CDC’s classroom counseling closes 90% of schools at least in part

The Centers for Disease Control and Prevention’s long-awaited clues on how to safely reopen schools during the pandemic could eventually keep children out of the classroom longer than necessary, four doctors who reviewed the guidance told CNBC.

Many public health specialists applauded the agency last week for announcing the clearest and most comprehensive federal guidance on whether and to what extent schools should be reopened. The 35-page document outlines ‘essential elements’ of reopening that include social distance, universal masking and a bit of testing. It also contains a set of parameters to determine how widely the coronavirus spreads within a community and whether schools should fully reopen for personal learning or maintain a partial or complete distance plan until the outbreak disappears.

Doctors who spoke to CNBC, however, pointed out notable shortcomings in the guidelines, saying they prevented more than 90% of schools, including in almost all of the 50 largest provinces in the country, from reopening completely.

If the CDC guidelines are strictly followed, these doctors said, schools could not reopen fully for personal learning for months, even if doctors think they can reopen safely much sooner.

At the heart of the criticism is the CDC’s decision to link reopening decisions to how severely the virus is spreading in the surrounding province. According to the guidelines, schools can only reopen for personal learning, only in provinces with low or moderate levels of transmission, which means less than 50 new cases per 100,000 inhabitants over seven days or a test positivity rate of less than 8%. Schools in provinces that do not meet this threshold should switch to hybrid learning, when students spend only a little time in the classroom, with the priority of getting elementary students into the classroom, the guidance reads.

Based on these measures, the vast majority of schools in the US should not bring students into the classroom five days a week. CDC director, dr. Rochelle Walensky, in a call with reporters on Friday, acknowledged that more than 90% of the K-12 schools in the country are currently in high-transfer areas.

However, more than 40% of the K-12 schools are already working full-time, according to data from Burbio, a service that monitors the opening plans of schools.

Only a handful of provinces, 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 fall within the CDC’s most restrictive requirements to reopen schools based on high levels of community transfer there. But doctors who spoke to CNBC said schools in the provinces could safely reopen for full-time personal learning, even with a high spread if the correct protocol is followed.

“Something we know one year into this pandemic is that you can keep schools safe, even if you have a high rate of transmission in the community,” said Dr. Syra Madad, senior director of the system-wide program for special pathogens at New York City Health + Hospitals, said. “These measures are likely to put more pressure on schools than is necessary.”

Walensky defended the agency’s approach.

“We know the amount of illness in the community is fully reflected in what happens at school. If there are more illnesses in the community, there will be more in school,” she told CNN on Sunday. “So, I would say it’s everyone’s responsibility to do their part in the community to reduce disease so we can open schools.”

Dr Megan Ranney, an emergency physician and director of the Brown-Lifespan Center for Digital Health, said the CDC is in a ‘difficult place’. She acknowledged that most of the country ended up in the CDC’s most restrictive level for reopening, but added that “most schools are absolutely unable to put in place the security measures.”

The 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 put desks in the classroom six feet apart, improve ventilation, and reopen safely in high-distribution communities. She added that the concern in areas with a high level of distribution is not that schools will contribute to the outbreak, but that school staff will become infected and leave schools for a short time.

Ranney noted that in her home state of Rhode Island, all public elementary schools, including those of her own children, are open five days a week for personal learning. Middle and high schools did hybrid learning, according to her, according to the CDC guidelines.

But dr. Bill Schaffner, an epidemiologist at Vanderbilt University, said the CDC should make it easier for K-12 schools to reopen. He said the leadership was generally “not bad”, but the CDC should have been less restrictive on the guidelines for spreading communities, given the need to reopen schools.

“Not only do parents want their children to be more effective in school, many of the children get a meal at school, children coming from poor areas,” he said. “The parents could then, whether they were working at home or going to work, address the economy and their work in a more coherent way.”

Schaffner said the CDC should have focused more on ensuring that schools know what measures to prevent infection, and less on the level of community spread.

Dr. Former Baltimore Health Commissioner Leana Wen noted that some of the CDC’s recommendations on preventing infections keep her waiting.

Ventilation measures are particularly absent from the CDC’s leadership. Evidence has been growing since the beginning of the pandemic that the coronavirus can spread effectively through the air. Airborne pathogen specialists and epidemiologists have called on the federal government to incorporate air safety standards in schools and workplaces.

The CDC’s guidance contains only one paragraph on ventilation and states: “improve ventilation as much as possible by opening windows and doors to increase the circulation of the outside air.” The four doctors with whom CNBC spoke said the ventilation duct did not go far enough. Wen said the CDC should provide guidelines on portable air filtration systems, if not recommendations on how to overhaul HVAC systems for schools, which would be very expensive.

Wen said she feels the omission of guidance on classroom ventilation is a sign that the CDC is best for school safety, but others defending the agency say it is likely an attempt to combine science with reality.

In addition, Wen, Schaffner and Madad all said that the CDC should have emphasized the importance of vaccinating not only teachers but all school staff as well. Although none of the doctors said that vaccinations by teachers were necessary to reopen schools, they said that the CDC should have encouraged states to prioritize teachers.

“If the CDC had come out and said really strongly, ‘This is a critical part of the reopening,’ it would have put pressure on these governors to prioritize teachers,” Wen said. “It’s the biggest oversight for me, and I really do not understand why they want to ignite this debate.”

– Graphics by CNBCs Nate Rattner.