Districts Are Leaning on Medical Advisers to Help With COVID Policies. It’s Paying Off

It’s a Wednesday night, and the DeKalb County, Ga., school district’s medical advisory committee is having its debut moment, so to speak.

The committee has been working with the district for about a year now, helping to shape its back-to-school plans, inform its upcoming decisions about COVID-19 vaccinations and testing, and increasingly, play a public-information role, as embodied by tonight’s meeting.

When the Zoom public forum goes live, the screen is a pleasing cross-section of medical experts in this diverse district: Doctors, disease experts, pediatricians, academics—younger and older, Black and white. They’re the same folks parents in the district take their kids to, and the same ones who work in nearby hospitals.

The public meeting starts with the basics—what is the COVID-19 virus, anyway? Why do masks seem to prevent transmission?—but it will conclude with much- more specific information and myth-busting for parents, like what to do when a child gets sniffly during the approaching cold-and-flu season.

Some of the committee members’ responses are sobering reminders of the seriousness of the pandemic.

“One myth that drives me crazy is that kids don’t get sick. They absolutely can get sick, and some children die from it, and they can have serious illnesses even if they aren’t hospitalized,” warned Dr. Veda Johnson, a professor of general academics and pediatrics at Emory University School of Medicine, midway through the meeting.

As the weeks and months of the pandemic have stretched into years, more districts are relying on arrangements like DeKalb’s to help them answer the ever-increasing number of questions and to boost confidence that their decisions find the right balance between keeping kids safe and keeping them learning.

Cheryl Watson-Harris, the DeKalb superintendent, decided to set up the medical advisory committee shortly after assuming the reins at the suburban Atlanta district in summer 2020. Formerly in the No. 2 spot in the huge New York City schools, she’d witnessed the summer surge there and the accompanying death and hospitalization of students and staff.

She knew that her new district, with more than 93,000 students, was heading toward a similar situation, and determined she would get access to the best information she could.

“In a district like mine that is so incredibly and beautifully diverse, including diversity of thought, I would never be able to please everybody. So as a superintendent, I felt it was very important to have as much of a scientific and clear way of decisionmaking so that I wouldn’t have to float in the wind based on politics or just the varying perspectives on what should be done,” she said. “And I am an educator; I am not a medical professional, nor am I a scientist in that regard.”

From big to small decisions, districts’ medical advisory panels weigh in

The pandemic has put superintendents in a near-impossible situation. They have had to wrestle with difficult health-related decisions on masking, mitigation protocols, “test to stay,” and vaccination policy. And they’ve had to do it while sorting through the morass of conflicting or unfeasible government recommendations and getting controversial new policies through U.S. school systems’ delicate and slow-moving arrangement of local board governance.

It’s unclear just how many districts have formally established a medical advisory committee to help them with those difficult tasks, but those that have detail a number of decisions that they’ve relied on their panels to help with.

Take Massachusetts, where recently issued state guidance says if schools hit a vaccination rate of 80 percent, they can move to make masking optional. It seems clear and direct, but there are a multitude of questions local leaders have to process before they can act on it, said David Fleishman, the superintendent of the Newton, Mass., district.

“Well, what do you do with that? Who do you consult? What about the 10-15 percent of kids who are not vaccinated, is that a sound thing to do? I’m not in a position to make that judgment, and depending on your community, you can imagine people are going to feel differently,” Fleishman said. He set up his medical advisory group in February of this year.

The panels serve a different function from the more typical community advisory groups comprised of parents, teachers, and other local constituents. They’re designed to weigh in on research and districts’ mitigation plans with the kind of professional knowledge laypeople don’t possess. They often have access to the newest research on COVID-19 coupled with the analytical backgrounds to make sense of it. Sometimes, too, they’re the ones who remind school leaders that there are questions about COVID that just don’t have clear answers yet.

The committees don’t actually set policy themselves—that would bump up against the governance and decisionmaking powers of school boards and superintendents. But they do weigh in, often forcefully, and sometimes their recommendations are prescient.

In the Howard-Suamico, Wis., district, for example, Superintendent Damian LaCroix decided at the beginning of the school year to make wearing a mask a recommendation. (His district’s medical advisory committee had urged a requirement.) But mid-September, as rates increased, LaCroix reverted back to a mask requirement.

