California schools try to outrace covid outbreaks

A fourth-grade camping trip led to one outbreak, a high school prom to another. But even with covid cases rising as schools head into the final stretch of the academic year, most California districts have not moved toward reinstating mask mandates.

That stance has left many parents confused and concerned as they witness or hear about covid outbreaks among students after field trips and proms.

Up and down California, school administrators are running out the clock, hoping to outrace the outbreaks. The Berkeley school system and a few others have reversed their mask-optional policies, and the San Diego district sent letters to parents warning that masks could be reinstated if cases continue to rise. But most districts — including those in Los Angeles, San Francisco, and Oakland — haven't revisited their guidance as summer draws near.

"I do not plan on making any new recommendations in the final three weeks of school," Dublin Unified Superintendent Chris Funk told KHN, noting that the Alameda County Public Health Department lifted mandatory masking rules in classrooms more than two months ago.

Among other factors, administrators are reluctant to expose districts to legal challenges. From the start, the attempt to create statewide covid protocols for schools was met with sometimes-fierce resistance. Some districts, many of them rural, ignored California's school mask mandate. In February, the Roseville Joint Union High School District, which enrolls about 12,000 students in Placer and Sacramento counties, dropped the mask rule even as a statewide mandate remained in effect.

Another reason that schools aren't rushing back to masking, several administrators told KHN, is that even though cases are rising, most districts follow county guidelines that tie public health precautions to either the number of covid hospitalizations or the strain they would put on local health systems. Hospital admission rates tend to lag positive case rates by two weeks. Still, hospitalizations remain low for now, likely because of the availability of vaccines and antiviral treatments.

"We should be past mask mandates, period," said Dr. Jeanne Noble, who directs covid emergency response at Zuckerberg San Francisco General Hospital and Trauma Center. She said that the virus no longer poses a significant health risk to young and vaccinated populations and that people need to adjust to living with covid. That means taking a "test-to-treat" approach, she said, rather than trying to prevent transmission. The Biden administration is moving to a model where patients are tested and then treated with antiviral pills such as Pfizer's Paxlovid or Merck's molnupiravir to lower their risk of going to the hospital.

"I know my advice sounds scary to many, but covid is here to stay," Noble said. "That is the endgame."

That can be a tough sell for some parents.

When 40 out of 100 fourth graders at Deterding Elementary in the San Juan Unified School District in Sacramento County contracted covid after sharing cabins during a sleep-away field trip, the school was overwhelmed by inquiries from parents of students in other grades wondering whether the health rules at school were about to change — and whether the fifth-grade camping trip, scheduled for June 1, would go on.

It will, although the district will monitor local conditions and public health guidance, according to Raj Rai, the district's communications director.

Some parents were confused or upset by the news that the fifth grade trip would remain on schedule, even though the district was following county health recommendations. Melanie Allen, the Deterding principal, said such confusion has been a common theme during a school year marked by shifting public health guidelines.

"Even though information was posted clearly by the district on the website, parents reached out constantly to school administrators to clarify next steps for exposure or positive results," the principal wrote in an email to KHN.

The rising case rates forced the Berkeley district to make a late reconsideration — it reinstated mandatory masking in classrooms from May 23 until the end of its school year, on June 3. Superintendent Brent Stephens noted in an update on the district's website that in addition to the spiking student infection numbers, the district could find substitutes for only about half of its absent teachers. District administrators, he said, are working in classrooms to cover the shifts. The city's chief public health officer strongly recommended the move back to mandatory masking.

"As we are not a health agency, we must rely on these experts to guide us," Stephens wrote.

Very few of California's more than 1,000 school districts have joined the Berkeley system in making such a decision. On May 16, school officials in Pacific Grove, near Monterey, ordered that masks be worn inside all classrooms by its roughly 2,000 students. Katrina Powley, the district nurse, said the district is one of the few that ties its masking policy to case rates in Monterey County. Therefore, when those rates moved from "low" to "moderate" transmission, a mask mandate was triggered.

The board of trustees for the San Mateo Union High School District voted in early May to extend its mask mandate until June 1 and strengthened protocols after a prom that was held in San Francisco in April resulted in an outbreak among 90 of the 600 students in attendance.

Those districts remain in the minority despite the statewide covid surge. Roughly 20 schools in Marin County experienced outbreaks in early May. And the Dublin school district, in the East Bay, saw rates shoot up fivefold from March to April and continue to rise in May. Those schools haven't revisited their optional mask policies.

Schools in Davis, in Yolo County, have not reinstated mask requirements despite rising cases, in large part because the county health director decoupled mandates from test positivity rates.

"We have sufficient protection against the virus, especially with Paxlovid available at test-to-treat locations," said John Fout, a spokesperson for the county. Only increased hospitalizations straining the health care system would prompt a change, he added.

At this point, an uptick in serious illnesses may not be recognized until after the school year ends — and that is what many school administrators appear to be counting on.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.