A student is seen on the steps of PS 139 closed public school in the Ditmas Park neighborhood of Brooklyn, New York, United States, October 8, 2020.
Michael Nagle | Xinhua News Agency | Getty Images
The long-awaited guidelines from the Centers for Disease Control and Prevention on how to safely reopen schools during the pandemic could keep children out of class for longer than necessary, four doctors who reviewed the guidelines told The Washington City Times.
Many public health specialists cheered the agency last week for releasing the clearest and most comprehensive federal guidelines yet on whether and to what extent schools should reopen. The 35-page document defines “essential elements” of reopening, including social distancing, universal masking, and some testing. It also includes a set of parameters to measure how widely the coronavirus is spreading within a community and whether schools should fully reopen for personal learning or maintain a partial or full distance learning schedule until the outbreak subsides.
However, doctors speaking with The Washington City Times pointed to notable shortcomings in guidance, saying it would prevent more than 90% of schools, including in nearly all 50 of the largest counties in the country, from being fully reopened.
If CDC guidelines are strictly followed, these doctors said, schools can’t fully reopen for personal learning for months – even if doctors think they can safely reopen much earlier.
At the heart of the criticism is the CDC’s decision to link reopening decisions to how severely the virus is spreading in the surrounding province. According to the guidelines, schools can only fully reopen for face-to-face learning in counties with a low or moderate transmission level, meaning fewer than 50 new cases per 100,000 residents for seven days or a test positivity rate lower than 8%. Schools in counties that don’t meet that threshold should switch to hybrid learning, when students spend only a while in the classroom, with the priority of getting elementary students into the classroom, guidance says.
However, based on those measures, the vast majority of schools in the US should not be bringing students to class five days a week. CDC Director Dr. Rochelle Walensky acknowledged in a phone call to reporters on Friday that more than 90% of primary schools in the country are currently located in high transmission areas.
According to data from Burbio, a service that keeps track of plans to open schools, more than 40% of primary schools already work full-time.
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 would fail. In fact, they fall within the CDC’s most restrictive requirements to reopen schools based on a high level of community transfer there. But doctors speaking with The Washington City Times said schools in those counties can safely reopen for full-time face-to-face learning, even with a high rate of dissemination, if the correct protocol is followed.
“Something we know a year ago in this pandemic is that you can keep schools safe even if you have a high rate of community transmission,” said Dr. Syra Madad, senior director of the system-wide specialty pathogen program. the New York City Health + Hospitals. “Those benchmarks are likely to put more pressure on schools than necessary.”
Walensky has defended the agency’s approach.
“We know that the amount of disease in the community is fully reflected in what is happening in the school. If there are more diseases in the community, there will be more in the school,” she said on CNN Sunday. “So I would say it is everyone’s responsibility to do their part in the community to reduce disease rates so 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 “dire situation.” She acknowledged that most of the country is heading for the CDC’s most restrictive tier for reopening, but added that “most schools are also absolutely incapable of taking the security measures.”
The necessary precautions are costly and require more funding, Ranney said. Without extra money, it is unrealistic to think that most schools can allow desks in classrooms to be six feet apart, improve ventilation, and reopen safely in communities of significant dispersion. She added that the concern in high-spread areas is not that schools will contribute 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 those of her own children, are open five days a week for personal learning. Middle and high schools have conducted hybrid learning, she said, “so basically according to CDC guidelines.”
But Dr. Bill Schaffner, an epidemiologist at Vanderbilt University, said the CDC should have made it easier for K-12 schools to reopen. He said the guidelines were generally “not bad,” but that the CDC should have been less restrictive on community handover guidelines given the need to reopen schools now.
“Parents don’t just want their children to learn more effectively at school again, many of those kids get a meal at school, kids who come from poor neighborhoods,” he said. “The parents can then, whether they are working from home or going to work, to 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.
Dr. Leana Wen, former Baltimore health commissioner, noted that some of the CDC’s infection prevention recommendations give her a break.
Notably absent from the CDC’s guidelines, Wen noted, are ventilation measures. Since the start of the pandemic, there has been evidence that the coronavirus can spread efficiently through the air. Specialists in airborne pathogens and epidemiologists have called on the federal government to include air safety standards in schools and workplaces.
The CDC’s guidelines have only one section on ventilation, which says “improve ventilation as much as possible, such as by opening windows and doors to increase the circulation of outside air.” The four doctors The Washington City Times spoke to said the ventilation guidance doesn’t go far enough. Wen said the CDC should have issued guidelines on portable air filtration systems, if not recommendations, for overhauling HVAC systems in schools, which would be hugely expensive.
Wen said she felt the omission of classroom ventilation guidelines is a sign that the CDC is pursuing expediency over school safety, but others who defended the agency said it was likely an attempt to combine science with reality.
In addition, Wen, Schaffner and Madad all said the CDC should have further emphasized the importance of vaccinating not just teachers but all school staff. While none of the doctors said teacher vaccinations were needed to reopen schools, they said the CDC should have urged states to prioritize teachers.
“If the CDC had come out and said very forcefully, ‘This is a critical part of the reopening,’ it would have put pressure on these governors to give priority to teachers,” said Wen. “That is the biggest mistake for me and I really don’t understand why they want to stir up this debate.”
– Graphic by CNBCs Nate Rattner