Using the bubble isolate concept to reopen schools without universal masking
BY MEGAN MANSELL
We find ourselves in quite a pickle.
Many are ready to fully reopen schools without masks, accepting risk of exposure to RSV, strep, flu, COVID-19, and the gamut of illnesses that have always come hand-in-hand with mixed youth populations. Some cannot mask; some prefer not to.
Yet we have another group of people: those who are immunocompromised (IC) or in direct contact with IC and feel the need for greater protection. Either of these groups in isolation do not elevate conversations to hysteria, but collisions between the policy preferences of the two groups are producing chaos.
As a district education director responsible for special populations integration, we safely integrated immunocompromised populations into our school districts long before the advent of the COVID era. Special populations include immunocompromised, profoundly disabled, autistic, behaviorally challenged, and undocumented populations, and school districts have existing plans for integrating them.
It is critical for policy makers to understand that there are a million and one qualifying conditions rendering one unable to wear a mask, so masks therefore cannot be our blanket solution. The Americans with Disabilities Act establishes that while there are accommodations allowable to those who are disabled, they must be reasonable. I served a young man who weighed 350 pounds; he was nonverbal, profoundly intellectually disabled, and had a pre-existing biting issue. Attempting to mask him would not only have been cruel and confusing but also dangerous for any staff member attempting to do so. Asking him to mask so that you feel safer is not a reasonable accommodation. Preventing a student with a hearing impairment from lip-reading is also a failure in accommodation.
If a student, teacher, or parent cannot risk a major respiratory event, there are existing accommodations under the current FLDOE Matrix of Services (which is how schools determine funding for staffing) that can support IC without dictating that others make changes they may be unable or unwilling to adopt. These accommodations involve buy-in, flexibility, and trust.
For instance, when integrating a student with a peanut allergy, we either mandate an entire school to be peanut-free or we build a class based on choice and buy-in, with stricter protocols only for those electing to be in the class. Children who are staffed into classes involving buy-in have far fewer incidents of exposure because trust and protocols give people choices and specifics. The issue of IC in the COVID era is no different.
If schools ask their populations to self-identify whether or not they are IC/in need of accommodation, we can then populate smaller classes for them, with restricted access. The learning cottages at many of Florida’s campuses are already ideal for this; this is the bubble isolate concept, in which a school puts higher-risk persons in self-contained tiered groupings based on the accommodations needed by students and staff. These groupings are ideal for those with incredibly-restricted access to the public, and they involve a code of conduct. In these classrooms, children could physically be around one another with reduced risk of exposure. There are no guarantees, but there never were prior to this, especially among at-risk populations.
Access to proper containment-based testing is currently limited, as most test sites are not using exhale-filtering Personal Protective Equipment (PPE), so I would begin reintegration for the participants in these classrooms with a self-quarantine period prior to the start of class. Once self-testing is more readily available or testing facilities develop widespread control variables to ensure they are not also serving as transmission points, those can be incorporated to create osmotic immigration to and from the self-contained groups.
Osmotic immigration is the use of contagion-appropriate testing and quarantine periods before accessing self-contained and easily-isolatable groups such as nursing homes and adult care facilities. Our test sites currently are not using the correct PPE (masks, etc.) for a sub-0.3 micron particulate, and therefore they can act as a method of transmission if personnel are not using exhale-filtering respirators. Correcting this oversight would allow us to better attempt to shelter our protected populations.
For the general population, I would drop all attendance restrictions and switch to year-round schooling with an aim of 150 completed days within a calendar year. It has been common—even in our best schools—to send children back to class unless febrile, even if vomiting, and these practices need to stop. If a child is unwell, he/she should not be at school. If a child is sick with a known contagion, it is best practice to keep siblings home as well, as our home microbiomes are intertwined more so than in public spaces.
It is certainly time to take hygiene and wellness seriously, but the repercussions of children and resourceless parents spending extended time in isolation are vast, and our teachers and administrators who serve on the front lines of defending our youth have seen atrocities with lasting effects that no disease could rival.
I believe that people, most especially children, need contact. I believe that we have suffered a trauma as a global society and that coming out from isolation is daunting for some and terrifying for others. Some will need time, help, and reasonable accommodation. This proposal offers a path to providing accommodation to those who want or need it while allowing the rest to resume normal classroom activities without masks or social distancing.