How Camps Can Manage the Summer 2021 Covid-19 Surge

"I expect 10 times the number of positive tests coming into camp this year over last year," top doctor predicts.

“Yes, camp can open. Here’s how.”

Such was the rallying cry last year of Laura Blaisdell, MD — pediatrician, public health expert, and medical director at Camp Winnebago in Fayette, Maine — who saw a way to keep the boys camp open for Summer 2020 when the vast majority of her peers could not. After a short but successful camp session with bountiful layers of protocol and protection, Blaisdell presented her data, along with that of three other Maine camps that opened, in a study published by the Centers for Disease Control that is now providing a roadmap for camps around the country to build a safe 2021 summer season.

But Blaisdell’s optimism is shaded by her belief that, despite the increasing availability of vaccines, COVID will have a greater presence at summer camps this year than it did in 2020 — primarily because kids and their parents are much less likely to have been sheltering in place. Helping camps prevent and manage widespread outbreaks has become her current mission.

Covid-19 is not Blaisdell’s first viral rodeo. Having manned the medical tent during the 2009 H1N1 crisis (her retrospective study on camp and that contagious rampage is published here ), she knew the adjustments and modifications necessary to make the summer work. “I watched the data roll in and knew, multi-system inflammatory syndrome notwithstanding, that Covid-19 was primarily not a disease of childhood,” she says. “I was interested in how camp could happen, and providing evidence to quell the hysteria of ‘no, not this summer.’”

Of the some 100 residential camps in Maine, only about 20 opened their gates in 2020. That was more than in most northeastern states, which had either banned camp altogether, or had guidelines so prohibitive that many camps didn’t feel they could follow them without destroying what made camp camp. This year Blaisdell is showing many of these same camps how they, too, can open safely. “Masking, social distancing, hand hygiene, outdoor ventilation, quick identification of infected campers or staff, and immediate isolation — these are tried and true Non Pharmaceutical Interventions (NPIs) that work for this virus,” she says. “Do I have zero fear or anxiety? No, I’m a mom. I have my own kids at camp.

“But I also know the price all kids are paying for this pandemic and that if camp is good for kids in any year, it is absolutely essential this year.”

My Q & A with Dr. Laura Blaisdell:

Campenings: Can residential camps open safely this summer during the continued threat of Covid-19?

Yes, and I believe that last year’s percentages will flip and about 80% of camps will open if states create sound policies. That said, camps cannot operate successfully without re-envisioning their programs for a time of Covid-19, and I worry that some will open without doing that. But as I work with more and more camps, I see the light bulb go off and they say, “oh, I can do this, I just have to do it this way.” The vast majority of camps are finding ways to do their programming in ways that fit their motto and their values

With robust testing and pre-camp protocols, do you believe Covid-19 will be entering camp this summer?

The rate of Covid coming into camp this year is going to be much higher. You have kids in school, doing community sports. Because of that I expect 10 times the number of positive tests coming into camp this year over last year, when kids were essentially sheltering in place.

What are some of the changes a camp needs to make to keep campers safe?

It’s less about changing or eliminating activities than it is about changing when and how you do certain activities. For the first week or two, kids need to be in cohorts, and choose from activities that let them be outside and masked and distanced. At our camp we would normally start a divided age basketball game during the first week. Now we do drills until we get a better sense of the health of our campers.

Last summer some state guidelines forbad singing, yet singing is part of the tradition at most camps. What are some other traditions and rituals to be avoided this summer?

These black-and-white recommendations are not helpful because it’s all contextual. We can sing! I wouldn’t recommend singing without a mask inside on the first day of camp. But if 100% of your camp has tested negative twice, can you mask and sing outdoors? Yes, you can. There is a way to make things happen, you just need to rethink how you do them.

This summer, camps probably want to avoid all camp color war, indoor all camp theater, anything involving prolonged hugging (OUCH!).

Is there a point during the summer when, after a few rounds of testing, a camp can declare itself Covid-free, and campers and staff can remove their masks?

Camps that decide at a certain point to go mask-free are putting themselves at risk in a major way. Huge outbreaks are still a possibility. If you have one that’s big enough, I fear camps might have to close. Here are just a few reasons I caution against that mentality.

1) As I said, we expect a higher rate of Covid coming into camp this summer over last summer.

2) Kids won’t be vaccinated. Even if staff is fully vaccinated, children will still be vulnerable to spread. We know that 50% of kids can be completely asymptomatic so spread can happen silently in ways that we don’t know about it until you have an attack rate like at the Georgia camp, which was 55%.

3) The degree of migration in and out of camp. Some camps say “We can’t do it without a wilderness program,” or “We can’t do it without letting our counselors take days off.” Those are opportunities for the virus to come into camp.

