Kinsey Et Al. School Closures During Covid.Pdf

AJPH COVID-19

School Closures During COVID-19: Opportunities for Innovation in Meal Service

In 2019, the National School Lunch Eliza W. Kinsey, PhD, Amelie A. Hecht, PhD, Caroline Glagola Dunn, PhD, Ronli Levi, MPH, Margaret A. Program and School Breakfast Read, MA, Courtney Smith, MPP, Pamela Niesen, Hilary K. Seligman, MD, MAS, and Erin R. Hager, PhD Program served approximately 15 million breakfasts and 30 million lunches daily at low or no cost to s COVID-19 disrupts reg- social condition wherein, at of marginal food insecurity and students. Aular access to food assistance times, 1 or more household the likelihood of skipping Access to these meals has resources and creates growing members are unable to acquire breakfast, especially among been disrupted as a result of economic uncertainty, low- adequate food because of in- low-income children.8 A rise in long-term school closures re- income families are being sufficient money or other re- food insecurity during the sum- lated to the COVID-19 pan- disproportionally burdened. sources.3 In 2018, nearly 1 in 7 mer months, particularly among demic, potentially decreasing Long-term school closures mean children (about 11 million) lived NSLP participants, further sug- both student nutrient intake that millions of students no in a food-insecure household, gests that school meals reduce and household food security. longer have access to the free or with higher rates in Black and food insecurity.9 In addition, By the week of March 23, reduced-price meals they rely on Hispanic households.4 Food in- school meals provide critical 2020, all states had mandated to meet their nutritional needs. security rates are rising as millions economic support to low- statewideschoolclosuresas As social distancing recommen- of people in the United States income families. The NSLP a result of the pandemic, and dations continue, with no clear experience job losses related to lifts 1.3 million people out of 10 thenumberofweeklymissed end date in many places, children COVID-19. Recent estimates poverty. fi breakfasts and lunches served and their families must be pro- show that as many as 33% of School meals signi cantly households with children, in- contribute to students’ daily di- at school reached a peak of tected from the unintended nu- cluding 40% of Black and His- etary intake and are generally approximately 169.6 million; tritional consequences of school closures. panic households, were food more nutritious than meals this weekly estimate remained 5 School meals are a vital insecure in April 2020. from other sources, including steady through the final week 11 component of the US social Federal school meal programs home-packed meals. This is of April. safety net. The US Department reduce household food insecu- especially true for children in We highlight strategies that 6 of Agriculture (USDA) National rity. Among households with at low-income households who rely states and school districts are School Lunch Program (NSLP) is least 1 child receiving free or on school meals as a substantial usingtoreplacethesemissed the largest antihunger program reduced-price meals, NSLP par- source of nutrition. The Healthy, meals, including a case study in the nation other than the Sup- ticipation is associated with a 14% Hunger-Free Kids Act, passed by fi from Maryland and the US plemental Nutrition Assistance reduction in food insuf ciency Congress in 2010, increased ac- Department of Agriculture Program.1 In 2019, the NSLP (an alternate measure of food cess to nutritious meals and had waivers that, in many cases, and the School Breakfast Pro- hardship closest to the most se- a positive impact on diet quality 7 have introduced flexibility to gram (SBP) served approximately vere form of food insecurity). by updating school meal nutri- 12 allow for innovation. Also, we 15 million breakfasts and 30 Access to the SBP reduces the risk tion standards. Its effects are explore lessons learned from million lunches daily at low or no 1 the pandemic with the goal of cost to students. More than three ABOUT THE AUTHORS quarters of all students partici- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, informing and strengthening Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health future school nutrition policies pating in school meal programs Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. for out-of-school time, such as qualify for free or reduced-price Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard meals because they live in a T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are over the summer. (Am J Public with the Department of Medicine and the Center for Vulnerable Populations, University of household with an income below Health. 2020;110:1635–1643. California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with 185% of the federal poverty Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the https://doi.org/10.2105/AJPH. Department of Pediatrics and the Department of Epidemiology and Public Health, University of level.2 2020.305875) Maryland School of Medicine, Baltimore. Loss of access to school meals Correspondence should be sent to Eliza W. Kinsey, PhD, 722 W 168th St, New York, NY puts millions of households at 10032 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. increased risk of food insecurity, a This article was accepted July 9, 2020. household-level economic and https://doi.org/10.2105/AJPH.2020.305875

