Before Gov. Ron DeSantis pressed the state of Florida into the third and final phase of its reopening plan last week, public health experts were cautiously optimistic that Miami-Dade County, the hardest-hit in all of Florida, could begin to reopen its schools without risking another jump in new COVID-19 cases.
But the governor’s Friday afternoon executive order rushed a new current into what were relatively calm seas for virus transmission in South Florida, undercutting local face mask mandates and business restrictions, and rendering the outlook for Miami’s autumn more uncertain.
Suddenly weakened mask orders and the reopening of bars and restaurants at full capacity over the weekend flustered Miami-Dade County officials who have been trying to push transmission of the virus down to a lower baseline ahead of the fall. The governor’s order came on the same day Florida’s Education Commissioner cornered Miami-Dade County Public Schools into starting its phased reopening of in-person learning by Monday, ahead of schedule.
The staggered reopening of schools begins Monday with about 22,000 students in pre-kindergarten, kindergarten and first grade and students with disabilities who follow a modified curriculum. The second wave of 40,000 students will return to the classroom on Wednesday, including all elementary school children and students in sixth, ninth and 10th grades.
By next Friday, about 130,000 students whose parents opted over the summer for in-person learning will be back in school, a little more than half of the district’s total enrollment of 255,000 in traditional public schools.
As the calendar turns to October, Miami-Dade County is coming off two months of improving metrics on virus transmission, but recent days have brought a plateauing of COVID patient volume in county hospitals and the percentage of tests coming back positive has begun to pick back up, signaling a potential rise in cases.
“In a way, one could look at what’s happening in Florida as an experiment in public health without the informed consent of the population,” said Barry Bloom, an infectious disease expert at Harvard T.H. Chan School of Public Health. “And I am very concerned that, as was the case in Israel and many other places that relaxed without reducing community spread to a very low level, that the numbers will go up again.”
After days of pleading from teachers and parents to stand firm, the School Board on Tuesday said they had to move forward in accordance with the state’s expectations, or risk losing up to $85 million in state funding — potentially even more.
And so the board greenlighted the reopening of schools, despite having no comprehensive testing plan and knowing that some schools lack proper ventilation for controlling the respiratory virus.
Looming over the Miami-Dade school district reopening is a new understanding of the virus’ potential for airborne transmission in indoor settings over extended periods of time. The district has not been able to ensure proper ventilation for each one of its 340 schools, many of which have HVAC systems not powerful enough to push air through MERV 13 filters — the minimum rating deemed sufficient to filter out the virus.
Superintendent Alberto Carvalho said the district has replaced 40,000 air conditioning filters and a “significant number” are MERV 13 filters.
“I need to be honest, they’re not the majority,” he said, adding that schools around the state also have the same problem.
4,500 COVID-19 cases in Florida schools
While concerns over the spread of SARS-CoV-2 in newly opened Florida schools have heightened in South Florida this fall, DeSantis has largely downplayed the risk, last week suggesting that schoolchildren shouldn’t be required to wear masks or physically distance. On Tuesday, the state finally released data on more than 4,500 coronavirus cases linked to reopened schools stretching back to Sept. 6.
The rates of severe COVID-19 illness in children in South Florida have been remarkably low so far, area children’s hospitals told the Miami Herald. That is in line with the public health understanding of SARS-CoV-2, which largely spares younger people from critical outcomes of the virus.
But there is considerable risk in opening schools during a pandemic because they can potentially spread the virus, with children and young adults acting as vectors, according to infectious disease experts interviewed by the Miami Herald. The extent of that spread will depend on the school district’s plan to mitigate it, the experts said.
And yet crucial questions about the district’s readiness remain unanswered, including its plans to implement successful contact tracing, the last unmet criteria out of eight metrics that have guided the school district on whether to reopen.
Dr. Aileen Marty, a public health expert and Florida International University professor who has been advising the county, charter and private schools as well as the school district on the pandemic, said it’s still unclear how prepared the schools are, even as they prepare for an imminent reopening Monday.
“You’ll notice how [school district officials] try to get out of all kinds of questions,” she said. “Are all the schools ready? ‘Well, they will be.’ Well, when will they be? Which ones? How many?’”
School Board members voted to accept formal recommendations from medical experts prior to school reopening, and Marty said she wants to see more proof to back up reassurances from the district.
“Show me the hard data, don’t just tell me it’s done,” Marty said. “Show me the list of schools, show me what’s been changed. And then I know I can safely and honestly tell people, yes, we’re in a situation where at least 50% of the students can be face to face.”
Carvalho said he received eight comments from medical experts, though one didn’t say either way whether schools were ready or not.
The “vast majority said yes, no one said no,” he said.
After DeSantis’ order lifting most coronavirus restrictions on businesses, infectious disease experts told the Herald that the likelihood for a spike in COVID cases had grown, but it will be difficult to discern whether they came from schools or the other social gatherings allowed under the revised orders from Tallahassee.
“I don’t think you’ll be able to tell,” said Bill Hanage, an epidemiologist at Harvard’s T.H. Chan school.
Like his colleague Bloom, Hanage compared Florida’s fall reopening to that of Israel over the summer — a wide-ranging lifting of restrictions including schools and businesses.
Israeli leaders recently issued a national lockdown in response to surging cases and hospitalizations. Israel connected some of the first outbreaks of its resurgence to high schools, Hanage said.
“It’s difficult to say that it was necessarily education [that caused the spike] because they did so many other things at the same time,” Hanage said. “It could be education was what they noticed first because people were looking there.”
How ready are schools to fight the virus?
