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CDC Says Schools Can Safely Reopen, but Will They? | Nutrition Fit


Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

The CDC on Friday released long-awaited guidance for how public K-12 schools in the United States should reopen, and advice on what to do to stay that way.

The 35-page document makes clear the Biden administration’s position: “It is critical for schools to open as safely and as soon as possible, and remain open, to achieve the benefits of in-person learning and key support services,” the document’s executive summary says.

The agency says that it’s been shown that schools can reopen safely if they follow strict mitigation strategies,” whether or not teachers and staff have received the COVID-19 vaccine. But, the agency also urges states and local communities to prioritize educators for vaccines as soon as supplies allow it.

President Joe Biden says he wants most K-12 students back in the classroom in the first 100 days of his administration, giving school administrators and teachers until April 30 to prepare. Many state governors and local officials have jumped on the reopening bandwagon, increasing the pressure on schools to reopen.

The pressure to reopen schools has also come from parents who are concerned their children are falling behind academically and suffering from being isolated at home without classmates to interact with. Some parents also can’t afford child care or the technology needed to maintain remote learning.

But many teachers have opposed reopening before they are vaccinated and other precautions are in place. Local teachers unions in several cities, including Chicago, Los Angeles, and Washington, D.C., have spoken out against reopening school buildings before they are deemed safe, and many have negotiated conditions for reopening.

The American Federation of Teachers, which represents 1.7 million educators, and the CDC have said vaccination is not “a precondition” for schools to reopen because the latest evidence shows that when safety measures are followed, few infections occur in the classroom, compared to other settings. The CDC released its latest guidance for schools to reopen safely Friday, describing the safety measures in detail.

These reopening plans would impact about 62% of all public school students who are learning remotely full-time or part-time. Only 38% of all K-12 students in the U.S. were attending school in-person full-time as of Feb. 1, according to a website that tracks the plans of schools in 3,000 counties.

While not binding on school districts, the CDC encourages school districts and leaders to follow its guidelines it outlines in an effort to get students in classrooms as soon as possible. There are significant caveats however.

To successfully reopen schools must practice “consistent implementation of layered mitigation strategies to reduce transmission of SARS-CoV2 in schools,” the guidance says. 

Those mitigation strategies are:

  • Universal and correct use of masks

  • Physical distancing

  • Handwashing and respiratory etiquette

  • Cleaning and maintaining healthy facilities

  • Contact tracing in combination with isolation and quarantine, in collaboration with the local health department.

But the agency also makes clear that reopening schools is only likely to work if these guidelines are followed.

“While risk of exposure to SARS-CoV-2 in a school may be lower when indicators of community spread are lower, this risk is also dependent upon the implementation of school and community mitigation strategies,” the guidance says. “If community transmission is low but school and community mitigation strategies are not implemented or inconsistently implemented, then the risk of exposure and subsequent transmission of SARS-CoV-2 in a school will increase.”

The CDC also calls on school officials to track both the rate of spread in their communities as well as the percentage of positive coronavirus test results. At different levels of either measurement the agency makes suggestions for how to respond.

The guidance creates four color-coded categories of local transmission of coronavirus. In the “Blue,” or low transmission, category, there are 0-9 new cases per 100,000 people in the community and the percentage of positive tests in the past 7 days is less than 5%. In this case, schools are open, sports and extracurricular activities occur, social distancing should be followed where possible and teachers and staff are offered tests once a week.

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For moderate local transmission, meaning 10-49 new cases per 100,000 people in the community and  percentage of positive tests in the past 7 days of 5-7.9%, the “Yellow” category keeps schools open, allows extracurricular activities with mandatory social distancing and offers weekly testing to students.

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The “Orange” category for substantial local cases (50-99 new cases per 100,000) and positive tests (8-9.9%), schools shift to a hybrid mode where students are in-school for part of the week and have virtual school the other days. Sports and extracurricular activities are only allowed if they can be held outdoors with social distancing enforced. The same is true for the “Red” category of high local spread of the virus (more than 100 new cases per 100,000 people; greater than 10% positive local tests), except sports and extra curriculars only occur virtually.

Around the country, many school leaders, even if they want to reopen, are unsure how to pay for the all the mitigation strategies the CDC recommends.

Biden has asked Congress to approve $130 billion in direct funding to help schools reopen, as well as $350 billion in flexible state and local aid to help districts avoid layoffs and close budget gaps. Other proposed funding would reimburse states for costs associated with reopening schools safely, such as personal protective equipment (PPE), testing, and contact tracing.