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especially pronounced among innovative meal replacement ef- price meals but rather paid full of school closures, and by the low-income students who re- forts being implemented by states price for school meals.2 These following week that number had ceive free and reduced-price and school districts, including a children may, however, come ballooned to nearly 125 million lunches.13 specific case study from Mary- from households with incomes meals. By the week of March 23, Prior to COVID-19, concern land. In addition, we explore that are just above the eligibility with all states having mandated about school meal access during lessons learned from this crisis cutoff or that fluctuate seasonally. statewide school closures, the school closures (e.g., hurricanes, with the goal of informing and Previous estimates suggest that number of weekly missed meals snowstorms, civil unrest, summer strengthening future nutrition as many as 15% of marginally reached its peak. Cumulatively, – break) was mounting.14 16 In a policies with respect to out-of- food-secure students and 10% of we estimate that among students previous policy brief, we pro- school time, including summer food-insecure students do not who receive free and reduced- jected the impact of school clo- meals and unexpected school qualify for free or reduced-price price meals, more than 1.15 bil- sures resulting from short-term closures. meals on the basis of household lion meals were not served in emergencies on the number of income, and thus they may rely school as a result of school clo- “missed meals” (meals that would on full-priced school meals for sures during the 9-week period have been served if schools were nutritious, low-cost meals.21 between March 9 and May 1. open) among children in Phila- Furthermore, with widespread Figure 1 maps total missed 14 delphia, Pennsylvania. These NATIONAL MISSED unemployment resulting from meals per state and the percentage estimates showed that even 3 days MEAL ESTIMATES COVID-19, it is likely that many (in gray) of enrolled students per of school closures could result in In an effort to slow the spread more children qualify for free and state participating in free and more than 400 000 missed meals of COVID-19, school districts reduced-price school meals now reduced-price meals. These esti- among school-aged children. across the United States started to than before the start of the pan- mates account only for break- Missed meals may have a sig- close in March 2020, with the demic. With the weekly value of fast and lunch; an estimated 1.5 nificant impact on children’s earliest closures in the Seattle area meals children receive at school million after-school snacks and health, nutrition, and food se- the week of March 2. By March conservatively estimated at $30 1.3 million after-school suppers curity. Such consequences are 16, at least 907 US school districts (not accounting for time spent are also served to children daily likely to be magnified among had closed and 8 states (in addi- purchasing and preparing foods), through federal child nutrition low-income, Black, and Hispanic tion to Washington, DC) had lost access to school meals could programs (Food Research and children who are already at closed statewide. Other states pose a significant added financial Action Center October 2018 greater risk for poor physical and followed rapidly, with Texas and burden for families.22 estimates). mental health and worse aca- Idaho being among the last states In the early weeks of March, demic performance than their to close schools (on March 23 and when closures were occurring at 20 higher-income and White 24, respectively). the district (rather than the state) 17 counterparts. Black and His- Here we estimate the number level, the number of missed meals INNOVATIVE panic students are also more of missed breakfasts and lunches was relatively modest. By the RESPONSES likely to be eligible for free or per week from March 2 through week of March 9, as shown in Here we provide an overview reduced-price meals and more May 1, 2020, using school closure Table 1, nearly 2.6 million school of USDA school meal program likely to participate in school reports from the independent meals had been missed as a result waivers and state and school meals than their White and Asian news organization Education peers.18 However, the fact that Week and USDA reports of rates of COVID-19–related state-level free and reduced-price TABLE 1—Weekly and Cumulative Missed Free and Reduced-Price morbidity and mortality are dis- participation in the NSLP and School Meals (Breakfast and Lunch): United States, March 2–May 1, proportionately high among SBP during 2019 (detailed 2020 Black and Hispanic populations weekly estimates by state are may limit their ability to access provided in Table A and Figure A, Dates Weekly Meals Cumulative Meals emergency meal sites.19 available as supplements to the March 2–6 36 802 36 802 Here we illustrate the impact online version of this article at March 9–13 2 598 526 2 635 328 of COVID-19 on students’ access http://www.ajph.org).2,20 This March 16–20 124 824 223 127 459 551 to food by estimating the number estimate of the number of stu- – of missed meals, which we define dents relying on school breakfasts March 23 27 169 479 514 296 939 064 as breakfasts and lunches that and lunches may be an under- March 30–April 3 169 619 512 466 558 576 would have been served in school estimate of need. April 6–10 169 619 512 636 178 088 if schools were open, although In 2019, 26% and 15% of April 13–17 169 619 512 805 797 601 many of these meals were ulti- children participating in the April 20–24 169 619 512 975 417 113 mately served at community NSLP and SBP, respectively, did – sites instead. We highlight the not qualify for free or reduced- April 27 May 1 169 619 512 1 145 036 625

