decision point, or tier, the numbers of students and staff will increase from individual sessions all the way to a full return of students and staff to campus—each tier building upon the previous tier.

Upside down triangle with Tiers listed

MSB’s Tiered Reopening Plan

Assumptions

  1. Each tier assumes an increased level of public safety based on improved infection rates and guidance from the scientific community, but no relaxation of safety protocols.
  2. With successful implementation of each tier, MSB will transition to the next tier.
  3. If circumstances improve dramatically, MSB could skip tiers, such as if infection rates decrease significantly or when a vaccine is successfully developed.
  4. If circumstances worsen, MSB could revert to an earlier tier with decreased numbers of students on campus, or to virtual instruction.
  5. Families will always have the option to continue remote instruction throughout this crisis.

Exclusive Student and Staff Learning Communities

In conjunction with consistent implementation of all other strategies, having developing small learning communities is one of the strongest ways to limit potential spread of infection strictly limiting the number of students and staff who interact with one another during the school day.

A recent statistical analysis (1) regarding the potential number of people (staff and students) with COVID-19 who will enter the first day of school shows that if schools can maintain exclusive groups of around 10 people, the risk of having someone with COVID-19 disease in any one of these small groups is statistically extremely low, even in places hardest hit throughout the U.S.

The experience of some European countries in successful reopening schools seems to support this. After a month in lockdown, Denmark became the first Western country to reopen its schools on April 15.

When children ages 2-12 returned to school, they were sectioned off into cohorts of twelve. These cohorts have lunch separately and have their own areas on the playground. All students are required to wash their hands every two hours. Interestingly, the students are not required to wear masks (notable because many students may not be able to tolerate mask wearing at MSB). Desks are kept two meters apart, all education material must be cleaned twice a day and when possible, classes are held outside. Parents are not allowed on school grounds. Denmark has seen decreased infections among all age groups since schools reopened.(2)

It should be noted that case counts (and death counts) at the time students returned to school in Denmark were extremely low compared to current U.S. counts which is another factor in their success.

(1) The University of Texas at Austin, COVID-19 Modeling Consortium, https://sites.cns.utexas.edu/sites/default/files/cid/files/covid-19_school_introduction_risks.pdf?m=1595468503

(2) Guthrie BL. Tordoff DM, Meisner J, Tolentino L et al., Summary of School Re-Opening Models and Implementation Approaches During the COVID-19 Pandemic. University of Washington. Published July 6, 2020. Accessed July 23, 2020. https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/20200706-SchoolsSummary.pdf

 

Cohorts and Pods

To date, there is no published scientific study on optimal maximum or minimum cohort sizes in reducing SARS-CoV-2 transmission among students in a school setting in the United States. However, CDC modeling and examples from some European countries such as Denmark and Germany as previously stated demonstrate that smaller cohort sizes are generally associated with less transmission in schools.

To talk about our plan, we will use other words to discuss hierarchical categories of groups. This also helps to distinguish from traditional words and the preconceived notions associated with them. One of those traditional words is “classroom.”

We will use the term “cohort” to refer to student/staff groups.

A cohort is similar to a traditional class but with notable differences: Cohorts will stay together throughout the day exclusively. They won’t have recess with other students. There will be no student mixing in gym, chorus, sport teams, common meals in dining rooms, assemblies or any other student gathering that would otherwise mix groups of students.

Related service providers, by necessity, will serve students in multiple cohorts. To preserve the integrity and the efficacy of the small group model in preventing spread of infection, we will need to limit the number of cohorts and the number of related service providers associated with those cohorts.

We will use the term “Pod” to refer to a collection of cohorts with the only common staff being related service providers.

This illustration is an example of a single pod. At the top of the illustration are the related service providers, the only common staff among cohorts.

Paradigm Shift

Assuming that the MSB community strictly enforces all other measures (hygiene, health screening, distancing, and personal protective equipment), one of the most important strategies is to eliminate mixing of cohorts/pods.

