Low cost, low effort COVID-mitigation strategies were more common in schools without nurses

Schools with a full-time nurse or school-based health center were more likely to use several COVID-19 prevention strategies early in the 2021–22 school year, according to new school analysis from the Centers for Disease Control and Prevention.

The study examined 21 school-level prevention strategies, including cleaning, mask requirements, COVID screening, quarantining, contact tracing and more. In general, strategies that were less resource-intensive had greater uptake than those that were more resource-intensive. For instance, most schools reported requiring masks for students and staff, but the prevalence of COVID-19 screenings or providing COVID-19 vaccines on-campus to staff, students or their families was much lower.

Such findings may have implications for future public health crises.

“Schools with health infrastructure and personnel were more likely to have certain prevention strategies in place even after adjustment for other school- and county-level characteristics,” according to the study, which will be published in the May journal of Emerging Infectious Diseases.

“Numerous methods to support school-based vaccination and COVID-19 testing have been documented (e.g., partnerships with local health departments, workforce capacity, and communication with parents and students), as have challenges (e.g., staffing shortages, availability of testing supplies, lack of perceived community support, difficulty reporting test results and obtaining consent forms, and low participation),” researchers continued. “Identifying additional sources of support at school, school district, community, health department, state, and federal levels might strengthen schools’ capacity to respond to public health emergencies.”

The study, comprising a nationally representative survey primarily of principals and school nurses in 437 public schools, was conducted Oct. 1 through Nov. 19, 2021. Researchers looked only at the prevalence of mitigation strategies rather than their effectiveness.

Key findings

Initiatives that required less resources were more commonly used than those needing more funding and time, according to the study. Of the respondents, 60 percent reported having a full-time school nurse and 17 percent had a school-based health center. Only 39 percent of schools across the country employ a full-time school nurse, according to the National Association of School Nurses, and just 35 percent of schools have a nurse on site part time.

Boosting the school nurse workforce and investing in school health programs “could … lead to long-term gains in emergency preparedness for schools, as well as positive downstream effects for other student health-related outcomes,” researchers wrote.

Among the prevention strategies survey respondents reported using:

  • 95 percent reported COVID-19 outcomes
  • 93 percent had designated isolation space for students
  • 84 percent quarantined close contacts
  • 80 percent cleaned at least once daily
  • 75 percent had HVAC systems inspected
  • 74 percent required physical distancing of 3 feet
  • 69 percent offered diagnostic testing
  • 67 percent opened windows to increase air circulation
  • 66 percent required masks
  • 31 provided COVID vaccines
  • 27 percent installed HEPA filters
  • 9 percent offered screening testing