CDC, Department of Education issue guidance for schools to reopen, stay open

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Guidance and a science brief from the Centers for Disease Control and Prevention (CDC) and a handbook from the U.S. Department of Education aim to help schools determine when to reopen during the COVID-19 pandemic.

The operational strategy for kindergarten through 12th grade schools includes phased mitigation and a pathway to in-person instruction and remaining open, and integrates tools to support safe school reopening, such as protecting teachers, students and school staff, according to CDC Director Rochelle P. Walensky, M.D., M.P.H.

“We know the benefits the classroom setting and the support services delivered by schools provide to our students, especially those from low-resource, racial and ethnic minority communities and children with disabilities,” she said. “The science also shows us that (kindergarten) to 12 schools that have implemented strict mitigation strategies have been able to safely open for in-person instruction and remain open.”

When looking to reopen, schools should implement layered mitigation strategies to reduce transmission of SARS-CoV-2 in schools; assess indicators of community transmission; and base mitigation and learning modes on levels of community transmission, according to the CDC guidance.

Dr. Walensky said the five mitigation strategies that are “the most pivotal” to safe reopening are:

• universal and correct use of masks,
• physical distancing,
• handwashing and respiratory etiquette,
• cleaning and maintaining healthy facilities,
• and rapid contact tracing in combination with isolation and quarantine in collaboration with the health department.

The CDC guidance calls for prioritizing masking and distancing, Dr. Walensky said. “We know that most clusters in the school setting have occurred when there are breaches in mask wearing.”

Improved ventilation is not listed in the CDC’s five strategies, but Dr. Walensky said it is an important component of improving school health.

Supporting vaccinations for teachers and school staff as soon as supply allows also is an important layer. However, vaccination should not be a condition for reopening schools for in-person instruction, according to the guidance.

“If we want our children to receive in-person instruction, we must ensure that teachers and school staff are healthy and protected from getting COVID-19 in places outside of schools where they might be at higher risk,” Dr. Walensky said.

The guidance recommends looking at levels of new cases per 100,000 people and percent positivity of tests in the prior seven days to determine the risk of transmission. The CDC recently added data on these rates at https://covid.cdc.gov/covid-data-tracker/#county-view. Only 5% of counties have community transmission under 5%, which would make them eligible to fully reopen for in-person learning, Dr. Walensky said.

The CDC and the AAP have emphasized that schools should be the last settings to close after all other mitigation measures in the community have been employed and the first to reopen when they can do so safely.

In-person learning in schools has not been associated with substantial community transmission, and evidence suggests that staff-to-staff transmission is more common than transmission from students to staff, staff to students or students to students, Dr. Walensky said. According to CDC data, less than 10% of COVID-19 cases in the U.S. have been among children and adolescents ages 5 to 17.

Dr. Walensky emphasized that schools should be prepared to follow a combination of mitigation practices while more Americans are vaccinated.

A second volume of the ED handbook will be released in the coming weeks that will provide strategies to address the disruption created by COVID-19 for students, educators and parents, particularly for historically underserved students and communities that have been hit hardest by this pandemic, according to Donna Harris-Aikens, J.D., senior adviser for policy and planning at the U.S. Department of Education. Topics will include strategies to meet social, emotional, mental health and academic needs of students; supporting educator and school staff well-being; and addressing lost instructional time for students, extended learning time and bridging the digital divide.

In a statement,AAP President Lee Savio Beers, M.D., FAAP, encouraged collaboration among schools and state and local health leaders to ensure that teachers and staff have access to vaccines.

“Children and adolescents … have already borne a disproportionate burden of the pandemic,” she said. “We agree with the CDC that it is a shared responsibility and that all members of the community play a role in protecting each other and keeping schools open by wearing masks and following other safety protocols.”