By Gabriella O’Leary, Alina S. Schnake-Mahl, Vaishnavi Vaidya, Usama Bilal, and Jennifer Kolker | November 18, 2021
In the context of disparate decisions across the country, heterogenous state and local policies, and little national guidance to prevent the spread of COVID-19, we set out to better understand decisions around re-opening indoor dining and in-person learning. We reviewed indoor dining and in-person elementary school policy decisions in the fall and winter of 2020 across 30 of the largest cities in the US. In this blog post, we summarize our findings from our article recently published in the International Journal of Environmental Research and Public Health`. Our analysis included descriptive data from the 30 cities that are members of the Big Cities Health Coalition (BCHC), a coalition of the largest metropolitan health departments in the US. We highlight important policy factors including pre-emption, jurisdictional power challenges, and political pressures, all of which played important roles in policy decisions across the cities. We found that re-opening dining was more common in cities across the country than re-opening in-person learning: indoor dining re-opened in fall 2020 in all 30 large US cities, but in-person learning resumed in public elementary schools in only 12 (40%) cities.
In-person learning is crucial for children’s educational and social development but there is debate in the literature about the COVID-19 risks associated with in-person learning. Importantly, recent research agrees that, when mitigation measures are in place, these risks are reduced, and levels of transmission in schools follow those of the general community (1-3). For this reason, keeping community transmission levels low is a key strategy to be able to continue in-person learning for children. Research now demonstrates that indoor dining is high-risk and closing indoor dining venues is an effective measure to reduce COVID-19 incidence and mortality rates (4, 5). Therefore, decisions about re-opening indoor dining directly affect risks for in-person learning. As we consider endemic COVID-19 and future pandemics, a retrospective analysis of policy decisions informs future responses as city and state governments assess the trade-offs between activities that are critical for society and non-essential businesses.
Indoor dining and in-person learning re-opening timelines
Our analysis compared re-opening of in-person learning in public elementary schools and indoor dining re-openings between May 1, 2020 and December 14, 2020 across the 30 study cities. The figure below (Figure 1) illustrates the differing indoor dining and in-person learning opening and closing dates throughout 2020.
Figure 1. Status of indoor dining and in-person learning in 30 large US cities. Source: O’Leary et al, IJERPH 2021.
Spring and summer 2020
In March 2020, schools in all 30 cities closed for in-person learning, and in-person instruction did not resume in any study cities until fall 2020. By September 2020, in-person learning resumed in 6 (20%) cities. In comparison, indoor dining re-opened in late spring/summer in 25 (83%) cities. Only 5 cities (Philadelphia, New York City, San Francisco, Oakland, and San Jose) did not resume indoor dining until fall 2020.
Early fall 2020
By the end of October 2020, indoor dining reopened in all 30 study cities while in-person elementary schools re-opened in only 12 (40%) cities (see Figure 2). In Charlotte and Indianapolis, public-school districts resumed in-person instruction in early fall, but returned to virtual learning by the end of fall because of heightened COVID-19 rates.
Figure 2. Status of indoor dining and in-person learning in 30 large US cities. Source: O’Leary et al, IJERPH 2021.
*New York City public schools closed for in‐person instruction on 19 November 2020 but reopened for elementary school students on 7 December
Late fall/early winter 2020
Figure 2 illustrates that by late fall, increases in COVID-19 cases led to the closure of indoor dining and in-person learning in many cities. By December 14, 2020, 15 (50%) cities were open for indoor dining; in-person learning was allowed in only 7 (23%) cities; dining was kept open, but schools were closed in 9 (30%) cities; and indoor dining and schools were open in 6 (20%) cities. New York City was the only city that kept schools open for in-person learning while closing indoor dining.
Discussion
Jurisdictional powers and political pressures around re-opening indoor dining and in-person learning informed policy decisions during fall and winter 2020, and are important considerations for future policy decisions. To start, there is substantial variation in jurisdictional power to close and re-open public schools and authority to determine indoor dining re-opening and re-closing also varies across states and cities(6). For example, in many cases, states, not cities, made indoor dining re-opening or closing decisions as part of state-led plans. Some state governments, such as Texas and Arizona, employed government pre-emption ceilings to prohibit local governments from enacting policies that put stricter restrictions in place. Secondly, political pressures also played a role in re-opening/closing policies. Teachers’ unions took part in negotiating school closures and re-openings, and the restaurant industry pushed to keep indoor dining open through lobbying efforts and lawsuits(7). In comparison to teachers’ unions, to our knowledge, there are few restaurant worker unions that advocated for the safety of restaurant workers.
