Before the pandemic, lunchtime in the school cafeteria was among the most unremarkable of moments in the average school day.

But now, mindful of the risk of spreading the coronavirus during lunch, some schools in North Carolina — aided by careful work from researchers and physicians — are choreographing the lunch hour down to the smallest detail. It’s work that’s being watched closely by schools and scientists here in Washington, too. 

So long as the temperature is above freezing, children head outside for lunch. With masks on, and at least 6 feet from friends, they cut crusts off sandwiches. Straws plunge into milk cartons. Oranges peel open, chip bags pop. And then, when every child is prepped and ready, their teacher says the magic words. 

Time to take off your mask.

“Then a timer goes on. And they’re not allowed to talk,” said Monique Felder, superintendent of Orange County Schools in North Carolina. “They’ve got 15 minutes to consume their food, and it’s amazing how much kids will eat when they’re not socializing.” 

Time’s up, mask on. Wash your hands. Head to class.

Orange County Schools are among 50 or so districts in North Carolina working together to perfect pandemic safety protocols. Like Washington and states across the U.S., many North Carolina schools began the year remotely. But in this state, a team of researchers and physicians teamed up to help schools draft detailed safety strategies for nearly every moment of the school day and adapt to the evolving nature of the pandemic. 

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And that’s helped schools open sooner, and more safely.

The group of scientists has a name — the ABC Science Collaborative — and a mission: to equip school leaders with the most up-to-date research on curbing coronavirus in the classroom. The researchers from Duke University and the University of North Carolina offer schools on-demand expertise on questions big and small — everything from how hybrid schedules could work to whether tubas and other spit-generating instruments are allowed at band practice. 

A growing body of evidence suggests that schools aren’t the breeding grounds for coronavirus that many expected. But cases do crop up. To keep infections at bay, North Carolina superintendents like Felder use dozens of safety protocols gleaned from their local research partners. 

“I know the CDC [Centers for Disease Control and Prevention] has information out,” Felder said. “That’s nice. I can’t pick up the phone and call the CDC. But I can pick up the phone and call experts who are on the front line of COVID-19 every day,” and are members of the ABC Science Collaborative. “We wouldn’t be where we are right now if it wasn’t for them.”

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The researchers say they don’t have an opinion on whether schools should reopen. Rather, they offer information on safety questions, including some issues that government agencies haven’t addressed. They’ve also helped foster an environment where teachers and school leaders learn from each other during weekly calls and webinars. Lots of lessons come from trial and error. 

Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Hospital, said many questions about school safety haven’t been meticulously tested. “The problem here is that science has not been able to provide adequate answers with sufficient expediency to help teachers, schools,” said Christakis, who is a strong proponent of returning to in-person learning. “There’s too much uncertainty and that’s part of the challenge because I think schools, and in particular, teachers, aren’t happy with that uncertainty.”

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Several Washington school districts, including Seattle Public Schools, have delayed plans to return to school buildings because of labor groups’ safety demands.

Even so, similar smaller-scale collaborations are cropping up in the Puget Sound area and other communities. Auburn School District is partnering with Christakis and his colleagues at Seattle Children’s to launch a coronavirus testing program, for instance. From Madison, Wisconsin, to San Diego, physicians are working as informal advisers to school boards. 

After months of partnership, what has emerged is a more robust model for how many school districts and health experts can work together on a large scale. What drives the collaborative’s success, say school administrators and the researchers, is a mutual respect for each side’s role in reopening schools.

“All I can give them is the science,” said Dr. Kanecia Zimmerman, co-chair of the ABC Science Collaborative and associate professor of pediatrics at Duke. “Our job is really to provide the information, put it into context and allow the local schools to make decisions.” 

Pandemic partnership

The collaborative was born over the summer when Dr. Danny Benjamin, Kiser-Arena distinguished professor of pediatrics at Duke, heeded the call of his children’s school district, Chapel Hill-Carrboro City Schools. Like several other districts that eventually participated, including Orange County Schools, the district is located near North Carolina’s Research Triangle, home to three major universities including Duke and several tech companies.

Benjamin is Zimmerman’s longtime research partner at Duke, and a coach for one of the district’s baseball teams.

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When the school board over the summer informally asked him for advice on its reopening metrics, Benjamin told them to slow down. “I immediately said, ‘We understand so little about COVID-19, and the science and the data are going to be so rapidly moving,’” Benjamin said. “‘My suggestion to you is not to immediately commit to a set of metrics.’” 

