A student is seen walking down the steps of PS 139 closed public school in the Ditmas Park neighborhood of Brooklyn, New York, United States on October 8, 2020.
Michael Nagle | Xinhua News Agency | Getty Images
The Centers for Disease Control and Prevention’s long-awaited guidelines on safely reopening schools during the pandemic could result in children being locked out of the classroom for longer than necessary, four doctors told CNBC.
Many public health professionals applauded the agency last week for publishing the clearest and most comprehensive federal guidance on whether and to what extent schools should reopen. The 35-page document defines “essential elements” of the reopening, including social distancing, universal masking, and some testing. It also sets a number of parameters that can be used to assess how far the coronavirus is spreading within a community and whether schools should be fully reopened for face-to-face learning or a partial or complete removal schedule should be followed until the outbreak has subsided.
However, doctors who spoke to CNBC pointed to notable flaws in the guidelines, saying it would prevent more than 90% of schools, including in nearly all of the country’s 50 largest counties, from fully reopening.
If CDC guidelines are strictly followed, schools may not reopen fully to face-to-face learning for months – even if doctors feel they could safely reopen much sooner.
Restrictive metrics
At the center of the criticism is the CDC’s decision to link the reopening decisions to the spread of the virus in the surrounding county. The guidelines state that schools can only be fully reopened to face-to-face learning in countries with low or moderate transmission, which means fewer than 50 new cases per 100,000 population over seven days or a test positivity rate of less than 8%. Schools in counties that don’t reach this threshold should switch to hybrid learning if students only spend some time in the classroom, with the primary goal of getting elementary school students into class, the guide says.
Because of these measures, the vast majority of schools in the United States should not have students in class five days a week. CDC director Dr. Rochelle Walensky admitted in a call with reporters on Friday that currently more than 90% of K-12 schools in the country are in high transmission areas.
However, more than 40% of K-12 schools are already working full-time in person, according to Burbio, a service that is tracking plans to open the school.
Only a handful of counties, including Honolulu County, Hawaii and Cass County, North Dakota, meet the CDC’s criteria for schools to fully reopen. 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 most restrictive requirements to reopen schools there due to a high level of community transmission. However, doctors who spoke to CNBC said schools in these districts, even with high prevalence, are safe to reopen to full-time face-to-face learning if the correct protocol is followed.
“We know a year after this pandemic that you can protect schools even if you have high community transmission,” said Dr. Syra Madad, senior director of the system-wide program for specific pathogens at New York City Health + Hospitals. “These benchmarks are likely to put more pressure on schools than necessary.”
Walensky has defended the agency’s approach.
“We know that the level of disease in the community completely affects what happens in school. If there are more diseases in the community, there will be more in school,” she said on CNN on 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.”
‘Strong point’
Dr. Megan Ranney, emergency physician and director of the Brown-Lifespan Center for Digital Health, said the CDC was in “an difficult position”. She admitted that most countries end up in the CDC’s most restrictive reopening tier, but added that “most schools are also absolutely unable to put the security in place”.
The necessary precautions are costly and require more resources, Ranney said. Without additional funding, it is unrealistic to believe that most schools can ensure that classroom desks are two meters apart, that they can improve ventilation and reopen safely in communities with significant distribution. She added that in areas with high prevalence, the concern is not that schools are contributing to the outbreak, but that school staff will be infected and schools will remain understaffed.
Ranney noted that in her home state of Rhode Island, all public elementary schools, including those of her own children, were open for personal study five days a week. Middle and high schools have done hybrid learning, she said, “basically following CDC guidelines.”
Infection prevention
Dr. However, Bill Schaffner, an epidemiologist at Vanderbilt University, said the CDC should have made it easier for the K-12 schools to reopen. He said the guidance was overall “not bad,” but the CDC should have been less restrictive of its community broadcast guidelines as schools now have to reopen.
“Parents not only want their children to learn more effectively in school again, many of these children also have a meal at school, children who come from impoverished areas,” he said. “Parents, whether they work from home or go to work, would then be able to approach the economy and their work more coherently.”
Schaffner said the CDC should have focused more on making sure schools know what infection prevention measures to implement and less on community spread.
Dr. Leana Wen, former Baltimore health commissioner, noted that some of the CDC’s recommendations on infection prevention give her a break.
ventilation
Wen noticed that the CDC guidelines specifically do not include ventilation measures. Since the beginning of the pandemic, there has been increasing evidence that the coronavirus can spread efficiently through the air. Air pathogens specialists and epidemiologists have called on the federal government to include flight safety standards in schools and at work.
The CDC guidelines contain only one paragraph on ventilation: “Improve ventilation as much as possible, for example by opening windows and doors to increase airflow outside.” The four doctors CNBC spoke to said the ventilation instructions didn’t go far enough. Wen said the CDC should have issued guidelines on portable air cleaner systems if it weren’t for recommendations on how to overhaul HVAC systems in schools, which would be enormously expensive.
Wen said she thought leaving out guidelines on classroom ventilation was a sign that the CDC was purposely looking to keep the school safe, but others defending the agency said it was likely an attempt to connect science with reality.
In addition, Wen, Schaffner and Madad said the CDC should have continued to emphasize the importance of vaccinating not just teachers but all school staff. While none of the doctors said teacher vaccinations were necessary to reopen schools, the CDC should have urged states to give teachers priority.
“If the CDC had come out and said really strongly, ‘This is a critical part of the reopening,’ it would have put pressure on these governors to give teachers priority,” Wen said. “This is the biggest oversight for me and I really don’t understand why you want to start this debate.”
– Artwork by Nate Rattner of CNBC.
