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

The long-awaited guidance from the Center for Disease Control and Prevention on how to safely reopen schools during the pandemic may end up keeping children out of the classroom longer than necessary, four doctors who reviewed the guidance told CNBC.

Many public health experts applauded the agency last week for spreading 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, which include social detachment, universal masking and some testing. It also presents a set of parameters for assessing how widely the coronavirus is spreading within a community and whether schools should reopen fully for face-to-face learning or maintain a partial or totally remote learning schedule until the outbreak subsides.

However, doctors who spoke to CNBC pointed out notable deficiencies in the guidance, saying it would prevent more than 90% of schools, including in almost all of the country’s 50 largest municipalities, from reopening entirely.

If CDC guidance is strictly followed, these doctors said, schools may not fully reopen for face-to-face learning for months – even if doctors think they could reopen safely much sooner.

At the heart of the criticism is the CDC’s decision to link the reopening decisions to the severity of the virus’s spread in the neighboring county. The guidance says that schools can reopen fully 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 in seven days or a test positivity rate of less than 8%. Schools in counties that do not meet this threshold should switch to hybrid learning, when students spend only some time in the classroom, with the priority of putting elementary school students in the classroom, says the guide.

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

More than 40% of elementary and high schools, however, are already working full-time in person, according to data from Burbio, a service that accompanies school opening plans.

Only a few counties, including Honolulu County, Hawaii, and Cass County, North Dakota, meet the CDC’s criteria for fully reopening schools. Los Angeles County, California, Cook County, Illinois, Harris County, Texas and almost every other city in the country would not make the cut. In fact, they meet the CDC’s most stringent requirements to reopen schools based on the high levels of community transmission there. But doctors who spoke to CNBC said that schools in these counties can safely reopen for full-time learning in person, even with high levels of dissemination, if the correct protocol is followed.

“Something we know a year after this pandemic is that you can keep schools safe even if there are high rates of transmission in the community,” said Dr. Syra Madad, senior director of the special pathogen program across the New York City system. Health + Hospitals. “These references are likely to put more pressure on schools than necessary.”

Walensky defended the agency’s approach.

“We know that the amount of disease in the community is completely reflected in what is happening at school. If there are more diseases in the community, there will be more at school, ”she said on CNN on Sunday. “So I would say that it is everyone’s responsibility to do their part in the community to reduce disease rates, so that we can open our schools.”

Dr. Megan Ranney, an emergency physician and director of the Brown-Lifespan Center for Digital Health, said the CDC is in a “difficult position”. She acknowledged that most of the country is at the most restrictive level of the CDC for reopening, but added that “most schools are also absolutely unable to implement safety precautions”.

Necessary precautions are expensive and require more funding, Ranney said. Without additional funds, it is unrealistic to think that most schools will be able to ensure that desks are six feet away in classrooms, improve ventilation and reopen safely in communities with substantial distribution. She added that the concern in areas with high levels of dissemination is not that schools contribute to the outbreak, but that school employees are infected, leaving schools with few employees.

Ranney noted that in his home state of Rhode Island, all public primary schools, including that of his own children, are open five days a week for face-to-face learning. According to her, high schools have been conducting hybrid learning, “basically following the 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 that the guidance “was not bad” overall, but the CDC should have been less restrictive in its transmission guidelines to the community, given the need to reopen schools now.

“Parents don’t just want their kids to go back to school learning more effectively, many of these kids have a meal at school, kids who come from poor neighborhoods,” he said. “Parents, then, whether they work from home or go to work, could approach the economy and their work in a more coherent way.”

Schaffner said the CDC should have focused more on ensuring that schools knew what infection prevention measures to implement and less on the level of dissemination through the community.

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

Notably absent from the CDC guidelines, noted Wen, are ventilation measures. Since the beginning of the pandemic, evidence has accumulated that the coronavirus can spread effectively through the air. Airborne pathogen experts and epidemiologists urged the federal government to incorporate air safety standards into schools and workplaces.

The CDC guidance has only one paragraph on ventilation, saying “improve ventilation as much as possible, such as opening windows and doors to increase the circulation of outside air”. The four doctors with whom CNBC spoke said that ventilation guidance does not go far enough. Wen said the CDC should have issued guidance on portable air filtration systems, if not recommendations on how to renovate school air conditioning systems, which would be extremely expensive.

Wen said he felt the omission of guidance on ventilation in the classroom is a sign that the CDC is looking for ways to improve school security, but others who defended the agency said it was probably an attempt to combine science with reality. .

In addition, Wen, Schaffner and Madad said the CDC should have further emphasized the importance of vaccinating not only teachers, but all school staff. Although none of the doctors said that vaccinating teachers was necessary to reopen schools, they said the CDC should have urged states to prioritize teachers.

“If the CDC had spoken out and said vehemently: ‘This is a critical part of the reopening’, it would pressure these governors to prioritize teachers,” said Wen. “That for me is the biggest oversight, and I really don’t understand why they want to start this debate.”

– Chart by CNBC’s Nate Rattner.