NSCPS Survey Wave 4 assessed factors that influenced administrators’ decisions to add, remove, or modify COVID-19 prevention policies, such as state government requirements, community levels of transmission, and teacher or staff input. Wave 5 examined the existence and creation of school EOPs, and whether or not schools exercised or implemented them. These survey questions can be found in Appendix 1. School characteristics included NCES school locale (city, suburb, town, rural), school poverty level (low, medium, high), and school level (elementary school, middle school, high school). Poverty level was calculated using the percentage of students who qualified for free or reduced-price lunch in the 2019-2020 school year. Cut offs were as follows: low poverty was ≤25%, medium was 26%–75%, and high was ≥76%.^17,18

For each survey wave, survey weights were created accounting for nonresponse and design strata. For both Waves 4 and 5, city schools were less likely to participate than non-city schools. Thus, a non-response adjustment class was created based on this characteristic. Additional description of the creation of weights have been published elsewhere.⁴ Unweighted numbers, weighted percentages, and 95% confidence intervals (CIs) of factors influencing implementation of strategies and EOP experiences among K-12 public schools were estimated overall and by school locale, poverty, and school level. Chi-square tests were used to test for differences by school characteristics. P values <0.05 were considered statistically significant. Estimates with a relative standard error (RSE) >30% were suppressed. Quantitative analyses were conducted using R version 4.4.0 (2024-04-24).¹⁹

Thematic analyses were conducted for interviews with 21 school administrators. Interview audio files were transcribed, cleaned, de-identified, and quality checked by research staff to ensure accuracy. A qualitative codebook, informed by previous published literature, was developed to better understand school-level decision making related to COVID-19 prevention strategy implementation, lessons learned, and future emergency preparedness. A priori codes included successes and challenges implementing COVID-19 prevention policies, influences on policy modifications, and availability and utilization of school EOPs. Prior to coding, all coders underwent training on the intercoder reliability process and the application of the established coding scheme. Group-coding of 2 transcripts was conducted by 4 analysts to assess consistency, coder reliability, and application of codes. Inconsistencies were discussed and iterative adjustments to code definitions occurred throughout the coding process. Intercoder reliability was established between the 4 analysts (Fleiss Kappa = 0.81). MAXQDA 2022²⁰ was used for coding. When inconsistencies in code application were observed, coders engaged in detailed discussions to reach a consensus on the appropriate interpretation and application of codes. This collaborative process resulted in iterative adjustments to code definitions, enhancing the reliability of the coding.

Most schools indicated that guidance at various levels (e.g., federal, state) informed COVID-19 prevention strategy decision-making and implementation. Schools noted that they relied heavily on guidance at multiple levels (e.g., federal, state) to help students and school staff remain healthy during the COVID-19 pandemic. One school administrator described how guidance was disseminated from the federal to the state to the school level stating:

“We received guidance from our district health Executive Director of Nursing and Wellness…When they received guidelines and figured out what was best practice and where we were at in the pandemic then they updated the guidelines as needed. So, they would get that information and disseminate it out to principals. I think the chain of protocol would be that the county offices were following the guidelines of either the state health department which is following the guidelines of the CDC.”

Most schools indicated that CDC operational guidance was foundational to their decision-making related to implementation of COVID-19 prevention strategies. Schools reported that, as CDC operational guidance changed, implementation at the school level also changed. One school administrator commented, “State guidance followed CDC guidance, and they would say CDC is recommending this, that’s why we’re putting this [into action].” Another stated, “We would always pull up the CDC’s most updated information as it changed and compare it to our plan, and we tried to stay as much in alignment with what CDC recommended as possible.” While schools highlighted the importance of CDC’s guidance, they also noted that frequent changes in guidance presented challenges for schools to implement prevention strategies effectively and in a timely manner.