So even if a camp is self-contained like a biosphere and everyone has been tested numerous times, there is still a chance for an outbreak?

It’s all contextual. If you have a camp of 100 people that is essentially hermetically sealed with nobody coming or going, and the local community rates are less than 5 per 100,000, yeah, there are certain circumstances where you could say, ok, you guys are really a bubble now; chances of anyone having or getting the virus are exceedingly low. As the person who has to deal with fevers at camp, the challenge is what to do when a camper presents with a fever. I’m going to Covid test him, right? But what will I do if it’s positive? What will I do if it’s negative? The question of what you do if it’s positive makes me caution camps from going whole hog into one large cohort.

Having been battle weary from last summer, the best advice I can give to camps is: Don’t let your guard down.

How can parents help make camp safe this summer?

A healthy camp begins ten days before kids leave home. Camps rely on parents to send their kids in the best shape possible. We all need to get beyond the pandemic fatigue that all of us feel and really limit our children’s exposures in those ten days leading up to camp.

Some families are planning their big outdoor celebrations in the weeks between school and camp — Bar and Bat Mitzvahs and weddings and family reunions. What do you think about campers attending these events so close to opening day?

I’m not telling parents they should shelter in place, but they should not plan to have or attend a big celebration the week before sending their kids to camp. Parents need to understand that. We will do our part on the camp side. Parents need to do their part in the ten days before camp.

How will camps keep children safe during the early days of camp?

Camps need to put in place as many layers of protection as they can in every component of camp. For instance, traveling to camp. The safest way is taking your child directly to camp. Another way is to charter buses and control behaviors on the bus. Another layer is ensuring that kids test negative before arriving to camp. Testing regimens of each camp need to be tailored with several factors in mind including the duration of the sessions, community prevalence of the virus, migration in and out of camp, to name a few things. Maybe they do a rapid PCR upon arrival, and hopefully one after that. Kids need to remain in their cohorts, and wear their masks when traveling outside of their cabin.

How safe are bunks with so many kids thrown together from Day 1?

I think of the cabin as a family unit. I don’t mask with my children or husband or the other family that I am bubbling with, because they are known and expected exposures. The cabin is also a known and expected exposure. And an unavoidable one. There is nothing we can do about it. At our camp I have built firewalls between the cabins — the NPIs I discussed earlier; masking, social distancing, and so on. So even if there is spread within a cabin, it doesn’t spill into the other cohorts within camp.

That’s why it is so important for families to reduce exposure as much as possible in the ten days leading to camp — to ensure the risk of spreading Covid is as low as possible. We understand how hard that is for families, but they have to understand that if they don’t do that, and we have 20 positive cases, that’s going to be the end of camp.

Camp is a privilege. That privilege will not be there if they don’t act like we are all in this together. The existence of camp relies on campers’ pre-camp behavior.

What about the things kids love to do at camp that they can’t do anywhere else, like the Aqua Park or the ropes course — activities where everyone touches everything?

First of all, we haven’t seen much Covid transmission through fomites, things you touch and then I touch. Secondly, the first week of camp is the time we do things as part of a “family.” As the camp feels more secure about everyone’s health and well-being, they can enlarge the cohort to a larger group of kids. So now you’re able to be unmasked with more campers.  That said, camps thinking about enlarging cohorts should also think about the isolation and quarantine and testing implications if someone in that larger cohort has Covid-like symptoms or is Covid positive. 

Can field trips be safe for campers?

There are field trips and there are field trips. Maybe we don’t have lobster rolls at the compound but we do hikes or go to beaches or other places where we can be socially distant and safe.

How about socials?

Socials between camps will be difficult and probably can’t happen this summer.

Inter camp sports?

If you are going to have competitions it has to be with camps that have similar protocols. When camps think about how much effort they’re putting into decreasing exposure and keeping Covid at bay, they have to put those things on the scale and determine the benefit of that to the risk of exposure.

Visiting Day?

I have the distinct benefit of being at camp where I can see my children, and it would break my heart to not be able to. We have good data from H1N1 that we had outbreaks at camp that we were able to handle, and then we had visiting day and had another cluster of outbreaks. So we know that visiting day is an exposure risk to a camp program, and that’s really unfortunate.

How do you think kids will feel with all of these restrictions and protocols in place at camp when they have had to deal with them all year at school and whenever they leave home?

Even with masks, and what we saw as onerous restrictions, our goal last summer was to create a program where kids did not necessarily see the walls we were building around them. And they had a blast. The amount of laughter was intoxicating. Kids so desperately need these interactions, and the fact that things had to be done in a certain way to protect them was softened by the innate human need to connect with others. That’s what we still do at camp, even in times of Covid.