CDC classroom orientation would keep 90% of schools at least partially closed

Expected guidelines from the Centers for Disease Control and Prevention on how to safely reopen schools during the pandemic could end up keeping children out of the classroom longer than necessary, four doctors who reviewed the report told CNBC. orientation.

Many public health experts applauded the agency last week for posting clearer and more comprehensive federal guidelines on whether schools should reopen and to what extent. The 35-page document defines “essential elements” of reopening that include social distancing, universal masking, and some evidence. It also sets a set of parameters for measuring the extent of coronavirus within a community and whether schools should reopen completely for face-to-face learning or maintain a partial or fully remote learning program until the outbreak subsides. .

However, doctors who spoke to CNBC noted notable shortcomings in guidance, saying it would keep more than 90 percent of schools, including virtually all of the country’s 50 largest counties, to reopen completely.

If the CDC guidelines are strictly followed, these doctors said, schools may not reopen completely to learn in person for months, even if doctors think they could safely reopen much sooner.

At the heart of the criticism is the CDC’s decision to link reopening decisions to the severity of the virus spreading to the surrounding county. The guide says schools can reopen completely for face-to-face learning only in counties with low or moderate levels of transmission, which means less than 50 new cases per 100,000 residents for seven days or a positivity rate of test less than 8%. County schools that do not meet this threshold should switch to hybrid learning, when students spend only one time in the classroom, with the priority of getting elementary students into the classroom, the guide says. .

Based on these measures, however, the vast majority of U.S. schools should not bring students to the classroom five days a week. CDC director Dr. Rochelle Walensky acknowledged on Friday in a call to reporters that more than 90% of the country’s K-12 schools are currently in high-transmission areas.

However, more than 40% of K-12 schools already operate face-to-face full-time, according to data from Burbio, a service that tracks school opening plans.

Only a handful of counties, including Honolulu County, Hawaii and Cass County, North Dakota, meet CDC criteria to completely reopen schools. Los Angeles County, California, Cook County, Illinois, Harris County, Texas and almost every other city in the country would not make the reduction. In fact, they fall into the CDC’s most restrictive requirements to reopen schools based on high levels of community transmission there. But doctors who spoke to CNBC said schools in those counties can safely reopen for full-time face-to-face learning even with high levels of outreach if the right protocol is followed.

“Something 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, principal director of the system-wide special pathogens program. in New York health hospitals. “These benchmarks are likely to put more pressure on schools than necessary.”

Walensky has defended the agency’s approach.

“We know the amount of illness in the community is fully reflected in what’s going on in the school. If there are more illnesses in the community, there will be more in the school,” he told CNN on Sunday. “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, emergency physician and director of the Brown-Lifespan Center for Digital Health, said the CDC is in a “difficult place.” He acknowledged that most of the country lands at the most restricted level of CDC for reopening, but added that “most schools are also not absolutely capable of implementing safety precautions.”

Necessary precautions are costly and require more funding, Ranney said. Without additional funding, it is unrealistic to think that most schools will be able to make sure desks are six feet apart in classrooms, improve ventilation, and safely reopen communities with substantial diffusion. He added that the concern in areas with high levels of spread is not that schools contribute to the outbreak, but that school staff become infected and leave schools with few staff.

Ranney noted that in his home state of Rhode Island, all public elementary schools, including his own children’s, have been open five days a week for in-person learning. He said middle and high schools have conducted hybrid learning “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 guidance was “not bad” overall, but the CDC should have been less restrictive in its community transmission guidelines, given the need to reopen schools right now.

“Not only do parents want their children to go back to school learning more effectively, many of these children get a meal at school, children who come from impoverished neighborhoods,” he said. “Parents, whether they work from home or go to work, could approach the economy and their work in a more consistent way.”

Schaffner said the CDC should have focused more on ensuring that schools know what infection prevention measures should be implemented and less on the level of community outreach.

Dr. Leana Wen, a former Baltimore health commissioner, noted that some of the CDC’s recommendations on infection prevention give her a break.

Wen noted that ventilation measures are absent from CDC guidelines. Since the beginning of the pandemic, evidence has been accumulating that the coronavirus can spread efficiently through the air. Pathogenic epidemic specialists and epidemiologists called on the federal government to incorporate air safety standards into schools and workplaces.

The CDC guidelines only contain one paragraph on ventilation, which says “improve ventilation as much as possible, such as opening windows and doors to increase outdoor air circulation.” The four doctors CNBC spoke to said the ventilation guides didn’t go far enough. Wen said the CDC should have issued guidelines on portable air filtration systems, if not recommendations on how to review school air conditioning systems, which would be hugely expensive.

Wen said he felt the omission of guidelines on classroom ventilation is a sign that the CDC is looking for convenience over school safety, but others who defended the agency said it would probably be an attempt to combine science with reality.

In addition, Wen, Schaffner, and Madad said the CDC should have stressed the importance of vaccinating not only 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 loudly,‘ This is a key part of the reopening, ’I would have pressured these governors to give priority to teachers,” Wen said. “That’s the main oversight for me, and I really don’t understand why they want to provoke this debate.”

– CNBC chart Nate Rattner.