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17.8

1.4 3.5 2.7 1.8

10.9 14.5 4.1 1.7 14.8 72.1 2.4 18 1.3 33.1 2.4 9.6 36.8 10.2 6.6 10.4 33.7 22.9 7.8 41 21.5 134.4 11.7 9.3 3.7 9.8 17.9 25.9 25.5 17.3 2.6 36.8 26 15.5 25.9 10.4 13.7 20.7

16.6 19.6 48.2

142.5 25.5

77.6

2.2 % FRP Lunch > 18–30 > 30–37 > 37–43 2.7 > 43–64

Note. This map depicts (in gray) students participating in free and reduced-price meals as a percentage of the total state student enrollment population. The number overlaid on each state is the total number (in millions) of free and reduced-price missed school meals (breakfast and lunch) between March 2 and May 1, 2020.

FIGURE 1—Free and Reduced-Price (FRP) Participating Students as a Percentage of Total Student Enrollment and State Cumulative Missed FRP School Breakfasts and Lunches: United States, March 2–May 1, 2020 district meal service innovations included allowing multiple meals waiver was used and whether and food procurement and implemented in an effort to re- to be served at one time, per- its implementation improved delivery systems. Here we place meals that could not be mitting a meal to be provided to school meal services. outline some of the innovative served in schools as a result of the a parent or guardian without a approaches and discuss chal- pandemic. child present, and relaxing nu- Innovations and lenges and barriers. trition requirements for federal Challenges Where meals are offered. Many financial reimbursement. The districts have sought to maximize Waivers Taking advantage of USDA program reach by situating meal The Families First Coronavi- intention of these waivers was to waivers, states and districts have delivery sites in central commu- rus Response Act gave the USDA ease program operations and developed innovative strategies authority to issue nationwide protect the health of students in which they vary where, how, nity locations such as school waivers to school meal regula- and program staff. and to whom they provide meals parking lots, community centers, tions. The USDA granted 18 State agencies are eligible to to maintain access while mini- libraries, apartment complexes, 23 nationwide waivers (detailed in use all nationwide waivers (after mizing the risk of COVID-19 and churches. Other districts Table 2) between March 20 and notifying their USDA regional exposure. As schools and districts are delivering meals at intersec- 24 May 1 to provide flexibility for office regarding which waivers have adapted to these new tions along school bus routes. states in determining where and they plan to use). However, they methods of serving meals, they Outdoor meal distribution is how school meals could be served must submit a report within 1 have faced unexpected challenges challenging in inclement weather, during closures. The waivers year summarizing how each with respect to health, finances, however, and there have been

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TABLE 2—US Nationwide COVID-19 Child Nutrition Response Waivers for National School Lunch and School Breakfast Programs Beginning March 20, 2020

