Safely Reopening Our Schools in NJ: Understanding the Constraints of Fragmentation in the Garden State

I have been trying to learn about the practical implications of reopening our schools in the fall. The stakes are profoundly important and the landscape is fraught with complexity and uncertainty, making this both a bumpy but extremely important learning curve. Much of what I've learned has been from Jersey City Together: from and with other advocates who are also researching and learning.  I'm writing this post in the spirit of sharing what I've learned thus far, in the hopes that more parents and community members will engage this dialog.

Full disclosure, I've been wearing a few volunteer hats lately and they inform what I understand at this point.  I'm not a public employee. I'm a parent of two public school children at PS #3 in Jersey City, an accounting and tax professor at Saint Peter's University in Jersey City, an advocate with Jersey City Together working on issues related to both education and COVID19 testing, and a parent member of Jersey City Public Schools' reopening committee. And I'm helping this week host a COVID19 testing clinic at my parish, St Aedan's: the Saint Peter's University Church.

I'm grateful to the many public workers - from our schools administration and teachers to our local health department to our elected leaders at both the state and local levels - who are steering us through this period.

But one thing is evident to me right now: we must all, as a community, ramp up on both (a) what is required to reopen safely and (b) what the constraints, or roadblocks, are that will hinder a safe reopening -- and how to get around those constraints.

A starting premise: we want to reopen our schools...safely.

I'll start with a basic premise that there are two objectives as it relates to our schools:

• We want schools to reopen in the fall.
• We want to avoid a resurgence of the coronavirus spread in the community.

These two objectives conflict because coronavirus is still prevalent and reopening schools invites social proximity, not social distance. Schools are designed for social proximity; from the school bus to the schoolyard to the classroom...schools are designed for socialization.

So a basic starting point for schools reopening is that we need low transmission -- which we have in NJ right now. The Harvard Global Health Institute's "Covid Risk Levels Dashboard" shows that most of New Jersey is currently at mostly "yellow" status - meaning less than 1 daily new case per 100,000 people, which indicates "low case incidence but potential for community spread." (emphasis added).

Here's a screen shot of the Dashboard from July 22nd, which shows most of NJ yellow and two counties even showing "green" status (this dashboard is updated daily - so check the link for the latest status):

A key question we all have is: what happens when we systematically stop socially isolating and systematically start reopening?  The reopening of our schools is forcing us to concretely grapple with this question.

Best Practice Guidance for Reopening beyond Social Distancing (A Primer)

Harvard Global Health Institute's "TTSI Technical Advice Handbook" emphasizes the importance of testing, tracing, and supported isolation (TTSI) to systematically reopen. The basic idea is that if there is an incidence of virus outbreak, we must be able to:

• easily and quickly test
• robustly contact trace - to find out where the virus has spread
• support strategic isolation - if someone is positive, they must be able to isolate and be supported in that isolation, ie not feel pressure to NOT isolate

A relevant note here is that contact tracing is "a long-standing practice and is an integral function of local health departments" per the NJ Department of Education's "The Road Back" (page 9 and emphasis added).

New Jersey's Inherent Roadblocks to Implement Best Practice TTSI (a Primer)

In New Jersey, we have inherent roadblocks to achieve a comprehensive TTSI plan and those factors are surfacing as we look to systematically reopen the schools.

First, we are a fragmented state with our "home rule" structure; we have 565 different municipalities and 688 separately administered school districts (some of which are charter schools, and thus a separate "district")

Second, we don't fund public health locally (perhaps for the same reason we don't fund it nationally -- many factors including our having a private insurance paradigm in this country). In effect, this is yet more fragmentation.

Let's dig into the details.

1) NJ's Fragmentation in Public Data: A Focus on 600+ School Districts

In June, the NJ Department of Education shared "The Road Back: Restart and Recovery Plan for Education" which is a mandate to create a reopening plan for each district. 

