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The Urgency and Challenge of Opening K-12 Schools in the Fall of 2020

The sudden closure of kindergarten through 12th grade (K-12) schools nationwide this spring likely helped to avert a medical catastrophe from the coronavirus disease 2019 (COVID-19) pandemic. This decisive step, however, is cast- ing a long shadow. By the time the school year ends in June, more than 55 million US children will have missed months of in-class instruction.1 The educational effect to date rep- resents only one dimension of the harm to children.

More than 20 million children rely on school break- fast or lunch; surveys now indicate that 1 in 5 mothers with children younger than 12 years old report that their children are going hungry.2 Millions of children have lost access to health services through school-based health centers. There are major divides by race/ethnicity, ge- ography, and economic class in access to home comput- ers and high-speed internet.3 When prolonged school closures are combined with summer break, some chil- dren may to fall behind normal academic growth by as much as a year in mathematics.4

The “COVID slide” will likely be greatest among those students who are already at educational and social risk. Children with significant learning disabilities may re- gress without in-person instruction. In addition, school

officials typically make about 1 in 5 reports regarding child abuse and neglect5; without involvement of school- based counselors and social workers, these concerns may not be investigated.

Reopening schools this fall is an urgent national pri- ority. To achieve this goal as safely as possible and re- duce the chances that schools are required to close again, policy makers at every level should consider embracing a framework with these 6 components.

Create the Conditions for a Successful Reopening Whether closing schools contributes more than mod- estly to a decline in coronavirus infection is a matter of ongoing debate.6 Nonetheless, in the event of signifi- cant community spread in the fall and winter months, parents and teachers are likely to again demand school closure, and, if they do, elected leaders are likely to agree. The best way to avoid a replay of the widespread clo- sures is to control the pandemic more effectively in the future. To open school safely, communities should drive down the spread of COVID-19 over the summer while building a strong public health response for the fall. Ev- ery community should implement a rigorous program of testing, contact tracing, isolation, and quarantine.

Establish Distancing at Each School Following guidance developed by the Centers for Dis- ease Control and Prevention, schools should imple- ment distancing whenever there are even low levels of community transmission.7 Protocols should involve creating more space for children in the classroom (with desks spaced 6 ft apart), keeping groups of chil- dren together throughout the day to limit mixing, staggering drop-offs and pick-ups, closing common areas, adding transportation options to increase spac- ing (such as on buses), limiting nonessential visitors, and canceling extracurricular activities that require close contact. Staff and older students should wear cloth face coverings, particularly when it is difficult to maintain distancing.

Prioritize Children Most at Risk From Missing School School systems should make on-site education a high pri- ority for youth who experience barriers to remote learn- ing, students who receive special education services or nutritional support at school, and younger children (for whom online learning may be particularly challenging).

School districts and individual schools within districts that have greater num- bers of such children should be pro- vided with additional resources for space, new staffing, and educational

technology. Restructuring school time with strategies such as alternate morning, afternoon, daily, or weekly schedules may be needed to permit distancing. These schedules should offer more in-school time to those chil- dren at greatest risk, while providing access to appro- priate educational technology for all.8

Ready a Strong Public Health and Environmental Response To prevent the spread of infection, schools should pro- vide parents a checklist to document that children have no symptoms every morning and no other family mem- bers are ill at home. Schools should also use paraprofes- sionals (such as nursing aides and other trained staff) to screen children quickly on arrival, make handwash- ing and other supplies readily available, and adopt schedules for cleaning high-touch areas and disinfect- ing classrooms, with appropriate protective equipment for maintenance staff. When symptoms appear, prompt testing should be available. Schools should inform their communities when cases are identified and estab- lish protocols for further testing of classmates and staff, additional school cleaning, and home isolation and quarantine.

Reopening schools this fall is an urgent national priority.


Joshua M. Sharfstein, MD Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Christopher C. Morphew, PhD Johns Hopkins School of Education, Baltimore, Maryland.

Corresponding Author: Joshua M. Sharfstein, MD, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room W1033F, Baltimore, MD 21209 (Joshua.

Opinion (Reprinted) JAMA July 14, 2020 Volume 324, Number 2 133

© 2020 American Medical Association. All rights reserved.© 2020 American Medical Association. All rights reserved.



Respect the Valid Concerns of Individual Families and Teachers Regardless of the measures used by schools, some teachers may be unwilling to return to the classroom, and some families may be un- willing to send their children to school. Parents and guardians who are older than 65 years or have chronic health conditions, or families with infants or other children with health conditions, may be legitimately concerned for the risk of transmission within their household. To ac- commodate these families, school systems should use the summer to identify and train teachers at high risk to serve as remote learning experts, with the potential to flex and incorporate other students and teachers during periods of quarantine or school closure.

Recent reports of a multisystem inflammatory syndrome in chil- dren associated with current or prior severe acute respiratory syn- drome coronavirus 2 (SARS-CoV-2) infection emphasize that re- opening schools is not without risks for children. While this syndrome appears uncommon, the potential for serious illness in children may lead some families to choose fully online options. Active surveil- lance for this new condition will be essential to informing school policy and public understanding over time. It will be important to present the facts to parents; regardless of what procedures are put in place, it will not be possible to reduce the risk of COVID-19 trans- mission in schools to zero.

