The CDC recently updated its guidance for COVID-19 prevention in public schools with new suggestions around masking, distancing, ventilation, testing, and in-person school.
Albert Ko, MD epidemiologist at the Yale School of Public Health, says that with the updated guidance, the CDC is taking a thoughtful and cautious approach to loosening COVID-19 mitigation strategies.
“I think that many of the changes in the policy are very reasonable, especially with the fact that we have this very transmissible Delta variant,” he says.“The most important thing is making sure kids go back to school, and we can do that safely. And so I think being very aggressive in terms of interventions in the school is overall a good policy.”
Schools are not required to follow the CDC recommendations, however, leaders have an enormous influence on the policies implemented by local health departments as well as school districts.
Key updates include:
1. CDC Schools Guidance: In-Person School is the Priority
The changes to the guidance stress the importance of keeping physical school buildings open to learning. “Students benefit from in-person learning, and safely returning to in-person instruction in the fall 2021 is a priority,” the agency says.
Most experts and educators agree that in-person school should be the norm this year.
AFT President Randi Weingarten also voiced support for a return to in-person learning. “The guidance confirms two truths: students learn better in the classroom, and that vaccines remain our best bet to stop the spread of this virus and get our kids and educators fully back to those classrooms for in-person learning,” she said in a statement.
2. CDC Schools Guidance: Masks On For Unvaccinated
“Masks should be worn indoors by all individuals (age 2 and older) who are not fully vaccinated” the CDC now says, extending its wider mask recommendation to school settings. This is especially important “indoors and in crowded settings, when physical distancing cannot be maintained.”
Masks are generally not recommended outdoors, the agency says.
Some school districts, such as New York City's, will continue to require universal masking. On the other end of the spectrum, at least eight states so far have banned mask mandates.
Monica Gandhi, MD, MPH, at the University of California, San Francisco School of Medicine, says that in areas of low hospitalization (5 or fewer hospitalizations per 100,000), children are protected by adult immunity and do not need to be masked.
The CDC guidance does not delve into that kind of specificity, but does allow for some variation on masking procedures based on factors such as community transmission and vaccination coverage.
Ko says the CDC’s cautious approach to masking makes sense as calibrating specific interventions by community might be difficult, especially at the start of the school year. “So it really looks good now here in Connecticut in the summer, but in the fall as kids are going back to school, there's going to be increased contact, so we know that transmission will increase,” he says. “So starting off with these recommendations and then seeing how things turn out is not a bad idea.”
3. CDC Schools Guidance: Distancing Stays, Deep Cleaning Goes
The CDC still recommends instituting 3-foot distancing between desks when possible but does not advise keeping schools closed if space does not permit it.
The updated CDC school guidance also emphasizes the importance of ventilation and offers resources for schools on upgrading the amount of outdoor air that is brought into a classroom. In addition, while still promoting hand washing, the guidance notes risk of surface spread from the virus is low and that cleaning once per day is usually enough to sufficiently remove potential virus that may be on surfaces.
Dr. Joseph Allen, director of the Healthy Buildings Program at Harvard University’s T.H. Chan School of Public Health, applauded both of these updates. “It’s great to see that airborne transmission, and the power of better ventilation and filtration, [is] finally being explicitly acknowledged,” he wrote in USA Today. “CDC also gets it right in terms of being explicit that the risk from surfaces is low, which means that schools can pull back on all of the ‘enhanced’ cleaning and disinfection. This should finally put an end to the senseless closing of schools for a day of ‘deep cleaning.’ Promoting good hand hygiene is enough.”
4. CDC Schools Guidance: Vaccination and Testing
“Vaccination is currently the leading public health prevention strategy to end the COVID-19 pandemic,” the CDC says. “Promoting vaccination can help schools safely return to in-person learning as well as extracurricular activities and sports.”
However, because children under 12 currently can’t get vaccinated, and not all students or staff who are eligible for vaccination have gotten vaccinated, other mitigation efforts will still be necessary when the school year starts, including screening testing, which the CDC guidance recommends.
As other respiratory viruses that had been largely absent during COVID shutdowns return, health experts expect more students to have COVID-like symptoms from other viruses this year.
Ko says testing both in and out of the school setting will be key to avoiding unnecessary quarantines and keeping students in class. “When somebody comes in with a cough or a fever, or a headache, or runny nose, it may or may not be COVID,” he says. “The school systems are going to have to tease that out. Testing for COVID has become part of our routine life. So I think there are ways to deal with this.”