In their piece, "Data-Driven Reopening of Urban Public Education Through Chicago's Tracking of COVID-19 School Transmission," in this issue, Marielle Fricchione, Jennifer Seo, and Allison Arwady, all from the Chicago Department of Public Health, share their findings on the rates of school-associated COVID-19 transmission in Chicago.1 The study highlights the differences in transmission rates among youth in an environment where the country's largest private school system, the Archdiocese of Chicago, reopened for in-person learning, while the city's public school system remained in virtual learning due to the pandemic. They find that the COVID-19 attack rate for students and staff attending and working at in-person schools was lower than that of the overall city population. These data are critically important as school systems across the country seek to remain open or contemplate reopening while waiting for readily available vaccine.

Despite the many challenges, leaders at the local and state levels must prioritize in-person learning. And, in communities where schools are open, they should be the last establishments to close in the face of rising cases.

As we write this, there continues to be limited data available at the local, state, and national levels on the transmission risk of COVID-19 among students, teachers, and staff who are attending school in person. Earlier in the pandemic, many decisions had to be made without the benefit of data or information, given the novel aspect of COVID-19. While we still lack uniform data on such decisions, surveillance conducted in areas where schools opened, as done by the Chicago Department of Health, is critical to inform public health decision making.

The limited data now available, such as this Chicago study and those from other parts of the world, suggest that many COVID-19 cases occurring in school-aged youth can be attributed to extracurricular activities, social events, or other community exposures rather than transmission resulting from in-person instruction. In January, the US Centers for Disease Control and Prevention (CDC) published data and recommendations similar to what we saw in the Chicago study. They found "the type of rapid spread that was frequently observed in congregate living facilities or high-density worksites has not been reported in education settings in schools."2 In the area where we both work and live, Washington, District of Columbia, and its suburbs, an investigation conducted by local health departments found that what appeared to be an outbreak at a private school within the District was actually an outbreak originating at a house party in neighboring counties that students attended. Outside of school socializing, not in-person learning, led to the outbreak.

CDC's 5 key mitigation strategies to getting and keeping schools open are achievable in many communities, and we need to commit to implementing the measures and securing resources, as needed, to support in-person learning. These CDC strategies are

* Consistent and correct use of masks;

* Social distancing to the largest extent possible;

* Hand hygiene and respiratory etiquette;

* Cleaning and disinfection; and

* Contact tracing in collaboration with local health departments.

In addition to making sure that schools have the resources they need to open safely, support for in-person learning from teachers and other school-based workers and parents is critical. To achieve in-person learning, communities should take 3 key considerations into account: (1) rates of disease (often referred to as community spread); (2) trust and confidence in institutions to act responsibly; and (3) collectively prioritizing in-person learning.

First, to manage rates of transmission, communities need to understand that we are truly all in this together. This means that despite "COVID fatigue," everyone must adhere to commonsense public health guidelines: stay at home whenever possible; wear a mask when around people who are not part of your immediate household; wash your hands; and social distance while outside your home. Until a critical mass of the population is vaccinated, people need to limit the size of gatherings, even with friends and extended family, and do so outside when at all possible. In most places, if we have strong adherence to these community mitigation recommendations, and we carry these into the school environment, the risk of school-based outbreaks can be managed. Where there is lower adherence to community mitigation strategies, such as masking and social distancing, it is riskier to have schools open, not necessarily because of the school environment but because of the community disease burden. Public health prevention measures are the most straightforward way to keep schools, as well as businesses, open. Unfortunately, too many people are failing to do their part.

Second, we need to rebuild trust in our institutions. This means that every member of the pre-K-12 school community must play his or her role in implementing strict mitigation strategies. Parents, students, teachers, and staff share responsibility in reducing school-associated COVID-19 transmission in partnership with principals, superintendents, and elected and public health officials. Ultimately, families should have the flexibility to determine the best course of action for their young learners during these unprecedented times; however, we cannot continue to ignore the adverse impacts on our most vulnerable learners and the long-term consequences the delays in returning to in-person learning will have on the achievement of educational equity and health equity.

In this incredibly difficult situation, we need to work together and not let fear and mistrust get in the way of our kids' learning and social-emotional health. For example, while testing itself is not a panacea, one option to build trust and allay fear of coronavirus infection is to implement testing for school staff and students in those districts where teachers and parents want it and where resources are available. Officials at the local level can work in partnership with state and federal officials to ensure access to timely, routine testing, which can provide information about potential spread in schools. In the event of a positive test or exposure, teachers and administrative staff must have the ability to isolate or quarantine. We need to pay people to stay home to keep themselves, their colleagues, and our kids safe (not just in the school systems but also in our communities at large). We also need parents to keep their kids home if sick, and for those parents who might not have sick, leave provide assurances that they can stay home if their kids become ill.

Third, the support of parents and community leaders in prioritizing in-person instruction over other school-based activities is essential. Educational environments are often microcosms of our communities and just as we "dial-up or dial-down" activities in the broader community, we must understand that a return to in-person instruction may not be immediately accompanied by a return of all extracurricular activities and sports, as well as social activities taking place outside of school.

Over the past year, we have all worked collectively to achieve shared goals to keep our communities safe and provide our children the educational opportunities they so richly deserve. We must improve the expediency by which we prioritize a return to in-person education for our kids. In-person education is essential to our kids' social-emotional well-being. Virtual learning threatens kids' ability, in particular those already more at risk, to get and stay at grade level in reading and math. We need to safely keep our schools open, and when leaders have to make tough decisions to mitigate the impact of COVID-19 on their communities, K-12 in-person schools should be the last thing to close.

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