COVID-19 Resource Center

COVID-19 Resource Center

Perspective from Amesh A. Adalja, MD
Perspective from Sara M. Bode, MD
Source:

CDC. Operational strategy for K-12 schools through phased mitigation. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/K-12-Operational-Strategy-2021-2-12.pdf. Accessed Feb. 12, 2021.

Disclosures: Walensky reports no relevant financial disclosures.
February 12, 2021
6 min read
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CDC releases guidelines for safely reopening schools, focusing on mitigation

Perspective from Amesh A. Adalja, MD
Perspective from Sara M. Bode, MD
Source:

CDC. Operational strategy for K-12 schools through phased mitigation. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/K-12-Operational-Strategy-2021-2-12.pdf. Accessed Feb. 12, 2021.

Disclosures: Walensky reports no relevant financial disclosures.
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The CDC published new guidance for safely reopening schools during the COVID-19 pandemic that focuses on layered mitigation strategies.

The new guidance was detailed in a 38-page report that CDC Director Rochelle Walensky, MD, MPH, called a “one-stop shop” for communities seeking advice on holding in-person learning. She said the guidance, which does not say that teachers need to be vaccinated for schools to be open, was based on a thorough review of current science and data on the subject.

Source: Adobe Stock
Source: Adobe Stock

In a color-coded chart of recommended mitigation strategies, the CDC said middle and high schools can be open even in areas of high transmission if they can “strictly implement” all the strategies. It does not say that elementary schools need to be this strict, but instead can implement hybrid learning or reduced attendance models in areas of high transmission while observing a required 6 feet of distancing.

Rochelle Walensky

“I want to underscore that the safest way to open schools is to ensure that there is as little disease as possible in the community,” Walensky said. “We know that the introduction of subsequent transmission of COVID-19 in schools is directly connected to and facilitated by transmission of COVID-19 outside of the schools and in the community. Thus, enabling schools to open and remain open is a shared responsibility.”

In a scientific brief that was released with the new guidance, the CDC said less than 10% of COVID-19 cases in the country have occurred among children aged 5 to 17 years, with 203 deaths among children up to age 18 through Jan. 27.

“Based on the data available, in-person learning in schools has not been associated with substantial community transmission. Although national COVID-19 case incidence rates among children and adolescents have risen over time, this trend parallels trends observed among adults,” the document states.

The CDC recommended two measures to determine the risk level of transmission in the community — the total number of new cases per 100,000 individuals in the past 7 days, and the percentage of positive nucleic acid amplification tests, including RT-PCR tests in the past 7 days.

The color-coded chart includes four columns indicating levels of severity: blue for low transmission (0 to 9 new cases per 100,000 individuals in the past 7 days, with less than 5% of positive tests in the community); yellow for moderate transmission (10 to 49 cases per 100,000 people, with a 5% to 7.9% positivity rate); orange for substantial transmission (50 to 99 cases per 100,000 people, with an 8% to 9.9% positivity rate); and red for high transmission (anything more than 100 new cases per 100,000 people, and a positivity rate of anything more than 10%).

The guidance states, “regardless of any level of community transmission, all schools should use and layer mitigation strategies.” The CDC provided five mitigation strategies that are “essential to safe delivery of in-person instruction”:

  • Universal and the correct usage of masks;
  • Physical distancing of at least 6 feet apart;
  • Handwashing and respiratory etiquette;
  • Cleaning and maintaining healthy facilities;
  • And contact tracing, in combination with isolation and quarantining, if needed.

“CDC recommends prioritizing the first two,” Walensky said. “These two strategies are incredibly important in areas that have high community spread of COVID-19, which right now is the vast majority of communities in the United States.”

According to the CDC, evidence from available studies suggests that the risk for SARS-CoV-2 transmission may be lower among elementary school-aged children than children in middle or high school. Due to this, there may be a need to adjust mitigation strategies based off increased susceptibility among teens compared with younger children.

“For these reasons, a phased mitigation approach emphasizes in-person learning modes for younger students throughout all levels of community transmission,” the guidance states.

If schools choose to implement screening testing into phased mitigation strategies, again, the CDC provided color-coded recommendations based on severity.

In all levels of transmission, schools should still adhere to the five mitigation strategies, as well as routine testing of teachers and staff once per week. If a school is in the low transmission group, students do not require testing, however, schools in all other groups should test students once per week.

“When determining which individuals should be selected for screening testing, schools and public health officials may consider prioritizing teachers and staff over students given the increased risk of severe illness among certain adults,” the document states. “In selecting among students, schools and public health officials may prioritize high school students, then middle school students, and then elementary school students, reflecting higher infection rates among adolescents compared to younger children.”

Currently, the U.S. is said to be on track to be able to vaccinate the entire adult population by the end of the summer. The Advisory Committee on Immunization Practices has recommended that people who work in the education sector be prioritized for vaccine allocation.

In the new guidance, the CDC said vaccinating teachers and staff can be considered a layer of mitigation, but that teachers and staff are not required to be vaccinated to be in a school building. Walensky said mitigation strategies may still be necessary when teachers and staff have been vaccinated.

“I want to be careful to assume that once we have vaccination, that we are going to need to continue at least some of these mitigation strategies over some period of time,” she said. “And so, it may very well be that some combination of the mitigation strategies that we have, we will need to be doing for some period of time. We do not know the durability of vaccinations. We don't know whether we're going to need booster vaccinations. And I do believe that we're going to need to continue at least some of these mitigation strategies for some time ahead.”

References:

CDC. Operational strategy for K-12 schools through phased mitigation. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools-childcare/K-12-Operational-Strategy-2021-2-12.pdf. Accessed Feb. 12, 2021.

CDC. Transmission of SARS-CoV-2 in K-12 schools. https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/transmission_k_12_schools.html. Accessed Feb. 12, 2021.