Viewpoint: CDC’s School Reopening Plan Gets an ‘F’

The US Centers for Disease Control and Prevention (CDC) has just released guidance on the opening of schools during the coronavirus disease 2019 (COVID-19) pandemic. This has come after recent reports of increased safety in schools as compared to the community. But with high rates of community spread, “safer” does not mean “safe.” The CDC has made numerous suggestions and advisements, but the statement that caught my eye was:

“Schools that are open for in-person instruction (either fully open or hybrid) may decide to remain open even at high (red) levels of community transmission. These decisions should be guided by information on school-specific factors such as mitigation strategies implemented, local needs, stakeholder input, the number of cases among students, teachers, and staff, and school experience.”

I fear that instead of giving clear guidance that this statement may punt the decision to the local level, which will result in a non-standardized random approach to this pandemic, especially in areas of our nation which have not yet fully accepted the seriousness of COVID-19. Many of these areas are rural and leaders are not consistently wearing masks and frequently mitigate the pandemic.

Kevin Kavanagh, MD

The argument that preventative strategies need to be tailored to the needs and resources of local communities, along with a one-size-does-not-fit-all approach, may placate political pressures, but the virus does not care. You need to do what you need to do to control the disease. It needs to be clearly stated what needs to be done and if a community cannot comply and wants to open schools, then the parents need to be informed of the increased risks to students. Recommendations should not be changed to reassure families of a degree of safety which does not exist.

The CDC described five mitigation strategies as “key” and “essential to safe delivery of in person instruction.”They are:

• “Universal and correct use of masks.”
• “Physical distancing” (of 6 feet).
• “Handwashing and respiratory etiquette.”
• “Cleaning and maintaining healthy facilities.”
• “Contact tracing in combination with isolation and quarantine, in collaboration with the health department.”
• But the guidance states that masks and physical distancing should be prioritized and cohorting or podding is recommended. This is confusing, since how can you prioritize two factors but have all 5 being essential?

Diagnostic testing is described as an additional prevention measure, stating: “Some schools may also elect to use screening testing as a strategy to identify cases and prevent secondary transmission” But frequent, (three times a week) screening of our athletes has been key to the opening of professional sports. Our students deserve the same safety precautions as professional athletes. Having students in small cohorts and with the performance of pod testing will make this possible. The use of pool testing which would allow the widespread surveillance and effective contact tracing, but it has all but disappeared from the narrative. It needs to be implemented in our schools.

Not only will testing and contact tracing be expensive, but so will physically distancing. Many of our classrooms are small and have a large number of students packed into them. It is not possible to physically distance students 6 feet apart. This is one of the reasons why I feel a hybrid structure should be incorporated into the curriculum. A hybrid schedule will allow small class sizes along with more personalized student contact. High-risk teachers could then be assigned to teach the virtual cases. Almost 25% of teachers are at high-risk for severe COVID-19, and that was before the new more infectious and lethal variants emerged.

Far too little attention has been placed on increasing complete air exchanges and air sanitization in schools. It was evident early last year that aerosolization of SARS-CoV-2 was an important mode of spread, as described in research calculating the R0 of SARS-CoV-2 equal to 5.7 and from detailed reports of spread in a restaurant and in a choir. Last year the Defense Production Act should have been implemented to provide abundant and proper PPE. Instead, strategies were implemented for droplet precautions. At first the public was even advised to only social distance and not wear masks. And many frontline workers were given cloth masks, even when their degree of exposure required N-95s.

In early August, Health Watch USA(sm) called for better ventilation and air sanitization in schools, with both high volume air flow and UV lighting for sanitation (central or stand alone ceiling units). Attention to air quality has been made even more imperative with the recent report from the National Academy of Sciences on aerosolization. This report has updated much of our research and now describes the size of particles capable of aerosolization as being less than 100 um, as opposed to “traditional thinking” of particles less than “5 um.” And that breathing, talking, and singing can produce particles less than 100 um in size. The viral half-life was reported to be approximately 1.1 hours, and the good news is that UV light “greatly decreases viral stability.”

The CDC has stated, in-person learning may have to be prioritized over extracurricular activities. I believe this translates to the fact that heavy breathing and shouting of indoor contact sports will readily aerosolize and spread the virus and that these activities should be curtailed, especially during the emergence of these more infectious strains.

In addition, crowded hallways are problematic for avoidance of aerosolized pathogens. Possibly having teachers, as opposed to students, change classrooms would minimize transmission.

Pandemics are transformative, but in schools, smaller class sizes and healthier buildings are desperately needed regardless of the SARS-CoV-2 pandemic. Our children deserve better than class sizes over 20 and for too many, dilapidated inner-city buildings whose windows no longer open.

We should not repeat the mistakes of last year with ill-advised recommendations regarding masks and not testing of asymptomatic carriers, which appeared to be driven more by resource availability than public safety.

I feel the CDC needs to take a pathogen centered approach at stopping the spread of diseases. It is their responsibility to delineate what is needed to stop a pathogen, regardless of the resources available. It is up to other agencies and communities to decide if they wish to invest in the needed resources. If the CDC does otherwise, it will provide an excuse for inaction and even greater public harm may occur.