Teachers’ Concerns

The National Education Association, the country’s largest teachers union, says vaccinating educators will speed the return of in-person learning nationwide. In Ohio, Gov. Mike DeWine has sped up the distribution of vaccines to school employees with the hope of getting all teachers back to the classrooms by March 1.

Scott DiMauro, president of the Ohio Education Association, the state’s largest teachers union, said he’s fine with getting teachers vaccinated faster, but many will not have their second shot by March 1. Federal guidelines also say peak protection may not occur until 2 weeks after the second dose.

Twenty-six states including Ohio, as well as D.C. and Puerto Rico, have made teachers a priority group for vaccination, after health care workers and nursing home residents.

“Several teachers in my unit recently received the first dose of the vaccine, but they wanted to wait at least 6 weeks before returning full-time so they could receive the second dose and develop immunity,” says Leila Kubesch, who teaches Spanish to eighth through 12th graders at Norwood High School in Cincinnati, OH. She has about 22 students in her classroom.

But the school board voted Feb. 9 to resume a traditional 5-day classroom week starting March 22. The high school has used a hybrid model of remote and in-person teaching since the fall.

“We’re feeling apprehensive about this decision because there is already maybe 3 feet between students’ desks rather than 6 feet, and there will be even less space with more students coming in,” says Kubesch, who cleans students’ desks with a bleach solution in between classes. Although students are required to wear masks, she still has to remind them to keep their noses and mouths covered and not remove them when they’re talking.

Kubesch opted out of getting vaccinated until more parents who are essential workers get vaccinated, preferring to “lead from the end of the line.” She also is unsure of how effective the vaccine is against the new strains of the coronavirus and says it won’t make her feel safer in the classroom.

Employees of the Long Beach Unified School District near Los Angeles started to receive the first doses of the vaccine in late January for a total of 2,000 doses. “But the district has 12,000 employees — a lot more than 2,000 employees want the vaccine and both doses before returning in person,” says Andrea Wader, a parent of a fourth grader and president of the John C. Fremont Elementary PTA in Long Beach. ” I think our teachers want to come back, we all want to come back, but when it’s safe,” she says.

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The teachers union representing Wisconsin Rapids Public Schools in Wood County, in the central part of the state, also wanted middle and high school teachers to receive at least the first vaccine dose before they start in-person teaching 4 days a week, but the school board recently voted to reopen those schools March 15, says district Superintendent Craig Broeren. Wisconsin is not one of the 26 states that made teachers a 1b priority group for vaccination.

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“Our medical advisers did not feel that was a necessary component for a few reasons: Teachers of secondary students will be able to continue to maintain 6 feet of physical distance from students, and our vaccine timelines in Wisconsin do not look good. It is possible that school staff may not even start vaccinations until April or later,” he says.

Emerging Evidence

Some public health experts don’t think it’s necessary to vaccinate teachers to reopen schools safely. “From a disease standpoint, the data show that other measures are as effective. But, does vaccination add another layer of protection? Yes. Does it boost teacher confidence? Yes,” says Jennifer Nuzzo, doctor of public health, senior scholar at the Johns Hopkins Center for Health Security, and an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

High rates of COVID-19 in the community should also not be a dealbreaker. “The conversation is shifting a little as we get more data as to where transmissions occur. If schools are using masks and other safety precautions, we’re seeing that the classroom is not where the virus is spreading,” she says.

She explained that while someone is more likely to be infected and bring it into the school when COVID-19 rates in the community are high, the risk of spreading it in schools is still lower than in other places.

CDC researchers found little evidence of the virus spreading when schools took precautions such as masks, distancing, and proper ventilation. The Wood County schools in Wisconsin, which include some from Wisconsin Rapids, had more than 90% mask adherence, small class sizes (maximum of 20 students), and limited contact between classes, which most likely contributed to the low number of cases — only seven of 191 cases among school staff and students were found to come from in-school transmission.

What happens outside the classroom can also affect infection rates. For example, the CDC study found that the risk of infection was greater when students in Mississippi attended gatherings and social functions outside the home and had visitors in the home than when they attended school.

Nuzzo suggests that schools test a random sample of students and staff regularly to monitor COVID-19 cases, isolate them, and prevent outbreaks, as private schools and public schools in New York City are doing. This surveillance approach would not replace daily screening, which is cheaper than trying to test everyone.

