A panel of pediatric disease experts interviewed by the New York Times broadly agreed that schools can reopen for in-person classes, provided certain precautions are in place—recommendations that generally aligned with new CDC guidance released Friday.
The Times surveyed a panel of 175 experts, the majority of whom were pediatricians with a focus on public health, on whether and how schools could reopen safely amid the pandemic. Respondents—of whom "nearly all" were physicians—included scientists and people on the membership lists of the Pediatric Infectious Diseases Society, the Decision Sciences for Child Health Collaborative, and the American Academy of Pediatrics.
According to the Times, respondents largely agreed that schools should open—full-time and in-person—for at least elementary students.
The experts emphasized the importance of assessing the risk coronavirus transmission at a granular level. Of those interviewed, 80% said school districts shouldn't base reopening plans on county-level infection data, but rather on Covid-19 transmission within the school itself.
"There is no situation in which schools can't be open unless they have evidence of in-school transmission," David Rosen, an assistant professor of pediatric infectious diseases at Washington University in St. Louis, said.
Respondents generally agreed that schools needed to take certain precautions, such as universal masking, social distancing, ensuring adequate ventilation, and avoiding large group activities. Of those, the panel especially emphasized universal masking and physical distancing.
"What works in health care, masks, will work in schools," Danielle Zerr, a professor and division chief of pediatric infectious diseases at the University of Washington, said. "Kids are good at wearing masks!"
In fact, so long as children and teachers wore masks, many on the panel also said that opening part-time with small cohorts on alternating hybrid schedules was also unnecessary, with just about one-third saying it was very important for schools to operate this way. If everyone is wearing masks, "school transmissions will remain close to zero and cohorts are unnecessary," Jeanne Ann Noble, an emergency medicine doctor and director of Covid-19 response at the University of California, San Francisco, said.
Similarly, many on the panel added that other precautions, such as frequently disinfecting buildings and surfaces, temperature checks, and using plexiglass dividers, weren't particularly important. And just 25% said routine surveillance testing for students and staff was very important for schools to reopen.
"Masks are key," Noble said. "Other interventions create a false sense of assurance."
Some respondents also pointed out the dangers of keeping children out of school. For instance, respondents noted that limiting time in school could undermine students' social development and increase the risk they were exposed to large groups of people outside of school—not to mention the mental health risks of staying home.
"Children's learning and emotional and, in some cases, physical health is being severely impacted by being out of school," Lisa Abuogi, a pediatric emergency medicine physician at the University of Colorado, said.
Separately, CDC on Friday issued a long-awaited, 35-page operational strategy for schools to reopen, accompanied by an 11-page review of relevant scientific findings. Overall, the guidance agrees with the suggestions offered in the Times survey, indicating that schools can reopen so long as they implement several precautions.
Specifically, CDC emphasized the importance of universal masking and social distancing in schools, recommending that students be placed into cohorts to reduce numbers. In addition, CDC emphasized the importance of handwashing, keeping all facilities clean, and conducting contact-tracing alongside isolation and quarantine when exposures to the new coronavirus occur.
CDC also emphasized the prioritization of teachers for vaccination, though the agency noted that having all teachers vaccinated is not a prerequisite for opening.
"Evidence suggests that many K-12 schools that have strictly implemented mitigation strategies have been able to safely open for in-person instruction and remain open," CDC said. "K-12 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 the guidelines, CDC provided a color-coded rubric to help school districts determine how much schools should reopen based on community infection rates and the percentage of positive test results.
Communities that have the lowest infection rates, coded as "blue" (0-9 new cases per 100,000 people in the past week) or "yellow" (10-49 new cases), can resume full in-person learning, while communities with "substantial" infection rates, coded as "orange" (50-99 new cases), should reopen with reduced attendance, which could be a hybrid system involving a mix of remote and in-school attendance.
Meanwhile, communities with the highest infection rates, coded as "red" (more than 100 new cases), can have hybrid programs provided all students are screened for the new coronavirus, CDC said. If not, CDC said red communities should offer hybrid programs for elementary schoolers and keep middle and high schoolers in a remote-only format.
In addition, the agency recommended frequent testing, calling for teachers and staff at all schools to be tested weekly, and—for schools in areas with moderate to high levels of transmission—weekly testing for all students as well.
However, CDC in the guidance said schools should be cautious about resuming athletic activities, particularly indoors. The agency recommended that in areas with substantial transmission, athletics should happen only "outdoors, with physical distancing of 6 feet or more," and in areas with high transmission, athletics should remain entirely virtual.
CDC also acknowledged that new variants of the novel coronavirus are a "concern," noting that if such variants start to drive community spread, "updates to this guidance may be necessary" (Miller et. al., "The Upshot," New York Times, 2/11; Meckler, Washington Post, 2/12; McKay et. al., Wall Street Journal, 2/12; Fernandez, Axios, 2/12; Turner et al., NPR, 2/12).
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