Each day a new headline seems to indicate dashed hopes of schools trying to teach students in person for the fall semester. Many of the big headlines indicate universities such as Notre Dame, Alabama, or UNC, but high schools all over the country have seen their shares of closing as well. Florida was so embarrassed at its high infection rate in its public schools that it actually hid its data after an early unintended release.
Successful Covid-19 prevention requires many components including symptom monitoring, hygiene, distancing, tracing, and disease education. One of the reasons is that these schools are seeing Covid-19 outbreaks is that they are not monitoring their students properly. Although many specially created electronic-based methods for Covid-19 symptom evaluation exist, many schools are using approaches such as surveys via Google Docs or loose papers to do the symptom monitoring. Unfortunately, these lower-tech methods have numerous problems as school administrators are quickly finding out. Often, these home-grown solutions lack HIPAA- or FERPA-compliance for storage of symptom data or user access. Many administrators do not even realize they may be violating regulations with these poorly secured methods and possibly even breaking the law.
However, the biggest problem with these inexpensive solutions from a public health standpoint is that they contribute to the spread Covid-19 infections.
Many reasons document why poor symptom monitors lead to further Covid-19 infections. First, the compliance is poor with these methods. Minimal oversight is given to seeing who is filling out the questionnaires as the administrators are often too busy with other aspects of Covid-19 preparedness. Since no alerts exist in these systems, administrators cannot easily determine who is even filling out the surveys. If the schools want to ensure that the surveys have actually been filled out, the administrators have to devote major resources to this endeavor.
The accuracy of these home-grown solutions is also a major issue. In many cases, even expensive college prep schools, students are the ones filling out the surveys. In many of these schools, the survey responders are children under 12 years old. These children just often check negative boxes and do not take the survey seriously. The data by this methodology is predictably poor and contributes to difficulty in identifying Covid-19 infections. If parents are empowered to fill these questionnaires out for their children, the parents are more likely to be accurate and take the symptoms seriously.
More importantly, these Google Doc or rudimentary symptom checkers do not help localize new infections and prevent their spread. With the manually created symptom monitors no real system of formalized contact tracing is available. Consequently, as in many of the schools where infections spread rampantly, early symptom identification did not allow the detection of probable exposed contacts. More sophisticated systems would identify the infected individual early in the symptom progression and alert school administrators who could then quarantine possible contacts to prevent spread. These primary and secondary asymptomatic contacts may be the individuals responsible for the disastrous spread of the disease past the infected local “patient zero.” Although children themselves have low likelihoods of fatal illness after Covid-19 infection, they may be more likely to spread the disease for longer periods of time. Additionally, these asymptomatic contacts need to be quarantined to prevent the spread of Covid-19 infection to vulnerable populations including older individuals such as teachers or school administrators.
Multiple other problems abound with these low-tech solutions. Often, the questions are the same for children and teachers whereas the symptoms are clearly different. These solutions rarely will be able to incorporate who has received Covid-19 vaccines which may occur for teachers realistically within 2-4 months. Testing is not captured by these systems either as clearance using more rapid testing methodology may be adopted in the near future.
Of course many other physical reasons could contribute to Covid-19 outbreaks in schools such as poor distancing, inadequate mask-wearing, bad ventilation, or poor cleaning protocols. However, as long as symptom monitors exist to evaluate and protect children, school administrators will be tempted to use cheap solutions. Sadly, many of these home-grown solutions are just that.