CDC classroom guidelines would keep 90% of schools at least partially closed

The long-awaited guidelines from the Centers for Disease Control and Prevention on how to safely reopen schools during the pandemic could end up keeping children out of the classroom longer than necessary, said four doctors who examined the guidelines for CNBC.

Many public health experts applauded the agency last week for issuing the clearest and most comprehensive federal guidance on whether and to what extent schools should reopen. The 35-page document defines the “essential elements” of reopening which include social distancing, universal masking and some tests. It also sets a set of parameters to assess how widespread the coronavirus is in a community and whether schools should reopen completely for personal learning or maintain a partial or complete distance learning program until the outbreak occurs.

However, doctors who spoke to CNBC highlighted notable shortcomings in the guidance, saying it would prevent the full reopening of more than 90 percent of schools, including in almost all of the country’s top 50 counties.

If the CDC’s guidelines are strictly followed, these doctors said, schools may not fully reopen for personal learning for months – even if doctors believe it could safely reopen much earlier.

At the heart of the criticism is the CDC’s decision to link reopening decisions to how severe the virus is spreading in the surrounding county. The guide states that schools can be completely reopened for personal learning only in counties with low or moderate levels of transmission, which means less than 50 new cases per 100,000 residents in seven days or a positivity test rate of less than 8%. Schools in counties that do not meet this threshold should switch to hybrid learning, when students spend only some time in the classroom, with priority over obtaining elementary students in the classroom, the guidance shows.

Based on these measures, however, the vast majority of schools in the United States should not bring students to class five days a week. CDC Director Dr. Rochelle Walensky acknowledged in a call to reporters on Friday that more than 90 percent of the country’s K-12 schools are currently in high-transmission areas.

However, more than 40% of schools in K-12 already operate full-time staff, according to Burbio, a service that monitors school opening plans.

Only a handful of counties, including Honolulu County, Hawaii and Cass County, North Dakota, meet the CDC’s criteria for full reopening of schools. Los Angeles County, California, Cook County, Illinois, Harris County, Texas and almost any other city in the country would not make the cut. In fact, they are part of the CDC’s most restrictive requirements to reopen schools based on the high levels of community transmission there. But doctors who spoke to CNBC said schools in these counties could be safely reopened for full-time personal learning even with high levels of spread if the right protocol is followed.

“Something we know a year from this pandemic is that you can keep schools safe, even if you have high community transmission rates,” said Dr. Syra Madad, senior director of the New York Special Pathogen Program. City Health + Hospitals. “These benchmarks are likely to put more pressure on schools than necessary.”

Walensky defended the agency’s approach.

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

Dr. Megan Ranney, emergency physician and director of the Brown-Lifespan Center for Digital Health, said the CDC is in a “difficult place.” She acknowledged that most countries land at the CDC’s most restrictive level for reopening, but added that “most schools are also absolutely incapable of implementing safety measures.”

The necessary precautions are expensive and require more funding, Ranney said. Without additional funding, it is unrealistic to believe that most schools will be able to ensure that offices are six feet away in classrooms, improve ventilation and reopen safely in communities with substantial spread. She added that the concern in high-spread areas is not that schools will contribute to the outbreak, but that school staff will become infected, leaving schools with fewer staff.

Ranney noted that in his home state of Rhode Island, all public elementary schools, including his own, were opened five days a week for personal learning. Middle and high schools have run hybrid learning, she said, “so it’s basically following the CDC guidelines.”

But Dr. Bill Schaffner, an epidemiologist at Vanderbilt University, said the CDC should have facilitated the reopening of K-12 schools. He said the guidance is not “bad” in general, but the CDC should have been less restrictive in terms of Community transmission guidelines, given the need to reopen schools right now.

“Not only do parents want their children to return to school to learn more efficiently, many of these children receive a meal at school, children from poor neighborhoods,” he said. “Parents then, whether they work from home or go to work, could approach their economy and work in a more coherent way.”

Schaffner said the CDC should have focused more on ensuring that schools know what infection prevention measures to implement and less on spreading the community.

Dr. Leana Wen, a former Baltimore health commissioner, said some of the CDC’s infection prevention recommendations are giving her a break.

Wen noted that the CDC’s ventilation guidelines are particularly lacking. Evidence has been gathered since the beginning of the pandemic that coronavirus can spread effectively through the air. Airborne pathogens and epidemiologists have called on the federal government to incorporate air safety standards in schools and the workplace.

The CDC has only one paragraph on ventilation, saying “improve ventilation as much as possible, for example by opening windows and doors to increase outdoor air circulation.” The four doctors CNBC spoke to said the ventilation guide did not go far enough. Wen said the CDC should have issued guidance on portable air filtration systems, if not recommendations on how to review school HVAC systems, which would be extremely costly.

Wen said he felt the omission of classroom ventilation guidelines was a sign that the CDC was pursuing the opportunity for school safety, but others who defended the agency said it was probably an attempt to combine science with reality.

In addition, Wen, Schaffner and Madad said the CDC should have continued to emphasize the importance of vaccinating not only teachers but all school staff. While none of the doctors said teacher vaccinations are needed to reopen schools, they said the CDC should have urged states to prioritize teachers.

“If the CDC had come out and said out loud, ‘This is a critical part of reopening,’ it would have put pressure on these governors to prioritize teachers,” Wen said. “For me, this is the biggest oversight and I don’t really understand why they want to start this debate.”

– Chart by CNBC Nate Rattner.