North Carolina, like Washington state, had released a reopening tool kit for schools. As Benjamin describes it, the document offered a “10,000-foot view” for the types of safety protocols schools could consider. “That left a gap, however,” he said. Benjamin and his colleagues decided then to hold off on telling a district when to stay open, or when to close. It’s a particularly dicey question.

But the researchers realized they could offer advice on practical questions and to expand their services to other districts that were calling for help. “We want to join, we want to join,” Benjamin remembers district leaders saying. The researchers started drafting documents with topics like “how to run band practice,” “how to run lunch” and “how to resume sports.” 

Their guidance relied on what they knew from their own clinical work and infectious disease backgrounds, in addition to information they culled from government agencies, academics and the experiences of school districts. Every two weeks or so, districts would jump on a call with the researchers to run their own ideas by the research team.

Eisa Cox, superintendent of Ashe County Schools, was one of the earliest members to join. Her district of 3,000 students is nestled in the mountains, more than 150 miles northeast of the collaborative’s hub at Duke. 

Cox said the collaborative has helped her figure out how to space out students in classrooms, and other practical concerns, like how to thoroughly contact-trace when cases pop up. She treats each case like an investigation. To begin contact tracing in one case, for example, she tracked down video footage from the child’s 1.5-hour-long bus ride to school, and watched for any evidence that children broke the district’s strict safety rules.

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“We want to make sure that when we open that we are not just following whatever the latest trend is,” Cox said. “We want to make sure that we’re doing it right. Safety is No. 1.”

In Orange County, 4,000 students, about 60% of the district, are now learning in-person on a hybrid schedule. The collaborative has helped Felder make swift adjustments. In the fall, for instance, students ate lunch in classrooms with windows cracked, doors open and air purifiers buzzing. But as coronavirus variants emerged and case counts increased, best practice changed. The collaborative suggested that the safest place for students to eat was outdoors. 

“I’m not making decisions based on my gut or my feelings or what I like or what my neighbor likes,” Felder said. “We’re making decisions based on what the medical experts tell us.”

Breaking ground

Out of this partnership has also come a gold mine of data — information that’s proven critical to state and education leaders across the U.S. who are weighing a return to schools.

Zimmerman and Benjamin asked 11 participating districts for logs on infections and safety protocols at buildings that reopened. Their database of nearly 100,000 students and staff allowed them to trace transmission in schools over nine weeks in the fall. 

Their trove was big, more representative than smaller studies before it, and in a region with relatively high transmission. Their findings eventually fueled the January publication of a research paper in the journal Pediatrics. Like a handful of smaller accounts, their study found “extremely limited within-school secondary transmission,” and suggested schools could reopen safely when they stuck to a long list of safety procedures, such as universal masking, hand-washing and social distancing.  

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Suddenly the collaborative’s researchers found themselves thrust into a debate they’d tried to avoid: Under what circumstances should schools reopen? Their research is now central to that question in social and academic circles — including in Washington — and was recently cited in a Republican-led bill that would require North Carolina schools to reopen. North Carolina Gov. Roy Cooper, a Democrat, vetoed the bill in late February. 

In some ways, entering the conversation about school reopening was inevitable, Zimmerman said. “Even our interactions with the school districts initially was like, can we actually use their data to inform what they should do? There’s one thing to have information from the literature, but it’s a whole different ballgame if you have [research] that’s specific to you.”

Although the team now has data to support reopening, not all member districts have done so. Chapel Hill-Carrboro City Schools, where Benjamin’s children attend, and Durham Public Schools are still closed to most students. 

It turns out that a multitude of ingredients — not just scientific expertise — predict when and how schools reopen. It also takes financial resources, political will and community and teacher trust.  

In many Washington communities, building that trust has equated to offering teachers and school staff new assurances. Some districts are offering school staff frequent coronavirus testing on campus, which may help give folks peace of mind; 13 districts piloted testing this fall and an additional 48 are expected to begin testing soon. And the state’s educators union has also asked government officials to move teachers up on the COVID-19 vaccine priority list.

In Auburn, school officials are partnering with Seattle Children’s Hospital to begin voluntary rapid testing for students and staff on school grounds. About 300 are currently learning in person, but the district intends to bring back students in prekindergarten through 5th grade in March. 

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Late last month, hospital staff trained school district nurses and techs how to administer the tests. Like the consortium in North Carolina, this local collaboration is learning as they go.

“This is totally new territory for me,” said Dr. Danielle Zerr, a co-leader of the partnership and chief of pediatric infectious diseases and medical director for infection prevention at Seattle Children’s. 

“One thing that’s inspirational is seeing just how flexible people are and how able people are to go with this plan for now. But then we’re going to learn something new, and it’s going to require us to change our plan.”