Different School Models

The Long Beach Unified School District, which has 85 elementary, middle, and high schools, has been 100% remote since the fall, when new cases were extremely high. Now the numbers in Long Beach are falling and the district is considering bringing kindergarteners back in-person 5 days a week and first through fifth graders back for 2½ hours of daily in-person learning, says Wader. The school board is expected to vote on these proposals once they receive the results of surveys sent to families.

Safety measures for in-person instruction include daily health screening of staff and students, mandatory mask wearing, desks 6 feet apart, and students in each class staying together to lessen contact with other students and staff.

But, even with the hybrid model, parents who work full-time outside the home worry about child care. “Is there child care or after-school care that is safe for everyone? It’s really a tough spot to be in,” says Wader.

She and other parents have questioned the school board’s rush to reopen. “Why not wait until the fall, rather than taking incremental steps towards reopening immediately? We can figure out a support system between now and then for parents who feel their kids have fallen behind,” says Wader, who heard other parents and teachers echo similar sentiments at a California PTA conference this week.

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Rhonda Blandford, a retired nurse and parent of two daughters at Jefferson County Public Schools in Louisville, KY, says the school board wants most of the students to return to 5 days a week in-person learning in mid-March after being entirely online last year.

“They are not choosing to do part-time or alternating days like many successful private schools have done here. I think that and the rush to go back for the last 2 months of school is a mistake,” she says.

Blandford says the money the district will spend to have kids back for just 2 months of school this spring would be better spent to prepare for the next school year. By then, vaccination data will better show how long immunity lasts or what the impact is of the three new coronavirus variants spreading around the country.

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“All we can know for sure is nothing has gone right when plans are rushed,” she says.

Resource Challenges  

Broeren just received school board approval to start his COVID-19 surveillance testing of about 20% of staff and students in middle and high schools starting Feb. 22. “I want to set a baseline positivity rate based on about 4 weeks of testing. Once we move to 4-day in-person learning in March, we will continue surveillance. If we see cases are rising, we can return to what we were doing before,” he says.

Now, all Broeren needs is funding. He is aiming for 457 tests per week, which will cost $31,990 per week. “We may be receiving these tests at no cost from the state, but if that falls through, we will pursue a grant to cover the cost from a local charitable foundation. Worst-case scenario is that we would use a portion of our CARES Act disbursement to cover all or part of the cost.”

He has already spent the first disbursement of CARES Act funds approved by Congress last year, which was around $750,000. “We have had new expenses since the pandemic started, including increased cleaning of all our facilities and structural changes to increase the air exchange rates in every building,” says Broeren.

The second disbursement is $3.1 million. “In general, we intend to use those dollars for continued mitigation strategies, such as updates to the buildings’ HVAC, and curriculum and instructional technology for the purpose of moving kids along and addressing lagging learning needs resulting from the pandemic,” he says.

Sources:

Leila Kubesch, Spanish teacher, Norwood High School, Cincinnati, OH.

Andrea Wader, parent; president, John C. Fremont Elementary PTA, Long Beach, CA.

Jennifer Nuzzo, DrPH, senior scholar, Johns Hopkins Center for Health Security; associate professor of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Craig Broeren, superintendent, Wisconsin Rapids Public Schools, Wood County, WI.

Burbio.com: “K-12 School Opening Tracker.”

Education Week: “Pressure Builds on Schools to Reopen During Pandemic,” “Where Teachers Are Eligible for the COVID-19 Vaccine.”

National Education Association: “Educators Should Receive Priority Access to COVID Vaccine.”

CBS News: “Biden school reopening guidance expected to focus on COVID mitigation, rather than teacher vaccination.”

Chicago Tribune: “Chicago Public Schools is about to reopen after a bitter union fight. Now the hard part begins: Rebuilding trust, and making good on COVID-19 protection vows.”

NBC News: “Teachers say they want the Covid-19 vaccine before they head back to the classroom.”

US News & World Report: “Biden’s Bid to Reopen Schools Plagued by Setbacks.”

JAMA Network: “Data and Policy to Guide Opening Schools Safely to Limit the Spread of SARS-CoV-2 Infection.”

CDC Morbidity & Mortality Weekly Report: “COVID-19 Cases and Transmission in 17 K-12 Schools — Wood County, Wisconsin, August 31-November 29, 2020.”

Long Beach Unified School District.

Cincinnati.com: “What happens when a county turns purple on the Ohio COVID-19 map?”





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