Waiver Waiver Name Programs Covered Release Date What It Does 1 Nationwide Waiver to Allow Meal Service NSLP, SBP, SSO, SFSP, CACFP March 20 Provides flexibility for serving times Time Flexibility in the Child Nutrition Allows for serving multiple meals for the same day at one Programs time 2 Nationwide Waiver to Allow Noncongregate NSLP, SBP, SSO, SFSP, CACFP March 20 Allows for off-site consumption of meals and serving Feeding in the Child Nutrition Programs models such as grab-and-go, curbside pick-up, mobile/bus routes, and home delivery 4 Nationwide Waiver to Allow Meal Pattern NSLP, SBP, SSO, SFSP, CACFP March 25 Allows for meal reimbursement even if meal does not meet Flexibility in the Child Nutrition Programs all nutritional requirements or include all meal components 5 Nationwide Waiver to Allow Parents and NSLP, SBP, SSO, SFSP, CACFP March 25 Allows for distributing meals without a child present Guardians to Pick Up Meals for Children 6 Nationwide Waiver of Community Eligibility NSLP, SBP March 25 Extends deadlines for various tasks within the Community Provision Deadlines Eligibility Provision data release and election process 9 Nationwide Waiver of Onsite Monitoring NSLP, SBP March 27 Waives the in-person component of the state agency’s Requirements in the School Meals Programs required monitoring activities Allows states to postpone required reviews of school food authorities that are closed and request an extension of their review cycle as needed 10 Nationwide Waiver of Onsite Monitoring SFSP March 27 Waives the requirement for an in-person site visit during Requirements for SFSP Sponsoring the first week of a site’s operation and the review of the Organizations site’s food service within the first 4 weeks of operation 11 Nationwide Waiver of Onsite Monitoring SFSP March 27 Waives the in-person component of the state agency’s Requirements for SFSP State Agencies required monitoring activities 12 Nationwide Waiver of 60 Day Reporting NSLP, SBP, SFSP, SSO, CACFP, SMP April 1 Extends the deadline to submit claims for reimbursement Requirements for January and February for January 2020 and February 2020 by 30 days each 2020 Allows 90 days for submission of reports rather than 60 days 13 Nationwide Waiver to Allow Meal Pattern NSLP, SBP, SSO, SFSP, CACFP April 21 Allows for meal reimbursement even if meal does not Flexibility in the Child Nutrition Programs— meet all nutritional requirements or include all meal EXTENSION components 14 Nationwide Waiver to Allow Area Eligibility SSO, SFSP April 21 Allows closed enrolled sites to determine site eligibility for Closed Enrolled Sites in the SFSP and through area eligibility (instead of collecting income NSLP SSO eligibility applications) 15 Nationwide Waiver of First Week Site Visits in SFSP April 21 Waives the requirement that SFSP sponsors visit each the SFSP of their sites at least once during their first week of operation 16 Nationwide Waiver to Allow Offer Versus SFSP April 21 Waives the limitation on the use of offer versus serve Serve Flexibilities in the SFSP 17 Nationwide Waiver of Meal Service Time SSO, SFSP April 21 Waives the amount of time that must elapse between the Restrictions in the SFSP and SSO beginning of one meal and the beginning of the next and the duration of a meal service 18 Nationwide Waiver of Local School Wellness NSLP, SBP April 23 Extends the deadline to complete the triennial assessment Policy Triennial Assessments in the NSLP and of compliance with school wellness policies SBP Continued

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TABLE 2—Continued

Waiver Waiver Name Programs Covered Release Date What It Does 19 Nationwide Waiver of Food Service NSLP, SBP, SSO, SFSP April 24 Waives food service management company contract Management Contract Duration in the NSLP duration and extension limits and SFSP 21 Nationwide Waiver to Extend Unanticipated SSO, SFSP April 27 Waives the limit on unanticipated school closure School Closure Operations through June 30, operations to October through April, allowing operators 2020 to continue current operations through June 30, 2020 Waives the federal application deadline for SFSP and SSO operators SP 12-2020 Fresh Fruit and Vegetable Program During FFVP April 9 Clariﬁes that participating schools may serve fresh COVID-19 produce through the FFVP in a noncongregate setting Clariﬁes that produce may be served through the FFVP outside the typical school day, at whatever time works best, including alongside other meals being distributed Applies to produce already in stock as well as produce ordered for distribution during closures

