CDC releases guidelines for safely reopening schools, focusing on mitigation
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The CDC published new guidance for safely reopening schools during the COVID-19 pandemic that focuses on layered mitigation strategies.
The new guidance was detailed in a 38-page report that CDC Director Rochelle Walensky, MD, MPH, called a “one-stop shop” for communities seeking advice on holding in-person learning. She said the guidance, which does not say that teachers need to be vaccinated for schools to be open, was based on a thorough review of current science and data on the subject.
In a color-coded chart of recommended mitigation strategies, the CDC said middle and high schools can be open even in areas of high transmission if they can “strictly implement” all the strategies. It does not say that elementary schools need to be this strict, but instead can implement hybrid learning or reduced attendance models in areas of high transmission while observing a required 6 feet of distancing.
“I want to underscore that the safest way to open schools is to ensure that there is as little disease as possible in the community,” Walensky said. “We know that the introduction of subsequent transmission of COVID-19 in schools is directly connected to and facilitated by transmission of COVID-19 outside of the schools and in the community. Thus, enabling schools to open and remain open is a shared responsibility.”
In a scientific brief that was released with the new guidance, the CDC said less than 10% of COVID-19 cases in the country have occurred among children aged 5 to 17 years, with 203 deaths among children up to age 18 through Jan. 27.
“Based on the data available, in-person learning in schools has not been associated with substantial community transmission. Although national COVID-19 case incidence rates among children and adolescents have risen over time, this trend parallels trends observed among adults,” the document states.
The CDC recommended two measures to determine the risk level of transmission in the community — the total number of new cases per 100,000 individuals in the past 7 days, and the percentage of positive nucleic acid amplification tests, including RT-PCR tests in the past 7 days.
The color-coded chart includes four columns indicating levels of severity: blue for low transmission (0 to 9 new cases per 100,000 individuals in the past 7 days, with less than 5% of positive tests in the community); yellow for moderate transmission (10 to 49 cases per 100,000 people, with a 5% to 7.9% positivity rate); orange for substantial transmission (50 to 99 cases per 100,000 people, with an 8% to 9.9% positivity rate); and red for high transmission (anything more than 100 new cases per 100,000 people, and a positivity rate of anything more than 10%).
The guidance states, “regardless of any level of community transmission, all schools should use and layer mitigation strategies.” The CDC provided five mitigation strategies that are “essential to safe delivery of in-person instruction”:
- Universal and the correct usage of masks;
- Physical distancing of at least 6 feet apart;
- Handwashing and respiratory etiquette;
- Cleaning and maintaining healthy facilities;
- And contact tracing, in combination with isolation and quarantining, if needed.
“CDC recommends prioritizing the first two,” Walensky said. “These two strategies are incredibly important in areas that have high community spread of COVID-19, which right now is the vast majority of communities in the United States.”
According to the CDC, evidence from available studies suggests that the risk for SARS-CoV-2 transmission may be lower among elementary school-aged children than children in middle or high school. Due to this, there may be a need to adjust mitigation strategies based off increased susceptibility among teens compared with younger children.
“For these reasons, a phased mitigation approach emphasizes in-person learning modes for younger students throughout all levels of community transmission,” the guidance states.
If schools choose to implement screening testing into phased mitigation strategies, again, the CDC provided color-coded recommendations based on severity.
In all levels of transmission, schools should still adhere to the five mitigation strategies, as well as routine testing of teachers and staff once per week. If a school is in the low transmission group, students do not require testing, however, schools in all other groups should test students once per week.
“When determining which individuals should be selected for screening testing, schools and public health officials may consider prioritizing teachers and staff over students given the increased risk of severe illness among certain adults,” the document states. “In selecting among students, schools and public health officials may prioritize high school students, then middle school students, and then elementary school students, reflecting higher infection rates among adolescents compared to younger children.”
Currently, the U.S. is said to be on track to be able to vaccinate the entire adult population by the end of the summer. The Advisory Committee on Immunization Practices has recommended that people who work in the education sector be prioritized for vaccine allocation.
In the new guidance, the CDC said vaccinating teachers and staff can be considered a layer of mitigation, but that teachers and staff are not required to be vaccinated to be in a school building. Walensky said mitigation strategies may still be necessary when teachers and staff have been vaccinated.
“I want to be careful to assume that once we have vaccination, that we are going to need to continue at least some of these mitigation strategies over some period of time,” she said. “And so, it may very well be that some combination of the mitigation strategies that we have, we will need to be doing for some period of time. We do not know the durability of vaccinations. We don't know whether we're going to need booster vaccinations. And I do believe that we're going to need to continue at least some of these mitigation strategies for some time ahead.”
References:
CDC. Operational strategy for K-12 schools through phased mitigation. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/K-12-Operational-Strategy-2021-2-12.pdf. Accessed Feb. 12, 2021.
CDC. Transmission of SARS-CoV-2 in K-12 schools. https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/transmission_k_12_schools.html. Accessed Feb. 12, 2021.
Perspective
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The scientific data is unequivocal about in-person schooling — it is not a major driver of spread and can be done safely. The scientific data also shows virtual learning is not optimal and children are being harmed by these policies. The CDC has provided important guidance for schools to operate during the pandemic and it should be immediately employed to reopen shuttered schools. As this debate continues, it is now clear and easy for all to juxtapose where the science stands and what the experts conclude to the political machinations of the teacher’s unions.
Perspective
Back to TopSara M. Bode, MD
In general, I think that there is a lot of alignment with the intent behind that guidance and the AAP recommendations, as well. I would say, to start with, it talks a lot about how we really need to prioritize, in our communities, the reopening of schools. Even above what's deemed nonessential business and community services, we have to get kids back into school. And that is definitely something that aligns with what the AAP has been saying.
The other piece the guidance talks about is that when we put these mitigation measures into place, there's evidence that shows that we can do this and get back to school safely. And so, we really need to put the focus on what the schools need to have all those safety measures in place, so students can get back to learning.
The guidance does talk about — and I think this is true — the importance of the community gathering together to really help reduce their risk-taking behavior outside of school, too, in order to help reduce that community transmission rate. So, we can more easily get kids back in to more days in school, and all in-person learning.
The guidance talks about the role of testing. I think this is complex. Not every school could stand up, for example, routine screening for COVID-19, nor is that appropriate in all settings, and the CDC guidance talks about that, and it just talks about how there's different levels and strategies that you might consider around testing. At a minimum, what schools should have is just a plan for where will they refer kids if they're showing symptoms in order to obtain what they need —whether that's visiting a doctor's office or a testing site that can quickly determine if they do have COVID-19 or not — because that's important for their contact tracing, so that they can keep the schools open.
That's a lot of what we've talked about in our AAP guidance, too. It's not necessarily about saying every district should have routine screening, but it really should be a targeted approach around what that community needs for testing.
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CDC. Operational strategy for K-12 schools through phased mitigation. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/K-12-Operational-Strategy-2021-2-12.pdf. Accessed Feb. 12, 2021.
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