School-aged children experienced substantial challenges to health and well-being as a result of school-building closures due to the coronavirus disease 2019 pandemic. In hopes of supporting equitable and safe school reopening for every student across North Carolina (NC) and improving child health, researchers from Duke University and the University at North Carolina at Chapel Hill established the ABC Science Collaborative (ABCs) in July 2020. The ABCs collected data related to in-school severe acute respiratory syndrome coronavirus 2 transmission and adherence to mitigation strategies. These data were presented to NC government officials, including the NC Department of Health and Human Services, the NC Department of Public Instruction, and Democratic and Republican representatives from the NC General Assembly. These data-sharing practices led to the implementation of in-person school legislation in early 2021 in which in-person school access for every student was required, the full-time in-person reopening of NC public schools was supported, and weekly reporting to the ABCs of coronavirus disease 2019 infections from >1 000 000 children and adults was required.
In March 2020, the coronavirus disease 2019 forced the younger generation into virtual learning environments. These school-building closures had negative consequences on children’s health and well-being, including social isolation, adverse psychological impacts, and food insecurity.
We describe a partnership between academic researchers and local school districts in North Carolina whose goal was to offer support regarding decisions about in-person learning, provide resources, and generate new data in favor of equitable and safe school reopening.
The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, resulted in immediate halting of in-person, kindergarten through 12th grade (K–12) education in the Spring of 2020. Concerns about potential COVID-19 spread in schools forced K–12 students into virtual learning environments. Unfortunately, these school-building closures had negative consequences related to child health and well-being. Compared with in-person learning, children aged 5 to 12 years receiving virtual education experienced decreased physical activity (30.3% vs 62.9%) and worsened mental or emotional health (15.9% vs 24.9%), as reported by their parents.1 Similarly, in the longitudinal Norwegian Family Dynamics Study (n = 442), researchers found significant associations between remote learning, social isolation, and adverse psychological impacts in children.2 Reduced access to in-person education also had an effect on access to proper nutrition and food security. In June 2020, the rate of food insecurity in children was 5.5 times the rate in 2018, as reported by the US Census Bureau.3 Furthermore, Feeding America has estimated that 13 million children, or 1 in 6, will experience food insecurity in 2021.4
As students struggled with virtual learning environments, many school districts across the nation were given the freedom to determine best practices for the schools under their remit. Local and state policies were paralyzed in some locales and fueled by COVID-19 disbelief in others. National policy, guidance, and leadership regarding the issue of school-building closures were absent. These factors ultimately resulted in disproportionate access to in-person school on the basis of race and ethnicity, geography, political affiliation, and grade level. From September to December of 2020, 38.0% non-Hispanic White students, 32.3% non-Hispanic Black students, and 35.9% Hispanic students had access to in-person learning.5,6
Researchers from Duke University and the University at North Carolina at Chapel Hill anticipated some of the difficulties that school districts would face when trying to decide whether to return to in-person education. In July 2020, these Duke University and University at North Carolina at Chapel Hill researchers partnered with local school districts to establish the ABC Science Collaborative (ABCs), whose goals were to offer support to school districts as they made decisions about in-person learning, provide resources, and generate new data in favor of equitable and safe school reopenings for every student across North Carolina (NC).
Methods and Process
The ABCs first established relationships with key stakeholders within >50 NC school districts, including superintendents, teachers’ union leadership, teachers, administrators, and parents. We held weekly (sometimes daily) meetings with these groups to understand their primary concerns and varying viewpoints related to COVID-19 and its effect on the school environment. During these meetings, ABCs faculty provided education to meeting attendees, including the most recent and relevant science related to COVID-19 transmission and mitigation practices. School leaders used the sessions to share information with each other, often devising practical and creative approaches to meet the demands of public health guidance within their school buildings. The ABCs also met regularly with NC Department of Health and Human Services leadership to report on research findings from school-related data collection and to provide updates from various stakeholders from NC school districts. Similarly, ABCs faculty established relationships with the NC Department of Public Instruction, as well as with Democratic and Republican representatives from the NC General Assembly. We provided updates to these stakeholders on their established processes for simple data collection from school districts, how the process of data collection had served as a point of accountability and transparency for the districts with parents and staff, and how return of results to the districts had resulted in mitigation strategies that helped limit within-school transmission of SARS-CoV-2.
The ABCs established data use agreements with 11 local school districts who opted to try in-person learning during the first 9 weeks of the 2020–2021 school year. Throughout the first quarter of instruction, the districts and local health departments engaged in close monitoring of primary and secondary COVID-19 infection data to assess within-school transmission rates, whereas the ABCs faculty provided real-time complimentary consultation; together, we recognized that mitigation strategies could control and reduce COVID-19 transmission within schools.7 These data provided the first large-scale account of SARS-CoV-2 transmission in US K–12 schools. This information assisted in prompting the first national guidance on schools from the Centers for Disease Control and Prevention and became a foundation of advocacy for safe in-person education for the children of NC.
