CDC releases 'watered down' national reopening guidance, ID expert says

The CDC released national guidance for reopening schools, mass transit, child care, camps, workplaces and bars and restaurants during the COVID-19 pandemic.

The guidance is a series of decision trees for businesses to follow. It comes a week after AP News reported that a detailed 17-page draft of reopening guidance developed by the CDC was rejected by the White House for being “too prescriptive.”

Tina Q. Tan, MD, a member of the Infectious Diseases Society of America Board of Directors and professor of pediatrics at Northwestern University Feinberg School of Medicine, told Healio Primary Care that the new guidance is “is definitely watered down from the previous one.”

She said the new guidance is good, but “it would be much better if there were more specifics that were added to the guidance.”

“The problem is that if you don’t provide specific enough guidelines, people don’t know what to do,” Tan explained.

Schools, child care programs, camps

Before considering reopening, the CDC calls for schools, child care programs and camps to follow state and local orders, ensure there are resources to protect children and employees at higher risk for severe COVID-19-related illness, and have the ability to screen for symptoms and history of COVID-19 exposure among children and employees upon arrival. Individuals who were recently in areas of high COVID-19 transmission should undergo more advanced screening such as temperature checks.

Employers must also promote proper hygiene like hand-washing, ensure that employees wear cloth face masks, and train employees on health and safety protocols. In addition, employers should encourage those who are sick to stay home and develop protocols for a situation in which a child or employee becomes sick. The guidance also calls for employers to monitor absences; review cases, exposures and updated policies with local health officials, employees and families; and consult local health officials if there is a case in the facility or a spike in cases in the area.

In comparison, the CDC’s draft guidance offered more specific recommendations. For instance, it instructed child care programs, schools and camps to ensure that classes include the same group of children each day, limit mixing between groups, space out seating to 6 feet apart, if possible, and serve meals in classrooms rather than cafeterias.

Tan said that the posted guidance “is so general that it really leaves it up to the people to decide how to implement this, and if you don’t have specifics there, many people are just not going to do it.”

Other public places

The CDC also posted decision trees for bars and restaurants, mass transit systems and workplaces.

The decision trees are similar to those for schools, child care programs and camps.

Social distancing recommendations vary depending on the type of business. For mass transit systems, the guidance recommends implementing social distancing by closing every other row of seats and, on buses, using the rear door as an entrance and exit, if possible. The guidance also recommends limiting routes in high-transmission areas.

However, this differs from the draft guidance, in which mass transit systems were also asked to keep passengers 6 feet apart.

For social distancing in bars and restaurants, the guidance recommends that businesses encourage drive-through options, curbside pickup and delivery, space out tables in dining rooms, avoid self-serve stations and stagger shifts.

In the draft guidance, these businesses are given more specific instructions, such as installing physical barriers in areas where people cannot stay 6 feet apart and using phone apps to alert patrons when their table is ready in place of buzzers.

Among other workplaces, the CDC recommends social distancing measures such as furthering space between employees, staggering breaks and shifts, and limiting large events in the workplace. The guidance also recommends that workplaces consider changing their commuting practices by encouraging those who do not live locally to work remotely.

In comparison, the draft guidance calls for workplaces to completely close shared spaces, encourage telework as much as possible and cancel all events with more than 10 people.

Tan noted that despite the separate decision trees for each environment, “it’s all pretty much the same thing.”

“All these situations are very different,” she continued. “Restaurants and bars are going to be very different from mass transit, that’s [also] going to be very different from schools... I think there needs to be more specificity added.”

A week after the guidance was published, the CDC issued recommendations for communities of faith. This guidance called for these institutions to work with state and local health authorities to determine their mitigation efforts. It also urged them to promote hygiene practices such as hand washing, encourage congregants to use cloth face coverings, increase cleaning and sanitizing efforts, promote social distancing, and to minimize the use of shared worship materials, such as hymnals, prayer rugs and religious texts.

The guidance also asks communities of faith to plan for a response in the event a staff or congregant member develops COVID-19, post messages about how to prevent the spread of the virus, and strongly suggests that they close for disinfecting for at least 24 hours after someone in the building tests positive for COVID-19.

Calls for more specific guidance

In response to the release of the shortened CDC national guidance, Sen. Maggie Hassan of New Hampshire and Sen. Tim Kaine of Virginia sent a letter to Vice President Mike Pence, calling on the White House Coronavirus Task Force to work with the CDC and release its full reopening guidance.

“The newly released CDC guidance provides only high-level guidance, at a time that local decision-makers need detailed, step-by-step guidelines about how to safely reopen in phases,” they wrote. “The Task Force must prioritize public health and safety, and guidance needs to be based on science and evidence — not politics or ideology.”

Hassan and Kaine stressed that more detailed guidance is particularly needed in schools, camps and child care programs because the current guidance published by the CDC “falls far short of what is needed for states and communities to be able to put in place thoughtful plans to reopen that will best serve their students and educators.” – by Erin Michael

References:

CDC. Child care programs during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/Childcare-Decision-Tree.pdf. Accessed May 18, 2020.

CDC. Interim Guidance for Communities of Faith. https://www.cdc.gov/coronavirus/2019-ncov/php/faith-based.html. Accessed May 22, 2020.

CDC. Public health considerations for reopening mass transit during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/community/pdf/MassTransit-DecisionTree.pdf.  Accessed May 18, 2020.

CDC. Restaurants and bars during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/restaurants-and-bars-decision-tree.pdf. Accessed May 18, 2020.

CDC. Schools during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/Schools-Decision-Tree.pdf. Accessed May 18, 2020.

CDC. Youth programs and camps during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/Camps-Decision-Tree.pdf. Accessed May 18, 2020.

CDC. Workplaces during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/workplace-decision-tree.pdf. Accessed May 18, 2020.

Hassan. Senators Hassan, Kaine call for release of full CDC reopening guidelines. https://www.hassan.senate.gov/news/press-releases/senators-hassan-kaine-call-for-release-of-full-cdc-reopening-guidelines. Accessed May 18, 2020.

Disclosures: Tan reports no relevant financial disclosures.

Editor’s note: This article was updated with information about the CDC’s guidance on reopening communities of faith.