Link Curricula, Teaching Strategies, and Remote Learning Technologies Given the likelihood of blended learning for many students, as well as periodic returns to fully remote learning in case of rising commu- nity spread of COVID-19, school systems should identify appropri- ate curricula that have both in-person and remote strategies, lever- aging technology where age appropriate, and linked to specific learning objectives.

Preparing K-12 classrooms for the fall will require substantial re- sources and personnel. School systems should develop plans in-

formed by public health guidance with broad input from parents, teachers, unions, school health services, and, where possible, stu- dents. Considerations should include not just academic planning, but also family support. Given the pandemic-related stress many chil- dren have experienced, school systems should hire additional coun- selors, social workers, and nurses to reach out to assist families on a regular basis. Lessons from successful community schools should be applied broadly for these types of interventions.

Congress should quickly make sufficient funding (in the bil- lions) available to states and localities to support K-12 education for the fall. Extra funds should be available to public school districts that would be expected to face the greatest gaps in staffing and infra- structure, based on formulas that measure the number of children who receive nutritional assistance and special education services.

The federal government should also accelerate research rel- evant to school reopening.9 Critical questions include how best to care for children with respiratory disease and multisystem inflam- matory syndrome from COVID-19, the extent of transmission in school settings, the relationship between school shutdowns on com- munity spread, and the value of specific educational designs and in- terventions for disease transmission and learning. There is much to learn now from countries that are opening K-12 schools during com- munity transmission of SARS-CoV-2. A cohort of teachers should be identified to assess whether antibody levels are associated with im- munity from further infection; results could inform future staffing policies. A parallel research program to study the effects of remote learning programs is also needed. An advisory body with represen- tation from the medical, public health, ethics,10 and educational com- munities should summarize the results of this research and its im- plications for practice on a regular basis.

The COVID-19 pandemic is more than a short-term threat to the nation’s health. Through its effects on children, the legacy of COVID-19 will last for years. The urgency and challenge of reopen- ing schools requires the nation’s full attention today.


Published Online: June 1, 2020. doi:10.1001/jama.2020.10175

Conflict of Interest Disclosures: None reported.

Additional Contributions: We acknowledge the research assistance of Trevor Wrobleski, BA, and the comments of Megan Collins, MD, MPH, and Anita Cicero, JD. They did not receive compensation.


1. Map: coronavirus and school closures. Education Week. Accessed May 24, 2020. https://www. coronavirus-and-school-closures.html

2. Bauer L. The COVID-19 crisis has already left too many children hungry in America. Brookings. Accessed May 24, 2020. https://www.brookings. edu/blog/up-front/2020/05/06/the-covid-19- crisis-has-already-left-too-many-children-hungry- in-america/

3. Auxier B, Anderson M. As schools close due to the coronavirus, some US students face a digital

‘homework gap.’ Accessed May 24, 2020. https:// schools-close-due-to-the-coronavirus-some-u-s- students-face-a-digital-homework-gap/

4. Kuhfeld M, Tarasawa B. The COVID-19 slide: what summer learning loss can tell us about the potential impact of school closures on student achievement. Accessed May 24, 2020. https:// Collaborative-Brief_Covid19-Slide-APR20.pdf

5. US Department of Health and Human Services, Administration for Children and Families, Administration on children, Youth and Families, Children’s Bureau. Child maltreatment 2018. Accessed May 24, 2020. sites/default/files/cb/cm2018.pdf

6. Esposito S, Principi N. School closure during the coronavirus disease 2019 (COVID-19) pandemic: an effective intervention at the global level? JAMA Pediatr. Published online May 13, 2020. doi:10.1001/ jamapediatrics.2020.1892

7. US Department of Health and Human Services, Centers for Disease Control and Prevention. CDC

activities and initiatives supporting the COVID-19 response and the president’s plan for opening America up again. Accessed May 24, 2020. https:// php/CDC-Activities-Initiatives-for-COVID-19- Response.pdf

8. Bryant J, Dorn E, Hall S, Panier F. Safely back to school after coronavirus closures. McKinsey & Co. Accessed May 24, 2020. com/industries/social-sector/our-insights/safely- back-to-school-after-coronavirus-closures

9. Cicero A, Potter C, Kirk Sell T, Rivers C, Scoch-Spana M. Filling in the blanks: national research needs to guide decisions about reopening schools in the United States. Accessed May 24, 2020. our-work/pubs_archive/pubs-pdfs/2020/200515- reopening-schools.pdf

10. Faden R, Collins M. There’s more to reopening than just deciding when to do it. Education Week. Accessed May 24, 2020. ew/articles/2020/05/08/lets-be-honest-about- the-ethical-trade-offs.html

Opinion Viewpoint

134 JAMA July 14, 2020 Volume 324, Number 2 (Reprinted)

© 2020 American Medical Association. All rights reserved.



Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.



Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.