By Rebecca Weintraub, MD

Like many families, we watched summer plans for our two children dissolve as the COVID-19 pandemic raged unchecked and travel restrictions mounted, forcing many camps to go virtual or shut down. As we scrambled to find alternatives, we learned of two camps opening in-person in Maine, a state within driving distance that had low community transmission rates. One of them, a music camp, was particularly high-risk due to the aerosols produced by woodwind instruments. But both had detailed safety protocols, and we felt fortunate to find spots for our sons. Due to a last-minute vacancy, I also had the opportunity to serve camp — as a volunteer doctor.

As a parent and camp physician, I witnessed how two enterprising camps — Camp Wigwam and the New England Music Camp (NEMC) — wrote their own pandemic playbooks in the absence of models or clear federal guidelines. At the end of the summer, neither camp had experienced a single case of COVID-19. This was a remarkable feat, considering the ill-fated reopening of other camps across the country.

At an overnight youth camp in Georgia, for example, nearly half of all Georgia-based campers and staff (n: 260, 44%) contracted COVID-19. One study found that camp protocols mostly followed recommendations from the CDC on risk mitigation at youth camps but strayed in two key respects: campers were not required to wear masks, and windows and doors were not kept open to provide increased building ventilation. The camp required negative tests prior to arrival but within a wide time interval (12 days), and cabins housed an average of 15 campers (range 1–26).

By contrast, Camp Wigwam and NEMC required a negative test within 72 hours of arrival, kept sleeping quarters limited, required strict mask-wearing initially, and kept most activities outside. In fact, many of the non-pharmaceutical interventions deployed at Wigwam and NEMC were later described in a September report of four other camps in Maine that successfully opened over the summer without an outbreak.

Rigorous Prevention Measures

Camp Wigwam, a 110-year-old all boys camp in Waterford, Maine focused on arts and athletics, determined that it could safely reopen this summer by implementing rigorous measures that combined regular testing by a hired vendor, social distancing, and hygiene practices. All staff arrived two weeks before the opening of camp to quarantine together as a cohort. The week prior to camp opening, they were tested onsite with a polymerase chain reaction nasal swab, the most reliable test on the market to detect active infection.

One week before opening, the camp sent a screening survey to all campers, asking families to document their interactions outside the home and to chart a daily temperature check in the seven days prior to the start of camp. They also required each camper to take a COVID-19 nasal cavity swab test close to home within 48 hours of camp reopening. Wigwam reimbursed the cost of the test if any family had to pay out of pocket. Campers arriving by air or by bus were given travel kits with personal protective gear, including masks and gloves. We dropped our sons off by car in a designated area and said a quick goodbye.

A Phased Transition

Wigwam planned a three-phase transition to camp. The number of campers in each cabin was reduced to allow for social distancing, with three to four kids in each cabin. During the first phase, campers stayed with their cabin-mates and joined another cabin or two, with pods of 8 to 12 campers. During phase two, the groups expanded to 35 to 40 campers. Finally, phase three allowed for campers to join different pods and activities, which mirrored a more normal Wigwam experience.

Progressing to each phase depended on a tightly monitored system of safety practices, medical screening, and testing. One week into the camp season, the camp arranged for a mobile testing vendor to test every Wigwam camper and employee onsite. Once the 230+ nasal swab test results came back — all negative — the camp held its first indoor meal and began to initiate team sports. Access to testing was integral to their strategy to keep everyone safe during the six-week camp season, and it instilled trust in their operating system among its wider community of camp families. Our younger son pleaded to stay an additional two weeks, so at week four, we picked up our older son at the border of camp property and could only see our younger son from a distance. No one who hadn’t quarantined could enter the grounds.

Lessons from a Camp Doctor

We then drove our oldest son to NEMC, an hour and a half away from Camp Wigwam, with its own rich history of providing intensive music education to young adults for over 80 years. My son had been accepted to its in-person, two-week chamber intensive in August. When I learned that the camp nurse wouldn’t be able to attend, I applied for a State of Maine camp doctor license and volunteered where I would live in the infirmary, advise on camp health and safety protocols, and care for the 40 students and 10 staff and faculty on campus. From my experience watching Camp Wigwam’s new policies play out, I carried forward several key lessons and the planning and implementation details needed for programs like this to operate safely.