Note. CACFP = Child and Adult Care Food Program (offers reimbursement to child and adult care institutions and family or group day-care homes for providing nutritious meals and snacks to the children and older adults or chronically impaired individuals with disabilities in their care); CEP = Community Eligibility Provision (allows the nation’s highest-poverty schools and districts to serve breakfast and lunch at no cost to all enrolled students without collecting household applications); FFVP = Fresh Fruit and Vegetable Program; NSLP = National School Lunch Program (provides reimbursement to states to operate nonprofit lunch programs in schools); SBP = School Breakfast Program (provides reimbursement to states to operate nonprofit breakfast programs in schools); SFSP = Summer Food Service Program (provides free meals to children and adolescents in low-income areas when school is out); SMP = Special Milk Program (provides milk to children in schools who do not participate in other federal meal service programs); SSO = NSLP Seamless Summer Option (a federal meal program that encourages more school food authorities already participating in the NSLP and SBP to provide meals in low-income areas during the traditional summer vacation periods and during school vacation periods longer than 10 school days for year-round schools). This list does not include waivers that apply exclusively to the CACFP. reports of canceled distributions through the Community Eligi- Solutions to address staffing an effort to increase meal par- resulting from high winds or bility Provision were automati- shortfalls, for example enlisting ticipation and decrease waste, rain.25 cally registered for home support from groups such as the some districts allow students to Home delivery is another delivery.27 National Guard, may uninten- preorder meals online or by common approach, especially National waivers have tionally discourage participation phone.34 in rural districts, although the allowed states to serve school by families who distrust authority These changes require schools USDA does not provide reim- meals in noncongregate settings. as a result of past negative expe- to adjust procurement, prepara- bursement for delivery-related However, concerns about viral riences (e.g., racial/ethnic mi- tion, and distribution techniques. expenses.26 Several states have exposure remain as staff, students, nority and immigrant families).30 Whereas schools could previ- encouraged rural districts to or families gather to prepare, How meals are offered. As a ously batch cook and serve hot participate in a program admin- distribute, or pick up meals. result of increased community meals, serving multiple meals istered by the Baylor Collabora- These concerns have caused need, some districts have ex- (e.g., breakfast and lunch) or tive on Hunger and Poverty, several districts to suspend meal panded meal service to 7 days per several days’ worth of meals at which, in partnership with the service, particularly after em- week.31 Others now provide up once requires menu and pro- USDA and private industry, ployees have tested positive for to 1 week of meals at once to curement changes. In addition, provides free weekly home de- the virus.28 Although efforts to decrease staff exposure and im- meals must be packaged, where livery of parcels containing a facilitate contactless delivery prove convenience for parents previously they would have been 5-day supply of shelf-stable, in- support social distancing, food and students. USDA waivers served in an on-site cafeteria. dividually packaged foods. Most service staff who lack access to allowing provision of bulk items, Changes to meal formats may also districts with home delivery have personal protective equipment such as a gallon of milk rather be complicated by nationwide encouraged students to sign up including gloves, masks, and than single-serve milk cartons, supply chain issues.35 online; in districts such as Saint hand sanitizer—items in short facilitate this approach.32 Back- To whom meals are offered. In Paul, Minnesota, all students at supply across all sectors—have pack programs (which provide many districts, school meal access high-poverty schools that were expressed concern about be- shelf-stable grocery items) have has been expanded beyond authorized before the pandemic ing exposed to the virus and also been adopted or expanded in school-aged children, including to serve universal free meals transmitting it to others.29 many districts.33 In addition, in to all children 0 to 18 years old

