Classroom CDC advice would keep 90% of schools at least partially closed

Long-awaited advice from the Centers for Disease Control and Prevention on how to safely reopen schools during the pandemic could end up preventing children from going to class longer than necessary, said four doctors who reviewed the guidelines at CNBC.

Many public health experts praised the agency last week for releasing the clearest and most comprehensive federal guidance yet on whether and to what extent schools should reopen. The 35-page document sets out the “essentials” of the reopening, including social distancing, universal masking and some testing. It also defines a set of metrics to assess the extent of the spread of the coronavirus within a community and whether schools should fully reopen for in-person learning or maintain a partial or fully distance learning schedule until. for the epidemic to subside.

However, doctors who spoke to CNBC pointed to notable gaps in the guidelines, saying it would prevent more than 90% of schools, including in almost all of the country’s 50 largest counties, from fully reopening.

If CDC guidelines are strictly followed, these doctors said, schools may not fully reopen for in-person learning for months – even though doctors believe they could safely reopen much sooner.

The CDC’s decision to tie the reopening decisions to the severity of the virus’s spread in the surrounding county is at the heart of criticism. The guidelines say schools can only fully reopen for in-person learning in counties with low or moderate levels of transmission, meaning fewer than 50 new cases per 100,000 population over seven days or a test rate. positivity less than 8%. Schools in counties that do not meet this threshold should switch to blended learning, where students spend just a little time in class, with the priority of getting elementary school students into the classroom, the guide says. .

Based on these metrics, however, the overwhelming majority of schools in the United States are not expected to bring students into class five days a week. CDC director Dr Rochelle Walensky admitted in a call to reporters on Friday that more than 90% of K-12 schools nationwide are currently in high transmission areas.

More than 40% of K-12 schools, however, are already operating in person full-time, according to data from Burbio, a service that tracks plans to open schools.

Only a handful of counties, including Honolulu County, Hawaii and Cass County, North Dakota, meet the CDC’s criteria to fully reopen schools. Los Angeles County, California, Cook County, Illinois, Harris County, Texas, and almost every other city in the country wouldn’t make the cut. In fact, they fall under the CDC’s more restrictive requirements to reopen schools based on high levels of community transmission there. But doctors who spoke with CNBC said schools in those counties can safely reopen for full-time in-person learning, even with high levels of spread if the correct protocol is followed.

“What we know a year after this pandemic is that you can keep schools safe even if you have high rates of community transmission,” said Dr Syra Madad, senior director of the Special Pathogens Program at the system wide at New York City Health + hospitals. “These benchmarks will likely put more pressure on schools than necessary.”

Walensky defended the agency’s approach.

“We know that the amount of illnesses in the community is completely reflected in what is happening at school. If there are more illnesses in the community, there will be more at school,” he said. she said Sunday on CNN. “So I would say it’s everyone’s responsibility to do their part in the community to reduce disease rates, so that we can open our schools.”

Dr Megan Ranney, an emergency physician and director of the Brown-Lifespan Center for Digital Health, said the CDC is in a “difficult situation.” She acknowledged that most of the country lands in the CDC’s most restrictive level for reopening, but added that “most schools are also absolutely unable to put safety precautions in place.”

The necessary precautions are costly and require more funding, Ranney said. Without additional funds, it is unrealistic to think that most schools will be able to ensure that desks are six feet apart in classrooms, improve ventilation, and reopen safely in communities with a large distribution. She added that the concern in areas with high spread is not that schools are contributing to the outbreak, but that school staff will become infected, leaving schools short of staff.

Ranney noted that in her home state of Rhode Island, all public elementary schools, including her own children’s, were open five days a week for in-person learning. Middle and high schools conduct blended learning, she said, “so basically following CDC guidelines.”

But Dr Bill Schaffner, an epidemiologist at Vanderbilt University, said the CDC should have facilitated the reopening of K-12 schools. He said the advice was “not bad” overall, but the CDC should have been less restrictive on its community transmission guidelines, given the need to reopen schools now.

“Not only do parents want their children to go back to school learning more effectively, but many of these children are getting school meals, children who come from poor neighborhoods,” he said. “Parents, whether they work at home or at work, could then approach the economy and their work in a more coherent way.”

Schaffner said the CDC should have focused more on ensuring schools know what infection prevention measures to implement and less on the level of community spread.

Former Baltimore Health Commissioner Dr Leana Wen noted that some of the CDC’s infection prevention recommendations give her food for thought.

Ventilation measures are particularly absent from CDC guidelines, Wen noted. Evidence has been accumulating since the start of the pandemic that the coronavirus can spread effectively through the air. Airborne pathogen specialists and epidemiologists have called on the federal government to incorporate aviation safety standards into schools and workplaces.

The CDC guide has only one paragraph on ventilation, saying “improve ventilation where possible, for example by opening windows and doors to increase the circulation of outside air.” The four doctors CNBC spoke to said the ventilation guidelines don’t go far enough. Wen said the CDC should have issued guidelines on portable air filtration systems, if not recommendations on how to overhaul school HVAC systems, which would be hugely expensive.

Wen said she felt the omission of classroom ventilation advice was a sign the CDC was looking for a school safety opportunity, but others who defended the agency said it It was probably an attempt to combine science and reality.

Additionally, Wen, Schaffner and Madad all said the CDC should have put more emphasis on the importance of vaccinating not only teachers but all school staff. Although none of the doctors said that teachers’ vaccinations were needed to reopen schools, they said the CDC should have urged states to prioritize teachers.

“If the CDC had come forward and said very loudly, ‘This is a critical part of reopening,’ it would have put pressure on these governors to put teachers first,” Wen said. “This is the biggest oversight for me, and I really don’t understand why they want to start this debate.”

– CNBC chart Nate rattner.