I created a data visualization to help illustrate what it means for each district being tasked to create an individual "road back". Each box below is a school district in NJ that must formulate a school reopening plan & submit to the NJ Dept of Education.  I've color-coded each box to show the proportional share of students in each district who qualify for free or reduced lunch -- the darker the blue, the higher the the percentage of students in the district who qualify. 

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I encourage community members to at least skim "The Road Back" document and get a sense of both the depth of detail, like:

"Students should wash hands for at least 20 seconds at regular intervals, including before eating, after using the bathroom, and after blowing their nose/coughing/sneezing." - page 19

...and the depth of the mandate being placed on local school district authorities, like:

"School districts should establish school-based Pandemic Response Teams in each school to centralize, expedite, and implement COVID-19-related decision-making...Members of the school teams should include a cross section of administrators, teachers and staff, and parents." - page 47

In effect, the NJ Department of Education has tasked school administrators, teachers, and parents to take ownership of public health decision-making in collaboration with local health departments.

Which brings me to local public health departments.

I recently looked at how much we spend on Health & Human Services across the Garden State as part of my series, "NJ's User Friendly Budgets" and the data shows minimal local investment in local public health. Here are some relevant facts from my earlier post:

• In NJ, "Health & Human Services" is a line item in every municipality's budget and it includes Animal Control, Board of Health and various health, human services and social services programs for veterans, senior citizens, teens or other groups. These are the "regular" (non-pandemic) services that we budget for related to public health.
• Most towns in NJ (557 out of 565, or 98%) spend 3% or less of their total municipal budget on health and human services. Only eight towns spend marginally more, between 3% and 7% of the total budget.
• In 2019, Jersey City spent about $5 million, or less than 1% of its $589 million budget, on Health & Human Services.

In effect: we're in the midst of a pandemic, but our local budgets don't match our urgent, local demand for the required local health response. I'm not a health expert but I assume this is largely rooted in our American system of private health insurance secured through employment and some public options (eg Affordable Care Act, Medicare).

Data showing municipal public health spending in New Jersey is below:

Local COVID19 Testing (A Primer)

I believe every local health department is doing its best to respond to this pandemic. We can glean insight into their fight by using public data and taking note of the cobbling-together of public, private, and civic efforts to test in community.

For instance, Jersey City shows, on its COVID19 Tableau dashboard, tests "conducted by the Jersey City Health Department" at Christ Hospital, Jersey City Medical Center, walk-up clinics, and drive-through clinics. But the public dashboard does not show data from private doctors, hospitals, or state run facilities:

Jersey City's COVID19 dashboard data also reveals an interesting aberration -- there is a noticeable 1-day jump in testing in early July.  That jump corresponds with an early July test clinic hosted by at Cityline Church in collaboration with Quest Diagnostics, Interfaith Urgent Care, and Jersey City Together with the support of Jersey City and state health officials.

Let's take a step back and look at what this data is telling us.

When the civic sector (Cityline Church, Jersey City Together, Interfaith Health Ministries), the private sector (Quest Diagnostics) and public sector (the State of NJ and Jersey City) all collaborated in early July, local public testing capacity jumped and we also had more transparency into that jump (since the city could publish the test results). This is needed collaboration.

Yet as positive as the collaboration between civic-private-public sectors is, it presents challenges.

We can look to the Cityline clinic for an example. Quest Diagnostics, the private company that conducted the tests, had a 3-week delay in getting results back. The delay was so bad that Jersey City Together was forced to send Quest an open letter demanding the results.  Challenges were unveiled here:

First, Quest was unwilling and/or unable to meet demand for about 1,300 tests. For scale - to highlight how insufficient this is for our schools - in Jersey City, Mahatma Gandhi PS# 11 and Dickinson High School each have more than 1,300 students enrolled....what if there were a virus exposure in one of those schools and the entire student body required testing?

