As public and Catholic schools in the Bethlehem area enter 2021, school officials hope to finish the year without unanticipated shutdowns.

In the Allentown Diocese, which serves roughly 10,000 students, most grade schools (kindergarten through eighth grade) are operating with students on-site five days per week, with an optional 100 percent virtual program for families who choose it. Allentown Central Catholic HS, Bethlehem Catholic HS, and Notre Dame HS have students on-site two days per week, in order to ensure six-foot distancing between students’ desks at all times.

The Bethlehem Area School District (BASD), which was profiled in the Washington Post in mid-November for its absence of in-school coronavirus transmission (https://www.washingtonpost.com/education/pennsylvania-school-in-person-classes/2020/11/12/c3119142-13a7-11eb-ba42-ec6a580836ed_story.html), has roughly 80 PERCENT of its students on-site two days per week in a hybrid model, in sharp contrast to the many public school districts on the East Coast practicing 100 percent distance learning. Some families and teachers have opted into a 100 percent virtual model called eClassroom, which is run separately from the virtual instruction students in the hybrid model receive on their at-home days.

BASD public schools used 100 percent distance learning from Dec. 14 through the first week after winter break, and plan to return Jan. 11 to the hybrid model.

Both the public and the Catholic schools have been operating with strictly enforced protocols aimed at preventing in-school transmission of the novel coronavirus.

At present, all students and staff in both public and Catholic schools (with extremely few exceptions, for students with very particular special needs) maintain six feet of distance at all times, and wear cloth masks at all times. Although some schools, such as Our Lady of Perpetual Help in Bethlehem Township, indicate on their health and safety plans that staff are temperature-screening students as they arrive at school, most schools in the Bethlehem area have tasked parents with checking students’ temperatures and looking for respiratory infection symptoms at home.

Although many school health and safety practices were developed with the assistance of the City of Bethlehem Health Bureau or in accordance with CDC recommendations, some were implemented when the Pa. Department of Health issued mandates at the end of the summer. For example, as we reported Aug. 11, the Allentown Diocese planned to have students wear neck gaiters for use in hallways and at times when contact might be unavoidable, but flipped to universal cloth mask-wearing 100 percent of the school day by the time schools opened in the fall. Similarly, although BASD had anticipated in mid-July having the bulk of elementary students in school buildings five days per week, dictates from the state Department of Health changed those plans as well.

The false assurance of temperature checks

There is no consensus among infectious disease experts on the best practices for schools. Dr. Jonathan Spero, CEO of InHousePhysicians and a consultant to New York City schools, advises schools to take temperatures on-site and to test asymptomatic students randomly for the novel coronavirus. Neither the Catholic nor the public schools in the Bethlehem area have adopted on-site temperature checks wholesale, nor is either system testing asymptomatic students who have not had contact with individuals who have tested positive.

City of Bethlehem Health Bureau Director Kristen Wenrich explained why her office has not recommended at-school or at-work temperature screening: “The first reason is that when we analyzed our data from COVID-19-positive cases, a large percentage did not have fever upon onset of symptoms, or never developed a fever.” Wenrich’s finding is consistent with what virologists have observed over the past several months. In a paper published Dec. 10 in the Virology Journal, Dr. Kuanrong Li and colleagues state that only 60 percent of their pediatric coronavirus patients had a fever, but that 92 percent of their pediatric adenovirus patients did, indicating that fever is neither necessary nor sufficient for coronavirus diagnosis. “I believe that temperature checks create a false assurance,” Wenrich clarifies.

Wenrich also points out that the logistics of managing at-school temperature screening pose challenges, and that “if someone does present with a fever, they have already traveled to school and entered the building,” limiting the effectiveness of observing the fever at that point.

Instead, Wenrich has helped schools implement at-home symptom screening. “Parents and guardians are asked to screen their child(ren) every day before school, and if their child(ren) present with certain symptoms, they are required to stay home from school.”

Dubious cost/benefit ratio for asymptomatic screening

Dr. Spero, who has advised NYC public schools to test asymptomatic students as part of a return to in-person instruction, asserts that “Frequent asymptomatic testing of the student population is a very effective way to limit the spread of the virus in the school.”

However, BASD public schools operated without testing asymptomatic students for the fall semester, and had no cases of in-school spread. Abundant data from schools in other countries, as well as data from daycare centers and summer camps in the U.S., indicate that children are far less susceptible than adults and that asymptomatic children have a lower viral load than symptomatic ones. In a recent JAMA Pediatrics paper (“School closures during the COVID-19 pandemic”) and a follow-up letter (“Debates around the role of school closures in the Coronavirus 19 Pandemic - Reply”), Dr. Susanna Esposito and Dr. Nicola Principi argue that “if susceptibility is low, [then] many children are asymptomatic with low viral load, and they do not have a relevant role in maintaining the COVID-19 pandemic.”

Common to both Catholic and public schools in Bethlehem is contact tracing, in which Bethlehem schools notify the City of Bethlehem Health Bureau about students and staff who test positive, providing the bureau with a list of any close contacts that occurred on school property. In BASD public schools, video camera footage from cafeterias is used to augment tools such as seating charts and individuals’ reports in identifying contacts. Close contacts of individuals who test positive are asked to stay home for a period of 14 days.

No normal in sight

It is unclear when local students will be allowed to have a normal school day. Understandably unable to predict community prevalence of positive tests, local officials appear reluctant even to go on the record with with specific numerical criteria for a return to normal education.

Regarding recommendations the City of Bethlehem Health Bureau would make, Wenrich told us that the bureau is monitoring several metrics, including community incidence rates (positive tests per 100,000 residents), community positivity rates (positive tests as a percentage of total tests), number of cases per school building over a 14-day period, spread within school settings, and absenteeism. “Now that the vaccine is available,” Wenrich added, “we will monitor this metric [vaccine uptake] as well.”

“We look forward to a return to normal school routines like those before the Coronavirus struck,” the Allentown Diocese said through a spokesman. “That will happen when the virus abates in the community and the Education and Health departments change their guidance.”

Given that the Pa. Dept. of Health mandated six-foot distancing and all-day mask-wearing in schools and recommended hybrid or fully online school attendance in August, when there were 27.9 positive tests per 100,000 Northampton County residents – there are roughly 1,000 per 100,000 residents now – a return to normal seems a long way off.