If a COVID-19-like illness (1) or laboratory confirmed COVID-19 case (2) is found, the number of staff and students who are exposed to the virus would be limited to the cohort/pod. Because of that, the students and staff who may have been exposed can be quickly identified.

Strict implementation of the cohort/pod model, however, means that each of us will need to be prepared to let go of traditional ideas of what school should look like. Everyone will need to be flexible when changes are required in order to maintain the fidelity of the cohort/pod model.

Why will there be changes? The reason is simply that as we increase the number of students and staff on campus, moving from tier to tier, maintaining the pod/cohort model will become more complex due to so many complicating factors such as ages, abilities, reading modes, cottages/dorms.

When moving to the next tier, staff and student assignments, related service providers, or dorm assignments may change. Or we may need to group students together from different programs who would not otherwise have been grouped together.   Some redistribution of some staff and students among pods is likely at key transition points.

These are not normal times, so we must be prepared to abandon what normal looks like in order to get through this crisis safely.

Figure standing at a crossroad with signs

The Tiers Explained

Tier 1: Individual In-Person Student Appointments

  • MSB staff initiated appointments with students (accompanied by a caregiver) for in-person services such as low vision assessments, educational, related service assessments, clinical, or instructional support needs which are not suited for virtual delivery.

Tier 2: Early Learning Students and Limited Student Cohorts with A/B Schedules

  • Preschool and kindergarten cohorts begin on-campus instruction on an alternating A/B schedule.
  • In grades 1-12, introduction of small classroom cohorts of select students will begin on-campus instruction on an alternating A/B schedule.
  • Initial student groups may or may not include residential services.
  • Not all students will return in Tier 2.

Tier 3: All Students with A/B Schedules and Limited Residential Program

  • All students return to the MSB campus on an alternating A/B weekly or daily schedule in cohorts as much as possible.
  • Residential program will be limited to students who live outside of a defined geographic radius of 30 miles from MSB campus in order to limit numbers of students/staff to safe levels. 

Tier 4: All Students Return to Five-Day Weekly Schedules with Limited Residential Program

  • Students return to a five-day weekly schedule in cohorts as much as possible.
  • Residential program remains limited to students who live outside of a defined geographic radius to maintain safe numbers. (The same as Tier 3.)
  • This Tier is the final stage until the end of the pandemic or infection rates are extremely controlled within the state of Maryland.

Tier 5: Everyone Back to School

Educational Recovery Plan

Recovery

The students served at MSB are all students with disabilities with Individualized Education Plans (IEP’s). Many of our students have complex learning needs as well as multiple and severe disabilities. Upon the start of the school year, all students will be assessed by their teachers and related service providers to determine priority needs based on any regression of academic and functional skills. The assessments will be a mix of standardized assessments, benchmark testing, curriculum-based assessments and teacher-made assessments for learning.

Instruction that all students receive whether through virtual instruction, a hybrid model of instruction, or with a full face-to-face model follows standards based in Maryland’s College and Career Ready Standards for all content areas. Many of our students receive curricular and specially-designed instruction based on alternate framework standards due to the severity of their disability.

 Equity

Many of the students at MSB struggle to attend to instruction without significant and consistent adult support. MSB will work directly with families and students to provide as much support as possible. This may include scheduled time on MSB campus for consultation, providing a 1:1 paraeducator to meet with the student in a community setting, or additional 1:1 or small group interventions for students in a virtual or hybrid environment.

To address equity, MSB will provide accessible technology access tools for all students with a need. This may include a laptop, a tablet, access and assistive technology devices or internet access.

 Safe Handling of School and Student Materials

During virtual and hybrid instruction, students will access a majority of their learning materials through online platforms. For our students that require paper materials, manipulatives and tangible objects and returning technology for repairs and upgrades, any item that is returned to the school will be quarantined for no less than 72 hours. When materials are interacted with, staff should wear any required PPE, including gloves. For materials that can be cleaned and sanitized, staff will use approved cleaners prior to and following use.

 Virtual Instruction

During times when education is delivered virtually, students will be expected to attend classes and related service sessions. Attendance will be taken in classes. Students that are not available synchronously will have the opportunity to view recorded class sessions and may request to meet with teachers for additional support or attend teacher office hours. Plans for virtual instruction, including the school schedule, will be available in a separate document.