In January 2021, while most NC school districts continued to only provide remote education, the NC General Assembly Committee on Education invited the ABCs faculty to present the most up-to-date data on COVID-19 transmission within participating NC school districts. Subsequently, NC General Assembly members drafted and successfully passed legislation requiring access to in-person education for all NC K–12 students. Per this legislation, all elementary school students, as well as disabled children of all ages, were required to have the option for full in-person education with appropriate masking and with no requirements for physical distancing. Middle and high school students were required to have the option to receive either hybrid or full in-person education with no requirement for physical distancing. Additionally, to provide a neutral third party for review and interpretation of data, all districts offering full in-person education for middle and high school students were required to submit weekly data to the ABCs on primary COVID-19 cases within school buildings, as well as secondary transmission. Data collection also included the number of students and staff participating in in-person school, physical distancing in school (eg, <3 ft, 3–6 ft, 6 ft) and on buses (eg, 1, 2, or 3 students per bus seat), and information about the contribution of sports to infections. Each month, the ABCs aggregated and reported the data to the NC Department of Public Instruction. Furthermore, we continued to provide real-time lessons learned to superintendents at weekly meetings, as well as to parents and the broader community in biweekly newsletters. Each week, the ABCs had weekly meetings with government agencies (twice monthly with NC Department of Health and Human Services and monthly with staff from either the Centers for Disease Control and Prevention or the National Institutes of Health) to provide data summaries and identify potential areas of risk.
The ABCs faculty taught superintendents about science, virology, epidemiology, and clinical medicine; in turn, superintendents taught ABCs faculty about engaging in K–12 education. The issue of safe school reopening remained a topic of much debate, not to mention a source of substantial division between political parties, parents, teachers, and administrators. These challenges were addressed by attempts to reach across party lines via collaborations with key NC Republican and Democratic leaders, as well as regular conversations with the teachers’ association, superintendents, and families. The ABCs’ advocacy efforts were aimed at helping politicians understand the existing scientific data, with directed focus on unifying issues that crossed party lines, such as the health and well-being of students in the virtual environment, as well as the long-term importance of health and safety within the school environment. For teachers, school leaders, and families, the ABCs focused on the common goal of establishing a long-term culture of health and safety within the school environment, starting with the safe return of students and staff to in-person learning during the pandemic. The success of our partnership with superintendents, administrators, teachers, and parents in NC was evidenced in the passage of legislation in which school districts were required to offer in-person school, the number of districts choosing to provide full in-person education for middle and high school students, and the consistent reporting of data from participating districts.
Through this advocacy work and the consequent legislation, 100 of 115 NC public school districts were able to provide full in-person education to grades K–12. Legislation requiring in-person education for all public charter schools and mandatory offerings of summer school soon followed. All 100 participating school districts and 14 charter schools submitted data to the ABCs, including completing the initial survey in March 2021, submitting weekly data, and completing the final survey in June 2021. Those reporting school districts and charter schools represented 2396 elementary schools, middle schools, high schools, and administrative buildings; >864 515 students who attended in-person school; and 160 549 staff who worked in school and administrative buildings. Including students who received online instruction, the districts comprised 1 281 202 students. We reported our key findings in a final summary document and a position paper.8
This advocacy work and the resulting data have proven critical to inform core mitigation measures and plans for reopening in-person school during the 2021–2022 school year. Overall, the advocacy was crucial to guiding the reopening of NC schools, informing policy nationally, establishing equity in access to in-person education for every NC child, and improving child health.
The ABCs highlight the importance of establishing a common cause across stakeholders, particularly because it was evident early in the process that political and personal interests were guiding stakeholder decisions. Nevertheless, encouraging a refocus on children’s needs supported by scientific evidence established an important common cause, which was prioritized over other interests. We found that securing local data, presenting the data, and having the data withstand peer review was centrally important to guide legislation. The ABCs advocacy work also highlights the importance of involving a neutral third party when navigating a highly politically charged issue, such as how to safely return to school in the middle of an international pandemic. In this instance, the ABCs acted as a third party, providing an objective stance to guide legislation. This collaboration of academic scientists, public schools, and local government successfully improved child health through the establishment and acceptance of local legislation.
The ABCs started locally, but grew nationally, as a partnership between academic investigators, legislatures, school leaders, and government agencies to inform legislation promoting child health, well-being, and equality through the reopening of in-person schools during the COVID-19 pandemic. The data-driven research infrastructure generated by the ABCs has become a trusted school resource and will continue to nourish child health advocacy for years to come.
Erin Campbell, MS, provided editorial review and submission.
Drs Zimmerman and Benjamin conceptualized and designed the study, drafted the initial manuscript, reviewed and revised the manuscript, designed the data collection instruments, collected data, conducted the initial analyses, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content; Dr Jackman conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: Funded in part by the Rapid Acceleration of Diagnostics (RADx) Underserved Populations (RADx-UP) (U24 MD016258 [National Institutes of Health [NIH] Agreement No. 1 OT2 HD107543-01, 1 OT2 HD107544-01, 1 OT2 HD107553-01, 1 OT2 HD107555-01, 1 OT2 HD107556-01, 1 OT2 HD107557-01, 1 OT2 HD107558-01, and 1 OT2 HD107559-01]); the Trial Innovation Network, which is an innovative collaboration addressing critical roadblocks in clinical research and accelerating the translation of novel interventions into life-saving therapies; and the National Institute of Child Health and Human Development contract (HHSN275201000003I) for the Pediatric Trials Network (principal investigator, Daniel Benjamin). The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the NIH. Funded by the National Institutes of Health (NIH).
CONFLICT OF INTEREST DISCLOSURES: Dr Zimmerman reports funding from the National Institutes of Health and US Food and Drug Administration. Dr Benjamin reports consultancy for Allergan, Melinta Therapeutics, and Sun Pharma Advanced Research Co. Dr Jackman has indicated she has no potential conflicts of interest to disclose.
In July 2020, academic researchers partnered with local school districts to establish the ABCs, which offers guidance on safe NC school reopening.