With a relatively low level of COVID-19 transmission in Maine, school districts can reopen for in-person instruction, according to a public health perspective. Credit: Linda Coan O'Kresik / BDN

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Thanks to its relatively low levels of COVID-19 cases, Maine is in a better position than other states to implement safety protocols and send students physically back to schools this fall, public health officials have said.

Even though the U.S. is planning to reopen schools as COVID-19 numbers across the country continue to rise, Maine is one of two states that recently has seen its number of cases decline.

But rates of infection vary throughout the state, and sometimes from one neighboring school district to the next. And while there have been ample studies on how students benefit from learning in group settings, much about how the disease spreads among children — even among those who don’t show symptoms — still is unknown.

From a public health perspective, local coronavirus infection rates are the most important factor in determining whether students should return to school this fall, according to Dora Mills, chief health improvement officer for the Portland-based hospital system MaineHealth and former director of Maine Center for Disease Control and Prevention.

“The biggest indicator for whether schools can reopen or not is the prevalence of COVID in that [schools’] area,” Mills said. “But I do think that it’s very possible for schools to reopen in person this fall.”

The Maine Department of Education along with the Maine CDC plans on providing districts across the states with local health markers including number of cases and hospital capacities to help school administrators make their reopening decision.

The decision to reopen school has to be made by combining public health recommendations and the expertise of education leaders, Mills said.

But what might be ideal from a public health standpoint might not be the best option for educating children.

While students are safest while learning from home, there is evidence that a long hiatus from in-person schooling is not only detrimental to students’ mental health and behavior, but they also don’t learn as well remotely for extended periods of time. Statewide, remote learning has also amplified the inequities of access since schools closed.

“It can interrupt vital services, [with impacts] worse than the social isolation,” Gov. Janet Mills, Dora Mills’ sister, said Friday in announcing that federal funds go toward helping Maine schools to develop and implement reopening plans.

The Department of Education has asked school administrative units across the state to come up with plans for three reopening scenarios: a full return to brick-and-mortar schooling, a hybrid of in-person and remote instruction, or a completely online semester. The department and many school districts hope to return as closely as they can to in-person schooling this fall, but making that choice is complex and districts have to weigh the educational needs of students against the public health risk of returning to school.

Even at schools that resume full in-person instruction, the state will require precautions that were not in place before the coronavirus pandemic spread to Maine.

Social distancing, grouping students in small units, increased hand-washing and widespread use of face coverings are going to be some measures every district is planning for, as they have been proven to curb the spread of the highly infectious respiratory virus.

Data on the disease collected in China has indicated that younger children are less likely than adults to develop serious COVID-19 symptoms, and less likely to die from the respiratory illness, according to the federal Department of Health and Human Services. In the United States, just 2 percent of confirmed cases of COVID-19 were among children younger than 18, according to the U.S. CDC.

The trend holds true in Maine, where people under 20 make up less than 9 percent of all positive COVID-19 cases, according to Maine CDC.

But they can still contract the virus, show no symptoms, and transmit it to others. Evidence on how easily children can spread the coronavirus compared to adults, however, is limited.

There also is a lack of direct evidence to show how much school closures have helped slow the spread of the coronavirus, just as there’s no precedent to show how the pandemic will be affected by reopening schools in the U.S., where the disease continues to spread at alarming rates.

When coronavirus cases first started to escalate across the country, nationwide school closures were expected to slow the spread of the coronavirus. But some recent research cited by the New York Times suggests that measures such as social distancing and use of face coverings have had a greater impact on mitigating the spread of the virus than closing schools.

Whatever decision schools make, the American Academy of Pediatrics recommends separating students into small batches (it has not recommended a specific size or range) at every grade level to limit exposure. These small groups of students might do everything from classes to lunch to athletic activities together while not physically interacting with other groups of students, or cohorts, at the same school.

Across Maine, nursing homes that have faced outbreaks have used this strategy of limiting residents and staff to designated groups within residential units so often that the MaineHealth official said it’s almost become a standard COVID-19 response.

“It’s a strategy to try to keep the transmission down because if you do have somebody with COVID, it’s less likely to spread across school,” Dora Mills said. “If it does spread it’s only limited to that cohort and that’s a much smaller group than the whole school.”

If districts do choose to reopen in fall, public health experts on the national level have recommended implementing strategies for pre-K and elementary school students that are different from those established for middle and high school students.

In addition to younger children being less susceptible to COVID-19 infection and transmission, they benefit more from experiential learning in classrooms than they do from online instruction. Also, parents across the country have had difficulty striking a balance in working from home and

supervising their children’s at-home schooling.

The Academies of Sciences, Engineering and Medicine published a reopening document this week that recommends prioritizing pre-K and elementary students’ return to brick-and-mortar schools over older students.

“From a public health standpoint, if you have to choose a group to go to school, choose the younger ones,” Dora Mills said, adding that younger children might pose less of a COVID risk to teachers than older kids. “We don’t know that for sure but it’s a possibility.”