Recommendations for Policy and Practice
As we shift to endemic COVID-19, this research presents important implications for policy and practice:
Policy:
- States and cities should consider vaccine mandates for indoor dining and in-person learning(8, 9).
- Continuation of federal funding is key for schools to implement mitigation strategies, particularly for underfunded schools.
- Federal, state, and local funding may be necessary to allow cities/states to close indoor dining or limit restaurants to lower-risk dining options if there are new outbreaks with extremely high levels of transmission.
- Cities need the ability to enact public health policies that are more protective than what the state enacts.
Practice:
- Strategies to safely re-open restaurants for indoor dining and reduce spread include providing adequate ventilation and outdoor dining options, promoting physical distancing, and offering flexible sick leave policies to employees(8).
- Mitigation strategies for schools include masking requirements, ventilation upgrades, vaccine mandates, and testing protocols (9).
- Cities/states should create plans to address learning setbacks from COVID-19 to ensure academic success for all (10).
Conclusion
As we look ahead to the 2021-2022 school year, endemic COVID-19, and future possible pandemics, this retrospective analysis can help inform future policy decisions around indoor dining and school closures/re-openings and help us understand past decisions. This analysis also has implication for future elections, as school decisions influenced some state-level 2021 elections(11). Moving forward, city and state governments should carefully assess the trade-offs between activities that are crucial for society and non-essential businesses.
To read the research in its entirety, please see the following link: IJERPH | Free Full-Text | Indoor Dining and In-Person Learning: A Comparison of 30 US Cities (mdpi.com)
References
- Levinson M, Cevik M, Lipsitch M. Reopening Primary Schools during the Pandemic. The New England Journal of Medicine. 2020 July 29, 2020;383:981-5.
- Lancker WV, Parolin Z. COVID-19, school closures, and child poverty: a social crisis in the making. The Lancet Public Health [serial on the Internet]. 2020; 5(5).
- Lessler J, Grabowski MK, Grantz KH, Badillo-Goicoechea E, Metcalf CJE, Lupton-Smith C, et al. Household COVID-19 risk and in-person schooling. Science. 2021 June 4 2021;372(6546):1092-7.
- Bilal U, Gullon P, Padilla-Bernaldez J. Evidencia epidemiológica acerca del rol de la hostelería en la transmisión de la COVID-19: una revisión rápida de la literatura Epidemiologic evidence on the role of hospitality venues in the transmission of COVID-19: a rapid review of the literature. Gac Sanit. 2021 April 8, 2021.
- Margaret A. Honein, Christie A, Rose DA, Brooks JT, Meaney-Delman D, Cohn A, et al. Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-Cov-2 and Related Deaths, December 2020. Morbidity and Mortality Weekly Report 2020 December 11, 2020;69(49):1860-7.
- School responses to the coronavirus (COVID-19) pandemic during the 2020-2021 academic year [cited 2021]; Available from: https://ballotpedia.org/School_responses_to_the_coronavirus_(COVID-19)_pandemic_during_the_2020-2021_academic_year.
- Will M. How Teachers Unions Are Influencing Decisions on School Reopenings. Education Week [serial on the Internet]. 2020: Available from: https://www.edweek.org/teaching-learning/how-teachers-unions-are-influencing-decisions-on-school-reopenings/2020/12.
- Jr. GPG, Massetti GM, Sauber-Schatz E. Mask Mandates, On-Premise Dining, and COVID-19. JAMA Insights. 2021;325(21):2199-200.
- Control CfD. Operational Strategy for K-12 Schools through Phased Mitigation. CDC2021 [updated July 9, 2021; cited 2021 August 3, 2021]; Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=.
- Board NYTE. The School Kids Are Not Alright. The New York Times [serial on the Internet]. 2021: Available from: https://www.nytimes.com/2021/08/21/opinion/covid-education-schools.html.
- Lerer L. The Unlikely Issue Shaping the Virginia Governor’s Race: Schools. The New York Times [serial on the Internet]. 2021: Available from: https://www.nytimes.com/2021/10/12/us/politics/virginia-governor-republicans-schools.html?action=click&module=RelatedLinks&pgtype=Article