Safety Lasagna: Precautions in Schools

Emily Oster

8 min Read Emily Oster

Emily Oster

Safety Lasagna: Precautions in Schools

Emily Oster

8 min Read

First, for those reading this on the West Coast, I hope you and your families are as safe as possible. Many of you have written to ask about evidence on wildfire smoke, and I hope to be able to write a bit on this early next week.

Today, I wanted to reflect a bit on safety precautions in schools and thinking about why each of them are in place. This is largely question motivated. For example:

Our kid is in a small home day care. Because the pod is so small, is there any reason to wear masks?

or…

The science teacher in my kids school goes around between the classrooms and teaches. Doesn’t this ruin the pod system?

or…

What on earth is the point of temperature checking?

The second of these is probably the most common, and complicated. I hear it from parents, but also teachers: you said the reason the school is safe is the pod system, and yet I’m being asked to visit all the different pods. How can that be safe?

If you are a regular reader here, you will probably recognize the fact that I have really only one insight. Namely, that we should not look at questions like this individually, but step back to the bigger picture and develop a framework for answering them. (Perhaps someday I will have additional insights, but today is not that day).

The framework I want to set up here is the “safety lasagna” (shout out to Steve Baskin for this phrase, and also this earlier guest post on this newsletter with lots of details on particular protections). Protection comes in layers, but not every layer protects from everything. What am I talking about? Read below. Lasagna framework first, then some guidance on questions.

The Lasagna

What are we trying to achieve?

Safe school reopen means preventing spread of COVID-19 in schools and preventing community spread of school-acquired infections. Period. That is what the schools can control; they cannot control what goes on around them, or what people do with their off school time.

There are three layers to this (hence, a lasagna).

  • Layer 1: Prevent cases from coming into school
  • Layer 2: If a case gets in, prevent it from spreading
  • Layer 3: If a case spreads in school, prevent it from causing an out-of-school outbreak.

Virtually everything places do in safe reopen plans fall into one of these layers. But the key is they do not fall into all of the layers.

Layer 1: Prevent Cases from Coming In

You do not want people to arrive at school with COVID-19. Beyond generally telling people to be cautious outside of school, the major activities schools do here are: enforcement of not coming to school sick, symptom reporting and temperature checking.

The first of these is probably the most crucial. As school and child care centers open, it is necessary to move to a system where people keep sick kids home, and where sick adults also stay home. Part of this is enforcing to parents that they cannot just medicate their kid up and send them in. But the other part is providing support (including testing, but also backup child care and paid leave) when families do need to keep a kid home. Schools need to make sure staff know that they should stay home when sick, and they need to pay them. This may seem obvious, but it is worth saying.

Symptom checking and temperature taking are, in some ways, more performative. You can always say you have no symptoms, and temperature isn’t the only indicator of COVID-19. However: I think they have value if only in making people reflect on how they feel and in making clear that the location is taking the problem seriously.

This first layer is also why we limit parents and others from entering schools. It’s all about keeping the virus out.

Layer 2: Preventing Spread

Most of what schools are doing is intended to prevent spread. This, itself, is multilayered.

  • Masks: prevent spread by limiting particles. Useful for both students and staff.
  • Distancing: keeping teachers distant from students; teaching from the front of the room, 6 feet away if possible.
  • Individual desks, distanced if possible.
  • Hand washing! Hand Sanitizing! So much of it.
  • Not sharing food, eating lunch at desks
  • Keeping windows open, being outside.

There are undoubtedly more things on this list. And not every school will do all of these things in every moment. One key is that they help reinforce each other. If kids aren’t always perfect at wearing masks, the fact that they have their own desks will keep spread limited. If they wash their hands, then the fact that they do not always successfully distance will matter less. Being able to keep the windows open is great, but if you cannot do that, masks and distancing and hand washing can all still help.

Or, if you cannot mask, or that isn’t a requirement of the school, these other efforts can help keep spread down.

The goal of this lasagna layer is to limit spread in schools. I emphasize this so we can interpret what we see in data. In particular: if a staff member at a school gets COVID elsewhere, or a child gets it from a parent, this is a school case, but it doesn’t suggest a failure of in school procedures. In school use of masks will not prevent this, and we should not assume masks are a failure in these cases.

Layer 3: Preventing Escape

If layers 1 and 2 fail, and someone is infected with COVID-19 at school — which will happen, it’s not reasonable to pretend it will not — the hope is that the infection will stop there. I think among the biggest fears about school re-open is that they will be the source of large outbreaks in the older population. This is of particular concern since adults are the higher risk group.

The most significant way schools are doing this is with use of pods. By keeping kids in stable groups, if a kid is sick and if they transmit in school, then the number of possible outside contacts is more limited.

This limits infections, and it also helps control quarantine needs. If every kid sees every other kid in the school regularly, then one infection would mean an entire school would need quarantine.

The other significant step to prevent escape is limiting adult access to schools. If parents are exposed only to their own children, that’s better than if they are exposed to everyone (this prevents intake also – its a layer 1/3 combo!).

There are many other things schools do which I haven’t mentioned here. But my guess is nearly all of them can fit into one of these layers.

Thinking Through Questions

This framework (at least for me) helps me think through both why we see some of the approaches we do and what to do if you have a choice.

Example: Why run a hybrid schedule with half the kids in each day? Hybrid schedules affect layers 2 and 3 of the lasagna. Fewer kids in school at a given time = possibility of more distancing (layer 2). And by stretching to have fewer kids in the same number of classrooms, you are able to create smaller pods (layer 3).

Example: Why is high school harder than elementary school? One reason for this is that high school students are more susceptible to the virus and spread it more; this isn’t part of the lasagna. But there are lasagna reasons too. High school often involves many different classes for each kid. Stable pods are hard to define. This means we worry more about viral escape with high schools, and are probably more wary about opening them.

Example: Is it really safe for specialist teachers to move between classrooms? Isn’t this a pod violation? The key to how this could be safe is layer 2. If someone comes into a pod and is protected — mask, standing distanced, hand washing — they are extremely unlikely to spread or contract the virus. Like, really, really unlikely. The CDC would not define this as a “close contact”. The reason to keep the stable group is layer 3, but in this case, layer 2 is the protection. This also tells us why this might NOT be safe. Having a teacher move back and forth between many classrooms without masks or distancing is a problem.

Example: Masks in small pods. My child is in a small home day care. Since the pod is small can we skip masks? Answer: it may or may not be a good idea to have masks (little kids touch their faces a lot with masks and they are limited transmitters, so this is less clear than with older kids ore adults). But the pod size isn’t really related. The masks are intended to do something different than the pod.

You’ll have your own questions, obviously. That’s why you need a framework, even a pasta-based one.

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Updated CDC Guidelines for School and Child Care

NO QUARANTINES!!!

Emily Oster

Instagram

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Just eat your Cheerios and move on.

Just eat your Cheerios and move on. ...

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
...

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
...

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
...

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
...

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
...

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
...

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
...

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
...

What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way. 

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way.

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes
...