Carvalho said he had questions about ventilation for a “handful” of schools. Parents whose children attend those schools will find out by the end of this week if their school is ready or not.
Only five schools have bipolar ionization in use, installed as part of the district’s general obligation bond program. They are Andrea Castillo K-8, Lake Stevens Elementary, Miami Palmetto Senior High, Southwest Miami Senior High and North County K-8.
According to a response given by the Centers of Disease Control to the American Society of Heating, Refrigerating and Air-Conditioning Engineers, bipolar ionization is considered an “emerging technology,” with a less-documented track record of cleaning and disinfecting large and fast volumes of moving air within HVAC systems.
In an email, Miami-Dade Schools spokeswoman Jackie Calzadilla said the district is currently evaluating its windowless schools and “will be providing recommendations as to additional air-purifying devices as a pilot,” though they’ve had filter changes and fresh air adjustments.
When asked how parents can find out what changes have been made to their child’s school, she said, “Parents should inquire at their school as to what changes were undertaken.”
Teachers says classrooms aren’t ready
The United Teachers of Dade showed up to Tuesday’s School Board meeting with tales of unprepared classrooms and schools.
Members made unannounced visits to 17 schools diverse in population and socioeconomic level. They saw desks fewer than one meter apart, lack of PPE and unmarked seating designated areas.
“We can assure you that none of the schools we visited yesterday were 100% ready,” said president Karla Hernandez-Mats at Tuesday’s School Board meeting.
At a meeting with medical experts, deputy superintendent Valtena Brown said schools would be “100%” ready with all precautions and protocols by Sept. 25. But that date came and went as the district is still scrambling to have schools and personnel ready by Monday.
Contact tracing remains unproven
One concern for schools and SARS-CoV-2 is that if ventilation is not addressed proactively, an outbreak could occur beyond infected individuals in one room. Studies have shown that one infected individual with a high viral load can transmit the virus to dozens of others, and more science is emerging that suggests those “super spreading” events drive the bulk of cases.
Marty, the public health expert advising the district, said she was encouraged by the increase of 600 contract tracers to 900 by Dr. Yesenia Villalta, the head of the Florida Department of Health in Miami-Dade County. Those contact tracers, however, are for the whole county, but Villalta said the department has dedicated teams who will respond and investigate cases associated with both students and staff.
“That will help enormously when there is an outbreak, and there will be, to limit it to the fewest number of individuals and households,” Marty said.
The Department of Health would not agree to an interview to discuss contact tracing efforts with the Herald, instead responding by email. The agency has struggled to make inroads on tracing the contacts of infected individuals in South Florida.
While the health department has refused to release data to reporters, it has provided it to local officials, who have relayed the findings on contact tracing so far — the vast majority of people don’t cooperate. It’s unclear if the dynamic would be different for teachers, students and their parents.
Marty said the current contact tracing plan needs “more teeth.” She said while schools are traditionally better at contact tracing than the general community, “leverage is going to be [needed] to get people to cooperate.”
At a meeting with medical experts including Marty, Carvalho said protocols and assurances “regarding the necessity for information exchange and compliance” will be in place.
“They need to have an actual plan so everyone knows this is the consequence of not participating,” Marty said.
District officials said an $800,000 contact tracing application that rapidly pushes out information to affected employees and families was due to be ready Sept. 28.
The school district also does not have a plan in place for testing of students. School district spokeswoman Natalia Zea said the district has no current plans and has not declared a previous intent to test students for COVID-19.
“We have not received public health guidance relative to the routine testing of students in our schools,” she said.
No plan for testing school kids
Miami-Dade County Deputy Mayor Maurice Kemp said the county has scaled up from 25,000 tests a week to 75,000 tests a week, though it’s still unclear if that will be enough in the event of another spike in cases.
The availability of testing was one of the eight criteria set by the school district to open up schools, as is the rapid turnaround time for test results, which are now mostly available within 48 hours.
“We scaled up capacity in response to tremendous increase in testing in June,” Kemp said. “And we are ready in case we get another surge like that. We will try to maintain the capacity that we have.”
Kemp said earlier this week that the county stands ready to help the school district and that he will be working with the district to figure out how the county will help, but there is no existing plan between the county and the district for testing.
“We don’t have a finalized plan for school testing,” he said. “They may have one that hasn’t been shared with us yet. The communications are open. I can’t tell you exactly what their plan is.”
He said the county has some sites with tests available for children ages 12 and older, and others can do children as young as 5 years old and older. He said the county could send its eight mobile testing vans (or as many as 12) to school sites to test students or faculty.
Kemp said the County Commission recently passed a resolution to give preference to school district faculty and staff at at least one testing site in the county. The school district’s human resources chief, Jose Dotres, has said that three rapid testing centers will be set up around the county for district employees and their dependents.
Because of quarantine, many families have not taken children to get their immunizations required to attend school. Villalta noted, however, that there is a lag in the reporting of school immunizations to the health department and those figures are improving.
The school district is providing free immunizations at locations around the county. Appointments are required. Vaccinations are required for all students who attend schools, even through online distance learning.
All experts agree personal behavior, in the schoolhouse and beyond, is key to keeping the coronavirus at bay. The school district has echoed that sentiment in its messaging. School marquees around Miami-Dade County display the same message: “Mask Up Miami so MDCPS can return safe.”
“If people abide by that, we might be able to get through the fall and winter without having an astronomical rise,” Marty said. “What happens in schools isn’t just about the children. It’s also about the adults in that school and the parents of children and that has a spin-off effect on society in general.”