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and students with disabilities 18 serving less than half of their numbers of meals served on its Department of Education re- to 26 years old.36 Rising rates previous meal volume.39 Web site40; data are shown in ported serving approximately of hunger among adults have Nonetheless, many school Figure 2 for the initial 7 weeks of 1.4 million meals weekly to sparked several districts to also food authorities and districts have school closures (the dip in meals school-aged children at 393 provide meals to adults at low or successfully reached children in week 5 is a result of spring feeding sites. The New York no cost, with some (e.g., in New with replacement meals during break closures in some districts, City Department of Education York City) offering separate school closures. In Maryland, which typically suspended meals reported providing 3 meals a times for child and adult meal statewide school closures were for 1–2 days). Beginning the daytochildrenandadultsat435 pick-up.37 Other districts have announced on Thursday, March week of March 16 (week 1 of sites across all 5 boroughs. Be- partnered with food banks or 12, with replacement meals to school closures), Maryland tween March 13 and April 13, food pantries to provide addi- begin on Monday, March 16, school districts served 313 244 the city served more than 3 tional food items for households providing only 1 business day to breakfast and lunch meals. In the million meals to children; in at a single site. prepare. The state department following week, the number of comparison, it served more than Although the $2 trillion of education collaborated with meals served nearly doubled. By 1 million breakfasts and lunches Coronavirus Aid, Relief, and Maryland’s 24 school districts to weeks 6 and 7 of school closures, daily before the pandemic.37 Economic Security Act includes develop a plan that met social districts were serving nearly 1 The School District of Phila- $8.8 billion for child nutrition distancing guidelines while also million breakfast and lunch meals delphia, which served approxi- programs, it remains unclear how reaching children in greatest need weekly. mately 135 000 school meals and when funds will be distrib- of a school meal. Specifically, the Using the same research per day prior to the pandemic uted. Meanwhile, increasing state department of education methods described earlier, we (according to district estimates), food insecurity is forcing many was granted, within the first 3 estimate that each day schools reported that between March 16 school meal distribution sites to weeks of COVID-19 meal ser- are closed in Maryland, 493 917 and April 20 it served nearly expand operations as household vice, 5 of the nationwide waivers free or reduced-price meals that 182 000 children at 49 pick-up incomes are plummeting and (1, 2, and 4–6) outlined in would have been served are sites, with a total of almost 1 more children and adults need Table 2. In addition, it received missed (equivalent to 2 469 585 million meals served. Before the food assistance.29 state-specificapprovalformealde- meals per week). This means that, pandemic, the San Francisco Continued meal service is livery to students’ homes and ex- at the peak of meal delivery, there Unified School District in complicated by financial and tended approval of area eligibility were approximately 1.5 million California served approxi- child-care challenges encoun- to sites serving catchment areas missed meals each week. Al- mately 38 893 meals per day, tered by food service staff where 30% or more of students though Maryland has been able totaling 194 465 meals per themselves. Considered essential were eligible for free or reduced- to shrink the missed meals gap week. Between March 16 and workers, food service staff face price meals (formerly 50%).40 over time with rapid innovation May 8, it distributed almost competing demands. The mean Innovations implemented by and implementation of USDA 862 000 meals through a com- hourly wage among these indi- districts included new distribu- waivers, additional support will bination of grab-and-go meal viduals is $10.29, and thus un- tion sites, mobile distribution be needed. It should be noted sites, home deliveries, and employment benefits may be using school buses, home deliv- that most Maryland districts are partnerships with community- higher than their weekly pay- ery in rural areas, shared meal also serving supper or a snack (or based organizations. Because checks and involve less risk of preparation resources among both) to help meet the needs of available data for meal re- COVID-19 exposure.38 nonpublic and private schools students. Researchers are part- placements served during the and districts, and coordination nering with the state to evaluate pandemic generally do not with community partners. In- meal service using an imple- distinguish between types of novations were shared during mentation science approach. meals (e.g., breakfast, lunch, weekly calls that included school Innovations will be tracked to snack), we cannot directly MARYLAND MEAL food authorities and district determine later effects on both compare replacement estimates REPLACEMENT leaders. In the following weeks, summer feeding programs and and meals served during a ESTIMATES the USDA granted Maryland school meal programs during the typicalschoolweek. Nationally, school food au- additional waivers (including 2020–2021 school year. In addition to school-based thorities are working at reduced adding the remaining waivers Although Maryland is, so far, responses to providing meals capacity relative to typical outlined in Table 2 and elimi- unique in making publicly to children during COVID- in-school periods. In a survey of nating the free and reduced-price available extensive data about 19, Congress has authorized geographically diverse K–12 food meal catchment area eligibility meals served during the pan- the USDA to approve state service operators conducted at requirement) and innovations demic, districts in other states applications for pandemic the end of March, 31% reported continued. are also working hard to reach electronic benefits transfer a full shutdown of operations, The state department of students. On its Web site in (P-EBT). P-EBT provides and an additional 49% reported education published weekly April, the West Virginia monetary benefits to households

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1 500 000 related to when and how schools underserved communities and to reopen. operate more effectively during 1 250 000 out-of-school times. Required 1 000 000 923 231 916 227 872 879 reporting by state agencies will 766 279 Feeding Children When provide further insight into how 750 000 705 735 593 602 Schools Are Closed individual waivers have been 500 000 National waivers provided by used and the extent to which 313 244 the USDA have eased adminis- they have improved services for 250 000 Total No. Meals Served No. Total trative burdens and provided the participants. 0 ﬂexibility necessary to feed chil-

a dren during this crisis. These Innovation in School waivers are aimed at addressing Nutrition Services Week 4 Week Week 6 Week Week 2 Week Week 1 Week

