While there were a few publicized outbreaks, including a camp in Georgia where hundreds of children tested positive for the coronavirus, the Centers for Disease Control and Prevention found that "public health prevention and mitigation strategies in an overnight camp setting can identify and prevent SARS-CoV-2 transmission" after studying four camps in Maine where basic safety guidelines were implemented.
Now, experts and epidemiologists think that schools can apply the lessons learned from successful summer camps to make sure students stay safe while returning to the classroom.
How did summer camps keep campers and staff safe?
The CDC report, which was published on Aug. 26, found that four camps in Maine used "non-pharmaceutical interventions" such as masking and social distancing to prevent the spread of coronavirus among the 642 children and 380 counselors at the sites.
The camps opened with identical protocols including pre-camp quarantining, pre- and post-arrival testing and symptom screenings and keeping children in cohorts. Masking, enhanced cleaning, and hand hygiene measures were put in place, and many activities were held outdoors.
According to the CDC report, daily symptom checks identified 12 camp attendees who had "signs or symptoms compatible with COVID-19." Those with symptoms were immediately isolated and tested, and their cohorts were quarantined until the test results came in. Three asymptomatic attendees received positive test results after arriving at camps; they were isolated and their cohorts quarantined for 14 days. No cohort members tested positively, and no secondary transmission was identified.
What makes the situations between camps and schools different?
Health experts pointed out two key differences between schools and summer camps: At sleepaway summer camps, like the ones evaluated by the CDC, it's much easier to keep children in a cohort and limit interactions, and in most areas, it's easier to switch activities to outdoor options.
However, summer camps can also be more complicated than a regular school day: Dr. Amesh Adalja, a senior scholar with Johns Hopkins University Center for Health Security, said that camps can be a "harder challenge" due to the "physical nature" of many activities and the "close quarters" and "prolonged periods of time" campers spend together. Despite this, there were limited outbreaks related to summer camps this year.
"It is reassuring ... I do think you can learn lessons about the use of pods, how they're managing social distancing, what face covering policies they have, how they're dealing with cases or exposures that might happen," Adalja said. "All of that, I think, is applicable to schools."
What measures can schools take?
One major way to limit the spread of coronavirus in schoolchildren is organizing students in groups so that only a portion of students need to be isolated or quarantined in case of an outbreak.
"There is definitely the potential for more community spread if children are going back and forth between home and school, because they're interacting with more people," said Krystal Pollitt, Ph.D., an assistant professor of epidemiology at the Yale School of Public Health. "...There are many schools that are implementing cohorting or smaller classes, and that is a really great strategy to decrease the number of contact points that children have within a school setting."
Pollitt said that to make cohorts or pods effective, it's important that children try to avoid interacting with students in other cohorts, so schools should take children's social and emotional health into account when determining classes.
"It's really important for schools to have that recognition and not only balance the educational needs of students this year but also acknowledge (when making assignments) the high chances that children will want to interact because they are best friends," Pollitt said.
Dr. Yvonne Maldonado, a professor of pediatrics (infectious diseases) and health research and policy at Stanford Health Care, said that she believes the biggest lesson schools and students can take home is the importance of correctly wearing masks.
"The camps that had problems are the ones that didn't do stuff right," she said, citing the case of the summer camp in Georgia where hundreds tested positive. "They said kids should wear masks, but they didn't enforce it, so people were not wearing masks and they had to shut the camp down. When people didn't follow the (safety) measures, they wound up with infections."
In addition to masking and hand hygiene, Pollitt also recommends that schools try to test beforehand, especially on college campuses where students are staying in one area and not going home to their families.
"This type of gateway testing is incredibly important, just making sure that everyone arrives on campus is not infected and at least ensuring that you have a clean start," Pollitt said.
Another major thing schools can do is increase ventilation and airflow as much as possible. While classes may not be able to be moved entirely outside in all climates, teachers should open doors and windows wherever possible. Pollitt recommends schools invest in low-cost solutions like box fans or air purifiers.
"Just opening windows and doors is really effective," said Pollitt. "It's incredibly simple and seems to good to be true, but it's an elegant approach that works. You can effectively decrease indoor contaminant levels just by (opening a window)."
While the CDC report and most of the health recommendations focus on non-pharmaceutical interventions — changing behavior instead of using medical supplies — Maldonado said that there is one thing students need to keep in mind before starting the school year: Make sure your vaccines are up to date.
"It's critical that all the kids are up to date on their vaccines, because the last thing you want to do is bring a whole bunch of kids back together and have them transmit a vaccine-preventable disease like measles or whooping cough or the flu," Maldonado said. "That's the last thing we need."