How might we use information from studies of Covid-19 outbreaks in nursing homes and summer camps to inform the reopening of schools?

Families/Kids Infection and Spread School Staying Safe

A: Let’s consider nursing homes and summer camps.

While these environments are different from schools for a host of reasons, the knowledge gained from these settings does inform the critical decisions being made about educating children in the fall.

A recent study of Covid-19 spread in nursing homes led by Dr. Elizabeth White found that larger nursing homes and nursing homes in areas with high rates of community spread were associated with Covid-19 outbreaks. They did not find that facilities with lower quality ratings had a higher probability of Covid-19 outbreak. In other words, facilities with more people coming in and out to provide care and in areas with higher rates of community spread more often had outbreaks, regardless of how “good” they rated. This was a cross-sectional study of more than 3,000 nursing homes in 12 states.

Case reports from summer camps across the country are reporting staff and camper infections with Covid-19, despite enforcement of strict precautions. In many cases, the camps close as a result of the infections. These case reports are individual accounts of single camps. Pooled data on summer camps remains limited in that it includes few camps that are not representative of the overall population of campers.

Using this information to inform policy and practice requires an understanding of the limitations in current findings as well as the application of what we do know to actions. Findings from this nursing home study, a rigorous observational study across multiple states, suggest institutional level interventions to prevent Covid-19 from entering a nursing home are not sufficient if community spread and the flow of people in and out remains high. The summer camp case reports are not scientific studies, but they are real life examples demonstrating that Covid-19 can spread when groups of children and adults are together all day.

Reasonable actions based on these findings should include the expansion of efforts to reduce community spread (closing of non-essential activities, access to reliable rapid testing, contact tracing). Unless we address community spread, plans to reopen organizations will fail. Like nursing homes, schools are essential institutions. Large schools in areas with high rates of community spread are likely to experience outbreaks, despite the best designed plans. In addition to plans to keep Covid-19 out of schools and nursing homes and summer camps, we must be realistic. Cases will occur. Developing a plan for the when the first case occurs in a given setting is critical.

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