 Athletics

MSB students compete in interscholastic athletics as part of the Eastern Athletic Association for the Blind (EAAB). MSB competes during four sports seasons throughout the year against other schools for the blind in the EAAB. While some sports activities will continue virtually for the purposes of practice and recreation, interscholastic competition will not begin again until all on-campus operations resume. We do not anticipate that this will happen until we reach Tier 5.

Protocols and Procedures

Daily Health Screenings and Symptom Monitoring

Students and staff will be required to complete daily health screenings for COVID-19 symptoms including temperature checks.

In order to implement the COVID-19-like Illness Response Plan, health screening and symptom monitoring are necessary.

It is noted that the CDC does not currently recommend universal (1)  symptom screenings (screening all students grades K-12) be conducted by schools. Given the wide range of symptoms and the fact that some people with SARS-CoV-2 infection (the virus that causes COVID-19) are asymptomatic, there are limitations to symptom screening conducted by schools for the identification of COVID-19. However, symptom checking continues to be a best practice in universities and long term care facilities. (1)https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/symptom-screening.html

(2)https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

Physical Distancing

Physical distancing means keeping space between yourself and others outside of your home. Limiting close face-to-face contact with others is the best way to prevent the spread of COVID-19 infection.

  • COVID-19 spreads easily among people who are in close contact.
  • Spread happens when a person with COVID-19 coughs, sneezes or talks and droplets are launched into the air and land in the mouth, noses or eyes of others nearby or if these droplets can also be inhaled into the lungs.

Practice physical distancing

  • Stay at least 6 feet (about 2 arm’s length) from other people
  • Avoid gathering in large groups
  • Stay out of crowded places and avoiding mass gatherings
  • People are particularly vulnerable for exposures due to mask removal for eating and drinking – remain at least 6 feet away from another person while consuming food and drinks.
  • Arrange student furniture to promote the 6 feet safe physical distancing.
  • In-classroom or remote therapy services whenever possible to avoid small enclosed rooms and maintain pod/cohort model.
  • In shared offices where staff cannot telecommute or offices with significant in-person interaction, barriers will be provided.

 Masks and Face Coverings

  • Every adult entering a building will be required to wear either a surgical/procedural or cloth face mask.
  • Every student should wear a face covering with the following exceptions: face masks or cloth face coverings should not be placed on children under age 2 or any student who has trouble breathing or is otherwise unable to remove the mask or covering without assistance. Safe alternatives may be hats with face shields(1). Parents are encouraged to experiment and practice mask wearing at home with their child(ren).
  • Face masks or coverings must be worn in any public area.
  • Procedural masks must be worn when providing direct student care. All student service staff (teachers, therapists, paras, residential staff, overnight staff, education office staff, principals and supervisors) will wear a basic procedural mask. Procedural masks can be used until wet or visibly soiled or damaged.
  • Do not attempt to wash a procedural mask. Do not wash or clean procedural masks. When they become wet, they lose their electromagnetic charge and are no longer effective.
  • Masks should be stored in a paper bag for reuse.  An old mask should be presented for exchange for a new mask. 
  • Do not touch or adjust the outside of your mask to avoid contamination.  If you must touch your mask, perform hand hygiene immediately before and after.
  • Properly place your mask to cover your nose and mouth.  Masks should not be worn on your forehead, chin, or around your neck or arms.
  • Masks with exhalation valves or vents should NOT be worn to help prevent the person wearing the mask from spreading COVID-19 to others
  • All administrative staff who do not work in student areas will wear a cloth mask.

(1)https://www.sheknows.com/wp-content/uploads/2020/07/orange-smiley-face-hat.jpg?w=800

Face Shields in Addition to Masks

  • Face shields are required when physical distancing of 6 feet is not possible.
  • Face shields should be used with masks. They are not a substitute for masks.
  • Face shields should be used to protect the eyes when providing direct student care such as toothbrushing or other hygiene or providing instruction or therapy where a distance of 6 feet or greater cannot be maintained, or working with students who cannot control their own secretions. 
  • Face shields are required during aerosol producing medical or speech therapy procedures
  • Face shields can be reused by a single individual and can be used from one student to the next without removing and cleaning.  Any time the face shield is removed it must be cleaned on the outside and inside. 
  • All personnel must also perform hand hygiene following any time they touch the face shield.

