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Schools can consider gradual return to in-person learning

TACOMA, WASH.—As part of collaborative discussions with school partners, Director of Health Dr. Anthony L-T Chen met on Sept. 3 with representatives of Pierce County public and private schools. He shared the results of that meeting today in a letter to school officials.

Sept. 4, 2020

Dear Pierce County School Superintendents and Heads of Schools:

Thank you for your ongoing partnership and the participation of your representatives at our meeting yesterday. We discussed the following topics:

Metrics for a gradual return to in-person education and current status.
How to have a gradual return to in-person education.
How to monitor countywide trends and support individual schools.
How to support ongoing collaboration and coordination between public and private schools.

1. Metrics for a gradual return to in-person education and current status.

To help schools and the public monitor COVID-19 activity level, we added metrics to our COVID-19 Information for Schools and Childcare webpage. Department of Health (DOH)’s decision tree provides four metrics for school administrators and local Health Officers to consider for in-person instruction:

14-day case rate per 100,000. Moderate target range = 75 to 25 per 100,000 population. Low target range = under 25 per 100,000 population.
Trend in percent of COVID-19 tests that are positive. Target = under 5% and stable or decreasing.
Trend in new cases of COVID-19 by day. Target = stable or decreasing.
Trend in hospitalizations because of COVID-19. Target = stable or decreasing.

Yesterday afternoon, the 14-day case rate was 73.5 per 100,000 population (with the required 6-day lag). We also see promising trends in the other metrics. This means Pierce County meets all criteria for the “Moderate Activity” level in DOH’s decision tree. While the decision tree recommends schools continue distance learning, they can consider expanding in-person learning to elementary students. Schools organized as K-6 should contact us (email Lori Karnes at to discuss an exception.

2. How to have a gradual return to in-person education.

As one of our participants stated, prudence and the intention of DOH’s decision tree encourages schools to return slowly and carefully. Each school district and private school has different facilities and considerations. We support schools as they implement their plans for a slow, careful return to in-person learning within the framework of DOH’s decision tree.

DOH’s decision tree for schools envisions in the moderate category that a return to school begins with elementary students. It suggests that, “over time,” middle and high school students could be added in a hybrid model. This gradual approach is informed by:

Youngest learners are at a critical stage in their development.
Youngest learners struggle the most with distance learning.
Elementary students in general remain in one classroom, which supports cohorting and infection control, in contrast with higher grade levels where students move between different classes.
Younger students appear to have milder disease and transmit COVID-19 less. However, older students are more similar to adults.

A participant asked about schools that are only high schools. We will meet separately to discuss.

3. How to monitor countywide trends and support individual schools.

We recommend, but are not requiring, schools interpret “over time” as a minimum of 21 days between steps. We have learned it takes about this long for stable or declining COVID-19 disease trends to become evident after policy changes. Surges and increases in community transmission often become obvious more quickly. Within 7-14 days we can see an upward trend in community transmission. If individual schools have positive cases or outbreaks of COVID-19, they should implement the necessary procedures in our School COVID-19 Case Response Toolkit. We will investigate the outbreaks and take necessary actions to address and contain the spread of disease. Outbreaks may require interruption of in-person learning to reduce disease spread.

4. How to support ongoing collaboration and coordination between public and private schools.

Collaboration and coordination with public and private schools to return students to in-person learning has been invaluable. We want to continue working this way as schools slowly and carefully resume in-person instruction and as the COVID-19 pandemic evolves. We will discuss what this might look like at future meetings. We are committed to working collaboratively with schools to provide the most stable and predictable educational experience possible for students and families while still protecting the community from disease outbreaks.

We are in a much better position today than we were in July and August when schools needed to plan for the beginning of the school year. The significant decrease in our case rate is a success to build upon as we continue to work together to drive down this disease in our community. Please continue to communicate to your communities the importance of wearing face coverings or masks, limiting their travel and group size, maintaining physical distance, and observing hygiene and sanitation practices.

To respect the request of participants to allow time to discuss internally and prepare communications for your community, we will delay our public announcement of this letter until later this afternoon.

Our small workgroup will meet again early next week.

Thank you for your continued partnership.


Anthony L-T Chen, MD, MPH Director of Health

About Tacoma-Pierce County Health Department: Tacoma-Pierce County Health Department’s mission is to protect and improve the health of all people and places in Pierce County. As part of our mission, the Health Department tackles known and emerging health risks through policy, programs, and treatment to protect public health. We are one of roughly 244 accredited health departments in the country and among six in the state to have met or exceeded the Public Health Accreditation Board’s quality standards. Learn more at

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