Second, Quest's inaction forced yet more work on the private sector (Jersey City Together) to demand follow-up because: testing is just the first step. The results must be rapidly delivered back so that we can then contact trace and, if need be, support the isolation of whomever was exposed to the virus.  Private entities cannot be enforcing compliance on other private entities...it's not feasible; and it's one reason why we need public (government) infrastructure.

One closing observation here is: the city public health department reports just over 39,000 individuals were tested from mid-March to-mid-July (including the Cityline clinic). For scale, to show what this means for a systematic reopening of our schools -- Jersey City's public schools have nearly 30,000 students (plus several public charters with more students).

Finally, it's worth mentioning that testing delays were not unique to Jersey City; they are an issue nationwide, as the Washington Post reported that:

"Outbreaks across the Sun Belt have strained labs beyond capacity. That rising demand, in turn, has caused shortages of swabs, chemical reagents and equipment as far away as New York." 

We don't have enough lab capacity - nationally - as explained by Danielle Allen in this recent op-ed. Dr. Allen explained that Quest operates in one of six categories of labs that can test...and only two of those categories have been fully activated to respond to the pandemic. Further, she writes "every test result [should] come back in 24 hours — 48 hours tops. After that, it is too late." 

The need to expand testing is cited by Governor Murphy in his statewide "Road Back" reopening plan; it is "Principle 2" in his "The Road Back" plan, which is summarized on a flyer from the state website. I've shown it below, along with my understanding of where we are on the road, given what we've seen play out locally in Jersey City:

Some final thoughts...from a parent

All of this is to get at a very important question we need to be asking: Will we have capacity by early September, as a community, to physically reopen our schools and then support that reopening with a local testing, tracing, and supported isolation (TTSI) plan? 

What we are seeing play out locally is concerning, and calls into question that we will not be ready.  Our highly fragmented school system and highly fragmented healthcare system are appearing to be roadblocks when the best practice guidance seems to be saying: we need a unified, comprehensive approach to reopening which includes a unified TTSI plan.

This all points to the state as a key lever in any solution.

Our fragmented status quo seems mis-aligned with what is needed to meet this moment to address the pandemic. To that end, I'll highlight a call to action from "Road to Pandemic Resilience" from Harvard's Edmond J. Safra Center for Ethics:

"COVID-19 IS A PROFOUND THREAT TO OUR DEMOCRACY, in certain respects comparable to the Great Depression and requiring levels of public-private coordination last seen in World War II. As ever, the greatest bulwark of democracy is us. What we do together—for one another and, even more, with one another—to fight this terrible disease, protect human life, secure our institutions, and prevent the destruction of our economy will determine whether free societies prove resilient in the face of existential emergency. What we need to do is much bigger than most people realize."

Let's learn together and work together to meet the pandemic in a way that will help us to get through this together.

More Reading

I'm sharing key documents to aid others in understanding the documents relevant to the NJ schools reopening process. These were either shared with me by others in Jersey City Together or I've found them online in doing research for this post.  If you're a parent interested in the safe reopening of the schools, I encourage you to learn more about Jersey City Together. You can check out the education team page here and the COVID response page here.

• "The Road Back" - The NJ Department of Education's "Restart and Recovery Plan that provides educators and administrators with the information necessary to ensure that our schools reopen safely and are prepared to accommodate students’ unique needs during this unprecedented time."
• Roadmap to Pandemic Resilience: Massive Scale Testing, Tracing, and Supported Isolation (TTSI) as the Path to Pandemic Resilience for a Free Society (Edmond J Safra Center for Ethics at Harvard Medical School)
• "The Lag in Testing Results is Our Achilles Heel. Here's How We Can Fix It." (Danielle Allen, Washington Post)
• "We missed one chance to open schools safely. Here’s the new, more expensive, option" (Danielle Allen, Washington Post)
• "What Congressional Covid Funding Means for K-12 Schools" (Phyllis W. Jordan, Future Ed at Georgetown's McCourt School of Public Policy)