There was variation in schools’ reported use of local COVID-19 case counts or other metrics to inform COVID-19 prevention strategy implementation. Some schools mentioned that local case counts informed changes to their COVID-19 prevention plans. One administrator commented, “All of our efforts were more concentrated early in the school year when we were having pretty high numbers in the area as far as confirmed COVID cases.” In some instances, changes in case counts or transmission rates in the community influenced strategy implementation. One administrator described their school’s reliance on local COVID-19 metrics and how it informed decision-making, “We would always keep an eye on the numbers… and follow our county and local positivity rates as far as how strict we needed to be here with things like masking and things like that.” Schools noted the importance of tracking and monitoring data to inform their decision-making. One school commented, “Basically, it always came back to our data. Our superintendent always looked at the data to decide if it was time to make a move.” Another administrator shared, “[Our superintendent] had us looking at the trend data. At one point we were doing it daily. And kept a dashboard of outbreaks so we had that accessible as well. So, when the decisions were being made and suggestions made about going to voluntary masking and things like that…” However, most schools reported that they did not use local metrics when making decisions regarding strategy implementation.

Schools reported that district-level infection prevention and control (IPC) teams were key influencers of decision-making for COVID-19 prevention strategy implementation. Schools indicated that prevention strategy implementation decisions were discussed at the district level and then shared with school administrators prior to implementation with one participant commenting, “Most of the COVID decisions were bounced off the entire school administration.” Schools also noted the importance of IPC teams and the role that they played in informing prevention strategy decision-making:

“Our district level had a committee that includes some local physicians, it includes someone from the Department of Health. It included a variety of parents, a few district employees, some school level employees and district office employees, and there was 1 high school principal. The committee, they would convene multiple times and come up with some ideas or strategies to recommend.”

For many schools, community input informed implementation of school-based COVID-19 prevention strategies. Community, district, and parental support were integral to schools’ ability to make decisions regarding prevention strategy implementation. This was especially important for divisive strategies like mask use, vaccinations, and physical distancing. School administrators indicated that having school district support helped schools address community and parental opposition, and that community opposition, at times, hindered decision making regarding COVID-19 prevention strategy implementation. One administrator described this challenge stating, “[School board meetings were] a little contentious, [when] we talked about masks. All the parents were coming to board meetings and expressing their opinion about masks, wanting masks removed much earlier.” Schools contending with community opposition often faced difficult decisions related to prevention strategy prioritization and reported that this frequently resulted in limited strategy implementation.

The COVID-19 pandemic highlighted the need for schools’ EOPs to include more guidance on addressing infectious diseases outbreaks. Most schools indicated that their EOPs were insufficient for addressing the COVID-19 pandemic. Some schools reported having existing EOPs in place prior to the COVID-19 pandemic but noted that these plans need to be broadened to address a wider range of emergencies, “We had a baseline crisis protocol, but we have incorporated our mental health protocol for that, COVID, and we are looking at even further broadening that scope besides just tornadoes, fire drills, and active shooters.” Schools indicated that the pandemic prompted them to update their protocols, “Definitely I think when you talk about emergencies, we had to revisit all the emergency protocols. Does everybody know their roles, does everybody know what we would do. [Are] there resources we don’t have that we would need more of?” Schools also noted the importance of tailoring plans, “There was a district plan, but realistically what worked at the high school might not work at the elementary school. What works in one school is not going to work in another school because of the size of the classrooms, population whatever it might be.”

Schools emphasized lessons learned from the COVID-19 pandemic and investing in preparedness for future threats. Following the height of the pandemic, some schools updated their EOPs and developed contingency plans in the event of a future public health emergency. Schools revealed that the pandemic taught them a lot about preparedness, “I think it taught us that we weren’t doing as much as we thought [in terms of IPC].” Another administrator highlighted this, stating, “We kind of have a framework for that stuff and it wouldn’t be like reinventing the wheel going forward.” One school administrator commented on the importance of having an EOP in place, “I think we’ve got things in place and if things make a downturn and change as far as positivity rates, if they go up around the area, then we have a plan for how to get back to making decisions to be able to get it back to where it was.” Schools emphasized the critical role of EOPs in protecting the health of students and school staff. They noted the importance of not only updating the plan, but also evaluating it over time, “We can handle it [an infectious disease outbreak] better than we did the first time yes, but we have to evaluate as we go along again.” In the aftermath of the pandemic, schools concluded that they are better prepared for future infectious disease outbreaks because of their experiences navigating the COVID-19 pandemic, “And really having the process set up for an emergency type situation, knowing how to get the group together, knowing how to make decisions, knowing how to form guidelines. Knowing the right questions to ask. We don’t have to learn that anymore because we’ve already been through that [COVID-19 pandemic].”