Infectious Disease

CDC publishes pointers for safely reopening colleges with an emphasis on harm management

February 12, 2021

6 min read

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The CDC released new guidelines for safely reopening schools during the COVID-19 pandemic, focusing on strategies to combat shifts.

The new guidelines were detailed in a 38-page report from the CDC director Rochelle Walensky, MD, MPH, called a “one-stop shop” for communities seeking personal learning advice. She said the guidance, which does not state that teachers must be vaccinated in order for schools to be open, is based on a thorough review of current science and data on the subject.

Source: Adobe Stock

In a color-coded table of recommended mitigation strategies, the CDC said that middle and high schools can be open in areas of high transmission if they can “strictly implement” all strategies. It does not mean that elementary schools have to be that strict, but can instead implement hybrid learning or models with reduced attendance in areas of high transmission while maintaining the required 6 foot spacing.

Rochelle Walensky

“I want to underline that the safest way to open schools is to make sure that there is as little disease as possible in the community,” said Walensky. “We know that the introduction of the subsequent transmission of COVID-19 in schools is directly linked to and facilitated by the transmission of COVID-19 outside of schools and in the community. Therefore it is a shared responsibility to keep schools open and to stay open. “

In a scientific report released with the new guidelines, the CDC said less than 10% of COVID-19 cases in the country have occurred in children ages 5-17, with 203 deaths in children aged 18 and under January to January 27th.

“Based on the data available, face-to-face learning in schools was not associated with significant community transmission. Although national COVID-19 incidence rates in children and adolescents have increased over time, this trend is in line with the trends observed in adults, “the document reads.

The CDC recommended two measures to determine risk of transmission in the community – the total number of new cases per 100,000 people in the last 7 days and the percentage of positive nucleic acid amplification tests, including RT-PCR tests, in the last 7 days.

The color-coded chart has four columns indicating the severity: blue for low transmission (0 to 9 new cases per 100,000 people in the last 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 positivity rate of 5% to 7.9%); Orange for substantial transmission (50 to 99 cases per 100,000 people with a positivity rate of 8% to 9.9%); and red for high transmission (more than 100 new cases per 100,000 people and a positivity rate of more than 10%).

The guidelines state: “Regardless of the level of community transmission, all schools should employ and overlay mitigation strategies.” The CDC provided five mitigation strategies that are “essential to the safe provision of personal instructions”:

  • Universal and correct use of masks;
  • Physical distance of at least 6 feet apart;
  • Hand wash and breath label;
  • Cleaning and maintaining healthy facilities;
  • And if necessary, contact tracing in combination with isolation and quarantine.

“CDC recommends prioritizing the first two,” said Walensky. “These two strategies are incredibly important in areas with high levels of COVID-19 in the community that currently makes up the vast majority of communities in the United States.”

According to the CDC, the available studies suggest that the risk of SARS-CoV-2 transmission may be lower in primary school children than in middle school or high school children. For this reason, there may be a need to adapt mitigation strategies based on an increased susceptibility in teenagers compared to younger children.

“For these reasons, a gradual mitigation approach will highlight personal learning modes for younger students at all levels of community transfer,” the guidelines say.

If schools choose to translate screening tests into incremental harm reduction strategies, the CDC again made color-coded recommendations based on severity.

At all levels of transmission, schools should continue to adhere to the five mitigation strategies as well as routine teacher and staff testing once a week. If a school is in the low rate group, there is no need to test students. However, schools in all other groups should test students once a week.

“When deciding which people to select for screening tests, schools and public health officials may consider prioritizing teachers and staff over students as certain adults are at increased risk of serious illness,” it said the document. “When choosing among students, schools and public health officials may prioritize high school, middle school and elementary school students due to higher rates of infection among adolescents compared to younger children.”

Currently, the US is said to be on track to vaccinate the entire adult population by the end of summer. The Advisory Committee on Vaccination Practices has recommended that priority should be given to people working in the education sector when assigning vaccines.

In the new guidance, the CDC said that vaccinating teachers and staff can be viewed as a level of harm reduction, but that teachers and staff do not need to be vaccinated to be in a school building. Walensky said mitigation strategies may still be needed after teachers and staff have been vaccinated.

“I want to be careful assuming that after vaccination we will have to continue at least some of these mitigation strategies for a period of time,” she said. “So it may well be that we have to carry out a combination of the mitigation strategies we have pursued for some time. We do not know the shelf life of vaccinations. We don’t know if we will need any booster vaccinations. And I believe that we need to continue at least some of these mitigation strategies for some time. “

References:

CDC. Operating strategy for K-12 schools through gradual reduction. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/K-12-Operational-Strategy-2021-2-12.pdf. Accessed February 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 February 12, 2021.

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Amesh A. Adalja, MD

Amesh A. Adalja

The scientific data clearly relates to personal schooling – they are not a major driver of diffusion and can be done safely. The scientific data also shows that virtual learning is not optimal and children are harmed by these guidelines. The CDC has given schools key guidance on how to operate during the pandemic and should be used immediately to reopen schools with shutters. As this debate goes on, it is now clear and easy for everyone to compare where the science stands and what the experts conclude on the political machinations of the teachers’ unions.

Amesh A. Adalja, MD

Senior Scholar

Johns Hopkins Center for Health Safety

Disclosure: Adalja does not report any relevant financial information.

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Sara M. Bode, MD

Sara M. Bode

In general, I think there is a great deal of agreement with intent behind these guidelines and the AAP recommendations. I would say there is a lot of talk first about how we really need to prioritize reopening schools in our communities. Even beyond what is considered minor business and community service, we need to get the children back into school. And that’s definitely in line with what the AAP said.

The other piece that is talked about in the guidelines is that there is evidence to show that if we implement these mitigation measures, we can do this and get back to school safely. So we really need to focus on what the schools need to put in place all of these safety measures so that students can learn again.

The guidelines talk about – and I think this is true – the importance of the community gathering in order to reduce their risk behavior outside of school and to lower the community transmission rate. This way we can more easily bring children back to school and learn everything personally.

The guide talks about the role of testing. I find that complex. For example, not every school could do routine screening for COVID-19, nor is it appropriate in all settings. The CDC guidelines talk about this, and just talk about how different levels and strategies can be considered when testing. At the very least, schools should just have a plan of where to refer kids when they show symptoms in order to get what they need – whether they’re visiting a doctor’s office or a testing site that can quickly determine if they have COVID-19 or not – because that’s important for contact tracing so they can keep schools open.

We talked about this a lot in our AAP guidelines. The point is not necessarily to say that every district should have routine screening, but it really should be a focused approach to figuring out what this community needs for testing.

Sara M. Bode, MD

Member of the AAP Council on School Health

Pediatrician, National Children’s Hospital

Columbus, Ohio

Disclosure: Bode does not report any relevant financial information.

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