Week 5 Week issues unique to the pandemic. (Apr 6–10) (Apr Week 7 Week Week 3 Week (Apr 13–17) (Apr (Apr 20–24) (Apr (Mar 16–20) (Mar 23–27) The pace at which schools For example, the USDA inten- (Apr 27–May1) (Apr (Mar 30–Apr 3) closed and officials issued shelter- Week ded for state agencies to approve in-place orders meant that school meal pattern waivers only when nutrition programs had to Note. The average number of free and reduced-price breakfast and lunch meals they are targeted and justified on quickly revise operations, from served each week before the COVID-19 pandemic was 2 469 585. the basis of food supply disrup- a distribution and staffing models Many districts suspended meal service for 1 or 2 days during spring break. tions. Similarly, waiving on-site to meal procurement, planning, monitoring visits addresses the FIGURE 2—Number of Breakfast and Lunch Meals Served per Week and delivery. Moreover, school – need for social distancing. During COVID-19 School Closures: Maryland, March 16 May 3, 2020 nutrition staff had to respond to However, many waivers also new guidance and changing cir- address universal challenges that d cumstances by continually re- with children who have tem- The COVID-19 crisis has child nutrition programs face in vising and improving program porarily lost access to free or spurred innovation in school reaching children when schools delivery. In many cases, this crisis reduced-price school meals. nutrition services. are closed. Child nutrition pro- d has accelerated trends in child Households are eligible to par- Children across the country grams are in place to feed children nutrition programs. Over the past ticipate in P-EBT if their child are missing out on the critical when schools are out of session decade, an increasing number of is eligible to receive free or school meals they relied on for the summer (i.e., the Seamless schools have provided universal reduced-priced meals, regardless when schools were in session. Summer Option and the Sum- free meals through the Com- of current participation in the mer Food Service Program), and munity Eligibility Provision, of- Supplemental Nutrition Assis- in some districts there are pro- fered grab-and-go breakfasts, and tance Program. As of May visions for school breaks or un- operated mobile summer meal 1, 2020, the USDA had approved Responding to Student anticipated school closures such programs. Future analyses will P-EBT implementation in only and Family Needs as during snowstorms. provide insight as to whether 18 states, and few states had begun The pandemic has cast a Yet, these programs consis- those schools were better able to distributing benefits. spotlight on the critical role of tently reach only a small fraction pivot to emergency feeding school food and nutrition pro- of children who rely on free or during COVID-19. grams with respect to the food reduced-price meals during the security and well-being of stu- school year.2 Summer meal dents and families. As unem- sponsors and program operators Replacing Meals Offered LESSONS LEARNED ployment and food insecurity have often cited congregate meal in Schools We learned the following rise, more families will need requirements as a barrier to ser- Despite the heroic efforts of lessons: support to ensure that children vice. Several federal demonstra- school nutrition professionals, tion projects that allowed for generous private-sector donations, have access to the food they need d School nutrition programs noncongregate summer feeding and increased program flexibility, it to thrive. School nutrition pro- are playing a vital role in in rural areas and during excessive is unlikely that school districts will grams will need funding, flexi- responding to student and heat successfully expanded pro- be able to replace, through emer- bility, and staff support to respond 15 family needs. gram access. Extending pro- gency meal distribution programs, to this growing need. Recog- d School nutrition operations gram flexibility beyond the all meals that were previously being during the pandemic have nizing the important role that pandemic, especially in regard provided in school. It will be im- underscored the challenges of school nutrition plays in sup- to the congregate meal require- portant to understand the extent to feeding children when schools porting students, school food and ment, would enable schools and which P-EBT supplements or re- are not in session and have nutrition service leaders must be other organizations to better places current meal distribution identified possible solutions. actively involved in planning reach children in rural and programs as well as the effects of

November 2020, Vol 110, No. 11 AJPH Kinsey et al. Peer Reviewed Analytic Essay 1641 AJPH COVID-19