In the spring, it had seemed unlikely that our son would even be able to attend this camp. With guidance from the American Camp Association, the Maine Summer Camps Association, and a small Facebook group of Maine camp directors, NEMC had previously decided the safest option was to offer its camp virtually for the 230 enrolled campers. The families that had already registered were given the option to opt out.

In June, however, as the state began to reopen and directives on group size loosened, the camp began to consider an additional model — a more condensed session where fewer campers could come together for a two-week chamber music intensive. The camp decided that if they could have 24 students for a two-week program, they could run a viable in-person camp. They eventually capped the program at 40 students since the program generated a lot of interest. Most campers came from states that did not require a 14-day quarantine but instead a negative test within 72 hours of arrival. The campers who arrived from Vermont, Connecticut, Massachusetts, New York, Rhode Island, and one from Washington, D.C. all needed a recent negative test; the campers from Maine did not.

In the absence of a model to follow, the camp leadership prioritized safety above all as they planned the details of reopening. NEMC updated their protocols in August when the State of Maine released new guidance. In addition to testing before camp, the campers needed to social distance upon arrival at camp, wear masks, and wash hands regularly. Masks were required in all indoor spaces. Each camper had their own room in one of the two dormitory-style buildings on campus, so they did not share sleeping space. Other safety measures were put in place due to the aerosolizing effect of certain woodwind instruments: all flutists, for example, were surrounded by three sides of plexiglass, even while playing outdoors. The camp invested thousands of dollars in cleaning supplies, thermometers, and hand sanitizer to create a safe environment.

Every evening we checked the temperatures by bunk. Mid-session a camper presented with a fever and tachycardia, after a vigorous afternoon of kayaking. His tachycardia improved with hydration. The camper was isolated as we strategized how to access a rapid test. Rapid testing is virtually impossible in Maine. A day later a counselor presented with a temperature of 102 that rose to 104 and nausea. I attempted to sign up the camper at a CVS MinuteClinic but was unable to register a camper under the age of 18, even with parental consent. The counselor was able to receive a test via CVS MinuteClinic. We waited for three days to get results from the camper. Both the camper and counselor stayed isolated in the infirmary until results came back. We continued to monitor staff and campers. After their test results returned negative, we resumed their activities.

To end the chamber intensive, the musicians performed outside in trios, quartets, and as a chamber group. The students performed with no conductor and the flutists played within their plexiglass. Listening to live music outdoors — safely — in the midst of a pandemic felt like a feat of orchestration.

NEMC directors are already planning for their 2021 session, despite not knowing what the pandemic will look like next year. They have built a budget to have one rapid test per child and staff member so that if someone does get sick, they can test them immediately. As Kim Wiggin, the camp’s co-director, told me, “Access is not the problem. It’s the response time. I could go 5 to 10 minutes from here to get a test, but it could be 5 to 7 days before I get the results.”

Summer camp teaches life lessons; this year, it also gave us models for how to safely gather, learn, and thrive during a pandemic. For camps that saw no outbreaks, their ability to open and operate safely came down to strong, well-informed leadership that integrated emerging local data and guidance from medical experts, monitored safety protocols, integrated testing to the greatest extent possible, and communicated with staff and families in detail about expectations and contingencies.

With fall entering full swing, parents again carry the burden of deciding how to educate and socialize their children while mitigating exposure to COVID-19. Colleges and schools are deploying new tools and protocols to open their physical spaces. Across the country, states are implementing non-pharmaceutical interventions including precautionary quarantine and remote schooling. My experiences at camp reinforced the tenets of transmission prevention: that we must continue to promote masks, reinforce community mitigation measures and ensure accessible and efficient testing. We need daily reassurance that we can provide care for each other and keep our patients, students, families, and communities safe.

Rebecca Weintraub, MD, leads Ariadne Labs’ Better Evidence program. She is an Assistant Professor at Harvard Medical School and leads the Global Health Delivery Project.

Illustration by kameshkova / iStock