Florida’s Orange County district’s medical advisory panel, begun before the 2020-21 school year, helped the district devise ways to keep band practice and football games going, and to troubleshoot small-seeming but consequential details, like keeping students hydrated when shared water fountains are off limits, noted Pam Gould, the vice chair of the county school board.

In Orange County, she said, the committee has also supplied critical anecdotal trend data of its own. Every day, its members are in hospitals, clinics, and other settings where they are directly observing the course of the virus. That’s important because Florida this summer changed how it collects and reports COVID-related deaths, and how it provides reports on school-based infections, which has led to delays in getting accurate figures to school leaders.

“Without that boots-on-the-ground perspective and access to that data, we would not have the information we need to make these decisions,” said Gould.

In Newton, Fleishman says, some of the recent questions include whether to permit students and teachers to sing in music classes even with masks on. (His panel has so far recommended that it should only be done outside or if 6-feet social distancing can be maintained.)

Overcoming obstacles

The committees generally meet in private with one or two board members, the superintendent, or other central office liaisons. (The Howard-Suamico district also included a student representative, whose participation led to a pop-up vaccination clinic for eligible high school students.) A few, like Orange County’s, are organized as board subcommittees and therefore open to the public.

The panels typically include pediatricians, general practitioners, epidemiologists, school nurses, and sometimes academics or representatives of the large local health systems or hospitals. In general, said Johnson of the DeKalb committee, district leaders interested in creating their own panels should reach out to whoever they think can effectively serve on the panels, including parents in the district who are themselves medical professionals.

The biggest challenges to putting such a group together she said, is that educators and health professionals often feel awkward navigating one another’s worlds.

“There are a large number of pediatricians and others who would like to be a part of something like this,” Johnson said. “They just don’t know how, and the schools don’t know how to reach out to them and galvanize them.”

And there can be discomfort over territory, too, from board members or district leaders who are wary about encroachment.

“They’ll say things like ‘schools are not doctors’ offices.’ So you have values systems that come into play, where they prohibit or discourage them from partnering with resources in the community,” Johnson said.

Building district leaders’ confidence

Have the panels, where they’ve been successful, helped tone down some of the high-pitched drama that has boiled over into school board meetings nationally?

In a word, no, superintendents say. But having the panels has bolstered their confidence in their plans, because they are able to point to a strong rationale for their decisions.

“If I could say anything about the committee, it’s that I’ve never felt like I was alone,” said Watson-Harris. “And I felt as though whatever decisions we’ve made with our expertise in terms of school management and education, we also had the added level of confidence from the medical advisory team.”

LaCroix of the Howard-Suamico district agrees.

“I will tell you there is clearly knowledge and understanding that the committee exists, and depending on [community members’] point of view, they think it’s a good idea or they wonder why that group has that degree of influence,” he said. “But I believe the school board feels like [the panel] plays a valuable role in being a thoughtful, informed, educated group who can advise us. … Even when we’ve had disagreements, the committee has been respectful, and stayed the course.”

Doctors and nurses who serve on the committees aren’t shielded from strong community responses, either, which is another wrinkle district leaders have to consider. In the Elmbrook, Wis. schools—the model for Howard-Suamico’s approach—the panel’s feedback was instrumental in helping that district offer-in-person learning in the 2020-21 school year. But the district closed the panel in June after members got abusive messages, said Chris Thomas, the district’s chief strategy officer.

“Unfortunately, this advisory board became a part of the partisan politics in our community, and we did not feel it was acceptable nor appropriate to put our medical professionals in the middle of the crosshairs of our community for their voluntary service,” he said.

Asked if she’s gotten nastygrams as a result of her work, Dr. Johnson of the DeKalb medical advisory committee chuckled. “Oh yeah, absolutely,” she said. “And I’m inclined to answer!”

She’s even gotten pushback from other non-committee doctors who advocate a lighter touch on mitigation measures than what the panel and school district have chosen. But she’s gotten some heartfelt thank-you messages as well.

The full range of opinions was on display when DeKalb held its Zoom meeting in September.

In the chat, some parents urged the district to return to remote learning given the state’s high rates of COVID-19 transmission and child hospitalization. Some pressed the district to expand testing locations or begin surveillance testing in schools. At least one anti-masking parent served up an odd mix of religion and conspiracy theories about masking, urging the district to rely on “the divine immune system.”

But beyond all that, the most telling moment came at the end: a quick profusion of messages in the chat from attendees who had up to that point been observing silently.

“Thank you,” one typed. Said another: “Please do another event like this.”