these efforts on child food security. that can guide future program CONTRIBUTORS 4. US Department of Agriculture Eco- These findings will provide im- delivery, investment, and policy. E. W. Kinsey led the writing of the article. nomic Research Service. Food security H. K. Seligman conceptualized the study. in the US: key statistics and graphics. portant lessons to rapidly deploy All of the authors collected data, con- Available at: https://www.ers.usda.gov/ alternative nutrition assistance to ducted data analyses, interpreted results, topics/food-nutrition-assistance/food- families during future crises. and contributed to the writing of the security-in-the-us/key-statistics-graphics. article. aspx#children. Accessed August 16, 2020. Moreover, evaluations of 5. Schanzenbach D, Pitts A. Estimates of P-EBT will provide insights into CONCLUSION ACKNOWLEDGMENTS food insecurity during the COVID-19 effective strategies to address Although there is still much to All of the authors are members of the crisis: results from the COVID Impact prolonged—albeit planned— be learned about school nutrition ad hoc COVID-19 School Nutrition Im- Survey, week 1 (April 20–26, 2020). during this pandemic, a few key plications Working Group, jointly supported Available at: https://www.ipr.northwestern. summer school closures. Al- by Healthy Eating Research (HER), a edu/documents/reports/food-insecurity- though summer meal sites themes have emerged. School national program of the Robert Wood covid_week1_report-13-may-2020.pdf. provide needed access for some nutrition programs play a vital Johnson Foundation (RWJF), and the Accessed August 16, 2020. role in meeting the nutritional Nutrition and Obesity Policy Research 6. Ralston K, Treen K, Coleman-Jensen children, the reach of summer and Evaluation Network (NOPREN). A, Guthrie J. Children’s food security and needs of children and responding NOPREN is supported by the Division of meal programs is far short of USDA child nutrition programs. Available Nutrition, Physical Activity, and Obesity anticipated need on the basis of to the rapidly growing food in- at: https://www.ers.usda.gov/webdocs/ of the Centers for Disease Control and security crisis. The challenges publications/84003/eib-174.pdf?v=0. school-year free and reduced- Prevention (CDC; cooperative agree- Accessed August 16, 2020. price lunch participation. A school nutrition operators face in ment 5U48DP00498-05). keeping children fed during the NOPREN provided funding for this 7. Huang J, Barnidge E. Low-income USDA demonstration program ’ pandemic highlight preexisting project as well as support to H. K. Selig- children s participation in the National providing a summer electronic man, R. Levi, and C. G. Dunn. E. W. School Lunch Program and household benefits transfer to school-aged hurdles associated with running Kinsey is funded by a Eunice Kennedy food insufficiency. Soc Sci Med. 2016;150: Shriver National Institute of Child Health 8–14. https://doi.org/10.1016/j.socscimed. children, an approach similar to school nutrition programs when schools are not in session, and this & Human Development Career Devel- 2015.12.020 the current P-EBT system, sub- opment Award (K99HD101657). A. A. 8. Bartfeld J, Kim M, Ryu JH, Ahn H-M. period can provide many useful Hecht received partial training support stantially decreased summer food The School Breakfast Program: Participation from the Johns Hopkins Center for a 16 lessons for future out-of-school and Impacts. Madison, WI: University of insecurity. Lessons learned Livable Future as part of a Livable meal provision. Wisconsin; 2009. from the P-EBT implementation Future-Lerner Fellowship. States and school districts have Note. fi 9. Huang J, Barnidge E, Kim Y. Children may solidify the need for similar The ndings described are responded quickly to the current solely the responsibility of the authors and receiving free or reduced-price school supplemental nutrition assistance fi lunch have higher food insufficiency rates in crisis, developing innovative so- do not necessarily represent the of cial support during the summer views of HER, the CDC, the RWJF, or summer. JNutr. 2015;145(9):2161–2168. lutions for addressing rapidly https://doi.org/10.3945/jn.115.214486 months. Share Our Strength. changing demands, including Further examination is needed 10. Gundersen C, Kreider B, Pepper J. expanding meal service to 7 days CONFLICTS OF INTEREST The impact of the National School Lunch to understand the extent to per week, offering grab-and-go The authors have no conflicts of interest Program on child health: a nonparametric which schools and other organi- to report. bounds analysis. J Econom. 2012;166(1): meals in outdoor locations, and – zations were able to fill the meal 79 91. https://doi.org/10.1016/j. providing up to a week of meals at jeconom.2011.06.007 gap during the COVID-19 pan- HUMAN PARTICIPANT once. These nimble and innova- PROTECTION 11. Cullen KW, Chen T-A. The contri- demic. Future studies can provide tive responses are essential for No protocol approval was needed for this bution of the USDA school breakfast and insight into factors that enabled research because no human participants lunch program meals to student daily di- reducing child hunger during the – schools to respond more effec- were involved. etary intake. Prev Med Rep. 2016;5:82 85. pandemic. https://doi.org/10.1016/j.pmedr.2016. tively and the distribution models 11.016 Despite these extraordinary REFERENCES and practices that contributed fi efforts by school nutrition pro- 1. US Department of Agriculture Eco- 12. Mans eld JL, Savaiano DA. Effect to success. It is especially critical grams, there is still a large gap nomic Research Service. National School of school wellness policies and the to understand how effectively Lunch Program. Available at: https:// Healthy, Hunger-Free Kids Act on food- between the number of meals consumption behaviors of students, 2006– food and nutrition programs are www.ers.usda.gov/topics/food- served in a typical school week nutrition-assistance/child-nutrition- 2016: a systematic review. 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November 2020, Vol 110, No. 11 AJPH Kinsey et al. Peer Reviewed Analytic Essay 1643