 Gowns

Gowns are essential for lifting and transferring students when their secretions might otherwise get on staff clothes. Not only does this help protect staff, but also other students who might be physically transferred by that same staff member.

  • Gowns should be used when partial or full body forward-facing direct contact is warranted; e.g., lifting, transferring students – beyond stand pivot
  • Gowns should be used when performing direct care functions (toothbrushing, feeding, etc) with students who are dependent on adults for completion of the task

Gloves

  • Gloves should be used as per standard protocol – there is no new guidance on glove use particular to COVID-19. Wearing gloves is never a substitute for hand washing except when hand washing is not immediately accessible. COVID-19 and other respiratory infections do not infect bare skin. If gloves are used, staff should remove or change gloves between students or after working with a student to protect against the transmission of illness between students and staff.
Icons representing the different types of Personal Protective Equipment and their usage

 

Housekeeping Staff

Housekeeping staff will wear basic procedural mask

  • Face shields to be used in a contaminated area (e.g. examining room in the health center or the room of a resident who has fallen ill) and when physical distancing of 6 feet is not possible.
  • Gowns as indicated by task
  • Gloves as indicated by task (nothing extra for COVID-19)
  • Electrostatic sanitizing housekeeping will wear safety goggles, N95 dust masks, and gloves

Nutrition Service Staff

Nutrition staff will wear basic procedural masks

  • Gloves per industry standard
  • Separate face shields when physical distancing of 6 feet is not possible.

Nursing Staff

Nursing staff will wear basic procedural mask

  • Separate face shields to be used with every student contact (taking vital signs, administering medications/GTfeeds/inhaler treatments.)
  • N95s (1 per week unless visibly soiled, per provider) to be used for any student who presents with acute illness*
  • Gowns and gloves as indicated by task

COVID-19-like Illness Response Plan

To help mitigate the risk of infection, staff and students who have symptoms that present as COVID-19-like illness and those exposed to them (more than 15 minutes within 6 feet) will be required to go home.

The Maryland Department of Education and CDC have defined COVID-19-like illness to be a new onset cough or shortness of breath OR at least two of the following: fever of 100.4 or higher, chills, shivering, muscle pain, sore throat, headache, loss of sense of taste or smell, and gastrointestinal symptoms (nausea, vomiting or diarrhea).

  • If students or staff symptoms meet the criteria for COVID-19-like illness, they will be required to go home immediately and should consult with healthcare professionals.
  • They will be isolated until they are able to leave campus.
  • Others in close contact (15 minutes or more within 6 feet) will also be asked to self-isolate for 14 days from the date of exposure unless otherwise notified.
  • The staff member will be contacted by HR and be offered resources, instructions and recommendations to seek further medical care and/or to obtain a COVID-19 test.
  • Staff and students who have been isolated will be able to return to campus when they are fever free for 72 hours without the use of fever-reducing medication.

 

Laboratory Confirmed Cases of COVID-19 Response Plan

  1. If a confirmed case of COVID-19 is identified, internal contact tracing will be conducted by a certified contact tracer who will investigate possible exposure to other staff, students, and the areas of the campus that may have been exposed.
  2. The affected areas will be closed for 24 hours and then sanitized.
  3. Others in close contact (15 minutes or more within 6 feet) will be asked to self-isolate for 14 calendar days from the date of exposure.
  4. People who are positive for COVID may return to MSB after 10 days and are fever free for 24 hours without medication and improvement in COVID-19 related symptoms.

