The CDC recently issued new guidelines for schools to return to in-person learning.
“I know that teachers, parents and state and local leaders have been stretched thin trying to navigate this pandemic,” said CDC Director Dr. Rochelle Walensky in a telephone press conference announcing the guidelines. “Instead of asking them to piece together a patchwork of guidances by topic, we believed it was important to create a one-stop shop to provide the scientific information they need to keep teachers, students, and other school staff safe when schools choose to reopen.”
But the eagerly awaited guidelines, which are recommendations and not requirements, quickly drew criticism. Some educators were disappointed that there were not more details about ventilation in schools and that educator vaccination was not a requirement for reopening. Others argue the guidance is too conservative when it comes to in-person learning.
What’s New in The Guidelines?
The CDC unveiled four color-coded zones to help guide school leaders on their decisions about reopening.
“Districts that have community transmission in the blue/yellow range -- up to 49 cases per 100,000 in the last 7 days -- are encouraged to consider opening for full in-person school,” says Dr. Sara B. Johnson, an associate professor of pediatrics at the Johns Hopkins University School of Medicine. “Those with more transmission can still open in a more limited way, but they have to implement a swiss cheese approach to public health mitigation, i.e., several imperfect strategies layered together,” adds Johnson, who is co-director of the Rales Center for the Integration of Health and Education and the Johns Hopkins Consortium for School-Based Health Solutions.
Schools in red zone communities, with more than 100 new cases per 100,000 residents, may still choose to stay open according to the guidelines, but are not encouraged to do so. “Only elementary schools are encouraged to consider limited re-opening based on evidence that suggests lower transmission risk in this group,” Johnson says.
In addition to the zones, the CDC recommended five key mitigation strategies, acknowledging that the first two are the most important:
While the CDC has been advising these types of mitigation efforts for some time, the new guidance clarified and strengthened some of the recommendations for schools.
“Overall, the guidance is more clear and directive about public health mitigation strategies that need to be in place to facilitate safer in-person schools. Masks are required, for example, not recommended,” Johnson says. However, “The guidelines mostly highlight what we already knew — masks, distancing, cohorting, handwashing, contact tracing are core strategies.”
What is Some of the Criticism?
“My first impression was that it was quite restrictive, and I have concerns about some of the language used and the metrics that they presented,” says Krystal Pollitt, PhD, P.Eng., at Yale School of Public Health.
Requiring less than 100 cases over 7 days for schools to be designated in one of the safer zones seems unnecessarily restrictive to Pollitt. “The community spread is not necessarily reflective of the school spread,” she says.
Current community spread levels in the U.S. place most schools within the CDC’s red zone. However, cases are trending down and most schools in the country have resumed at least partial in-person classes. According to tracking maintained by Burbio, as of Feb. 14 only 33 percent of U.S. students are attending virtual-only classes, while 40 percent are attending schools that offer classes every day and 25 percent in hybrid schools.
What Does It Say About Ventilation?
The new guidelines urge school administrators to improve ventilation to the extent possible, such as by opening windows and doors to increase circulation of outdoor air. But Johnson says the plan is light on evidence-based ventilation recommendations.
“I think the CDC didn’t want to leave the impression that schools should remain closed until they completed massive, expensive retrofits of systems,” she says. “That’s reasonable, but there are other things that can help reduce aerosol transmission risk — such as installing new filters and using portable air purifiers. School administrators should know that these are still key strategies even if the CDC didn’t highlight them.”
Pollit says that clearer guidance around ventilation would have helped schools improve air quality as well as ease the concerns of some educators who worry about returning to in-class instruction.
What Does it Say About Screening Tests?
The CDC guidelines note that testing students and staff who have no symptoms is particularly valuable in areas with moderate, substantial, and high levels of community transmission.
Johnson says this is a positive step. “The addition of screening testing for areas with high community transmission is an important component of the new guidelines,” she says.
Another important component around testing is the new requirement that testing data from schools gets reported to the CDC. “This will give us a much clearer understanding of what is happening in schools that are opening for in-person instruction, as is the requirement that testing data get reported back to the CDC” Johnson says.
What Do the Guidelines Say About Vaccines for Educators?
The new guidelines urged vaccination for teachers and staff, and in communities, as soon as supply allows, but did not make educator vaccination a requirement for reassuming in-person class.
“Ideally, educators would be vaccinated ahead of school re-entry,” Johnson says. “That said, this goal and the reality of supply and distribution collided. Facing an uncertain and potentially long-time horizon to get all teachers and staff vaccinated, the CDC decided to follow the evidence we have about transmission in schools. Before the vaccine was available, with public robust health mitigation strategies in place, in-school transmission was rare. That suggests that while we can’t vaccinate teachers right away, we can rely on strict mitigation measures.”