 

Confirmed Cases within Pods and Cohorts Response Plan

One confirmed case within a single cohort

  1. All members of the cohort and any related service providers who were exposed (15 minutes longer within 6 feet) will revert to remote instruction and isolation for 14 calendar days from the date of exposure.
  2. Parents and staff will be asked to closely monitor for COVID-19 symptoms during the period of isolation.
  3. Related service providers and teachers who are in isolation will continue to provide instruction remotely.

More than one confirmed case or more than one cohort exposure

  1. Two or more confirmed cases within a pod in different cohorts, everyone in the pod will revert to remote instruction and self-isolate for 14 days and monitor for COVID-19 symptoms while a contact tracing investigation is completed.
  2. If contact tracing and medical professionals determine that each person contracted COVID-19 outside of MSB then their individual cohorts who were exposed will continue in remote instruction while the other cohorts will be allowed to return.
  3. If it is determined that the source of the infection was a staff member who worked in multiple cohorts, then all of those cohorts would remain in remote instruction as they self-isolate. Any cohorts that were not exposed may return.

Patti Bell, MSB Health Center Manager, will be responsible for contacting the Baltimore City Health Dept when there is a suspected case on campus. (revised 9.14.20)

Baltimore City Health Department Contacts:  

White, MaryGrace M. (BCHD) marygrace.white@baltimorecity.gov and Sherlina Holland Holland, Sherlina (BCHD) <sherlina.holland@baltimorecity.gov>email (revised 9.14.20)

Graphic representing the steps in the presentation of a COVID-Like illness

Community-Based Services

Staff in Early Intervention, Teacher of the Visually Impaired (TVI), Orientation and Mobility (O&M) and other community based services should refer to the local school system’s reopening status and guidelines.

Assessments in our Low Vision Clinic will take place as needed and on-campus assessments for new enrollments will be scheduled in locations with adequate size/space for social distancing and masking precautions in place.

Families are asked to disclose COVID-19 risk factors with staff, and to assist in creating safe work conditions by maintaining masking and physical distancing.

Outdoor Activities

When the campus reopens, outdoor activities are encouraged including educational and therapeutic activities. Aside from the health benefits of sunshine, fresh air, and exercise, outdoor activities tend to be safer since there is a lower risk of transmitting viruses so long as safe distancing and regular hand washing practices are observed.

However, some outdoor activities will be suspended including:

  • Field trips into community establishments (restaurants, grocery stores, etc.)
  • Community-based instruction that are in local establishments
  • Groups larger than six (combined students and staff) in recreational activities in order to  facilitate appropriate physical distancing

Use of the Pool Upon Reopening

  • Closed upon initial return to school
  • Considerations will be made for opening on a gradual basis as more guidance becomes available:
  • Shallow end (1 and 2 feet areas):  No more than 4 people
  • Four feet area:  No more than 6 people
  • Deep end:  No more than 3 people (1 per lane)

Nutrition Services

Breakfast

Residential students:  Delivered to students in the dormitories, individual servings

Day students:  Grab and go foods delivered to students in classrooms, individual servings

Lunch

Delivered to students in the classrooms, individual servings, disposable containers and plasticware for students for whom it is appropriate. Nutritional service staff to deliver specialized feeding equipment.  (Trash to be picked by housekeeping)

Dinner

Delivered to students in the residences, individual servings, disposable containers and wrapped plasticware for students for whom it is appropriate.  (Specialized feeding equipment will be stored and maintained in residences) Nutrition service staff to deliver feeding equipment each day.

Nutrition service staff will wear masks, shields when unable to maintain distance of 6 feet and gloves, per industry standards.

Cleaning and Sanitizing

High Touch Surfaces

High touch surfaces such as desktops, doorknobs, railings, and restrooms will be cleaned throughout the day. All staff will assist with sanitizing high touch surfaces within the classrooms and residences throughout the day.

 

School Vehicle Cleaning and Sanitizing

The MSB fleet vehicles have been treated with PermSafe, a disinfectant with long-term residual properties.  The following are links to several select PermaSafe Videos and Online Presentations critical to understanding the products and programs.

Electrostatic Misting

MSB housekeeping and other staff will help disinfect high touch surfaces using an electrostatic misting system.* This utilizes electrostatic spray technology to allow disinfecting solutions to reach surfaces outside the line of sight, covering what conventional trigger sprays may miss, including the sides, underside and backside of surfaces. It works by using an electrode to introduce an attractive charge to the disinfecting or sanitizing product and atomizes the solution, using an air compressor to generate a quiet, but powerful liquid flow at 9,000 sq feet per gallon.

This cleaner is EPA-registered to kill 19 illness-causing organisms in two minutes or less. The ready-to-use, one-step disinfectant cleaner eliminates odors and kills outbreak-causing viruses like influenza, rhinovirus and norovirus and bacteria like Staphylococcus aureus, MRSA and Vancomycin Resistant Enterococcus faecium (VRE). The non-bleach-based formula is specifically designed for broad surface compatibility, making it ideal for use on a wide variety of surfaces found in schools, athletic facilities, offices and more.

*Electrostatic misting will not be used in Early Learning due to Office of Childcare Regulations.

HVAC Systems and Air Quality

Knowing that stagnant air is a significant risk factor in the transmission of COVID-19, it is important to address HVAC systems on campus. With consultation of HVAC and industrial hygiene experts, MSB is in the fortunate position of having new buildings with modern HVAC systems. MSB’s HVAC systems run 24/7 providing a constant flow of air and increasing outdoor air ventilation. The system supplies 6-8 air changes per hour in classrooms, up to 10 air changes per hour in offices. Inside air is replaced with outside air approximately 2 air changes per hour. These air change rates are at the levels recommended for hospital rooms, including those with COVID-19 patients. As we reopen campus, HVAC systems will be upgraded with MERV-13 filters.

Transportation and School Vehicles

All student transportation must be performed using a fleet minivan.  No one may be seated in the middle seat to ensure physical distancing. Transportation is limited to one staff member and one student.  The student and staff must be properly masked at all times while in the vehicle.

Local School System Transportation

As MSB resumes on-campus instruction, we will coordinate with each LSS to arrange transportation plans. Since MSB depends on the local school systems (LSS) to provide transportation, as part of each student’s IEP, MSB also relies on the LSS to institute safe protocols and social distancing, particularly for students who are not able to wear face coverings.

Meetings

Meetings including IEPs and other student related meetings will be held virtually to minimize the risk of COVID-19 exposure to the campus.

Parent Town Hall Meetings

Parents will be informed of the plan and apprised of changes to the plan via scheduled on-line Town Hall Meetings.  

Meetings dates:

July 8, 2020

August 4, 2020

September 17, 2020 – Family Back to School Meeting

October 1, 2020

(revised September 14, 2020)

Visitors

Most meetings will be held virtually. However, when it is necessary for visitors to come on campus, they will schedule appointments and comply with all rules and screening procedures including wearing masks.

Parent Drop off and Pick up

Parents should release their child to staff during drop off and not enter school buildings. When picking up students, parents should wait at their vehicle until a staff member brings their child to them.

Required Staff Training

In order to return to work on campus, all staff must complete the following trainings:

1.   COVID-19 Disease Education

2.   When and How to Use Personal Protective Equipment

3.   Cleaning and Sanitizing Protocols

4.   Health Screening/Temperature Taking (if appropriate)

5.   Supervisor Training (if appropriate)

Student Training

Through virtual platforms and upon return to campus, all students will receive additional education on COVID-19 and safety protocols needed to keep the community safe and healthy. Educational opportunities will come in a variety of forms and be appropriate to the students’ age and developmental level.

Supply Replenishment Procedures

Staff should check with supervisors or designated point of contact when PPE supplies are needed.

Contact Information

For questions or more information, please contact:

Patti Bell, Health Center Manager:  410-444-5000 x1555

Matthew Andrews, Assistant Director of Campus Operations:  410-444-5000 x 1716

Lauren Pappas, Director of Human Resources:  410-444-5000 x1469

Kim Poswiatowski, Benefits Specialist:  410-444-5000 x1364

Robert Hair, Superintendent:  410-444-5000 x1710

Research on COVID-19 is evolving on a daily basis and recommendations may change.