New school guidelines around COVID-19: What parents need to know

Claire McCarthy, MD

Senior Faculty Editor, Harvard Health Publishing

We all want our children to be able to go back to school. What we don’t want is for them — or their teachers — to get sick from COVID-19.

There is no easy, let alone perfect, solution, which is why, a year into the pandemic, there is no clear way forward. Recently the Centers for Disease Control and Prevention (CDC) released new guidelines to serve as a roadmap for navigating this difficult part of our pandemic journey.

According to these new guidelines, all schools offering in-person learning should prioritize universal, correct use of masks and physical distancing. The CDC also notes three more strategies are essential for safe in-person instruction: hand washing, cleaning school facilities, and contact tracing. Layering together these five strategies can help lessen the spread of COVID-19 in schools.

Below are key highlights from the CDC guidelines.

Children need to be in school

I think that all of us agree that remote school pales in comparison to in-person instruction for the vast majority of our children and teens. It’s not just about education, which is clearly better when one has the ability to interact in person with other students, but also about equity. So many families have struggled with access to the technology, learning space, and support that are necessary to make remote learning even vaguely successful; for so many children and communities, the pandemic has caused learning loss that will have long-reaching consequences.

There are also consequences in terms of mental health. Being isolated at home has led to a significant increase in depression and anxiety among children and teens — and a decline in the mental and economic well-being of families in general, given how many parents have had to leave their jobs to stay home with their children.

What the CDC guidelines urge is to prioritize opening schools over more economically- or socially-driven openings. The more a community opens, the higher the risk of transmission of COVID-19, which impacts schools, too. We can’t have everything; we need to choose what is most important to us.

Elementary school children don’t pose as high a risk as older students

While our understanding of COVID-19 is still evolving, it appears that younger children are less likely to get sick and less likely to transmit the virus than teens and adults. Because of this, the CDC argues that they should be getting in-person instruction, not remote.

The amount of community transmission matters in decisions to reopen schools

The CDC stratifies community spread of COVID-19 into four levels based on cases per 100,000 people and the percent of tests that are positive. The levels are

  • low (0 to 9 cases per 100,000, less than 5% positive tests)
  • moderate (10 to 49 cases per 100,000, 5% to 7.9% positive tests)
  • substantial (50 to 99 cases per 100,000, 8% to 9.9% positive tests)
  • high (more than 100 cases per 100,000, 10% or higher positive tests).

For communities with low or moderate spread, the CDC believes that K-12 should open for full in-person instruction for all grades, with precautions like masking and social distancing in place.

For communities with substantial or high spread, the CDC recommends a hybrid model in elementary schools. For middle schools and high schools, it recommends hybrid for communities with substantial spread and all-remote for high.

Masks, distancing, hand washing, ventilation, and cleaning are key

The CDC recommends that everyone wear masks that cover their mouth and nose.

Physical distancing goals for classrooms differ depending on age, community spread of the virus, and whether students are grouped in cohorts. (Cohorts keep the same group of students and staff together throughout the school day to reduce risk for spreading the virus.)

  • Elementary schools At least three feet apart whether community spread is low, moderate, substantial, or high.
  • Middle and high schools At least three feet apart if community spread is low, moderate, or substantial.
  • Middle and high schools At least six feet apart if community spread is high and students are not in cohorts.

The CDC also recommends washing hands frequently, ventilation (such as by opening windows and doors), and cleaning of shared surfaces.

The devil is very much in the details here. Getting elementary students back to full-in person instruction while also physical distancing is tough. So is getting adequate ventilation into old buildings, or figuring out exactly how to do effective cleaning while also managing all the other work of running a school.

Flexibility is needed

Some children need remote instruction because their health conditions, or the health conditions of family members, put them at higher risk of severe COVID-19 disease. Some schools are going to need more support than others. The realities of this pandemic and of our society defy simple recommendations, and we will need to realize and work with that.

Testing is needed, too

Ideally, schools should have access to testing for students and teachers with symptoms, as well as routine screening to identify asymptomatic cases. Additionally, they should work closely with local departments of health to isolate active cases, and do contact tracing and quarantining as needed.

This is another area where the devil is in the details. Testing costs money, and not all communities have ready access to testing and the ability to get results quickly.

Vaccination of teachers is important but not required

Teachers are essential workers and ideally all should be vaccinated against COVID-19. But the reality is that we are unlikely to get all teachers vaccinated before the end of the school year. The CDC argues that first, the overall risk to teachers is low (especially elementary school teachers); and second, that our children are losing too much education for us to wait.

Understandably, many teachers are worried about their health, and the health of their families, and don’t want to be forced to choose between that and the education of their students.

Even as vaccination offers a light at the end of the tunnel, we are still in the tunnel, and may be there for many months yet to come. We can’t just wait for everything to be over to address the needs of our children; we need to come together to take care of them. Our children are our future, after all.

Follow me on Twitter @drClaire

Related Information: Harvard Health Online

Comments:

  1. Jeanne

    I can understand to a point…but how are teachers any different from grocery store cashiers, servers in restaurants, health care workers, etc. We are exposed to hundreds of people a day and yet we still show up for the job with our masks on. Children in my state haven’t been to school in a year…it’s time that they get back to the classroom before any more damage is done.

    • Gordon

      How are they different? Grocery workers and restaurant workers do not spend hours exposed to the same individuals every day- they have fleeting encounters that typically don’t qualify as ‘close contact’. The chance of becoming infected from a carrier in a few minutes is very low. The chance of becoming infected from a carrier around you for several hours, multiple days in a row, is very high. Grocery stores and restaurants are much larger spaces with greater air flow than classrooms. Grocery workers and servers are dealing primarily with adults that are capable of following basic instructions and guidelines. Many school age children are not and require adult assistance to do so- from the teacher. Children are much more likely to be asymptomatic. This makes them more likey to continue to attend school and infect others over longer periods of time because they or their parents dont realize they have the virus. Shoppers at stores are typically adults who are more likey to get symptoms when infected and then stay home.

      As for health care workers– students dont imminently die if the teacher is not physically with them.

      Store shelves cannot be stocked remotely. Food cannot be cooked remotely. Dishes cannot be washed or tables cleared remotely. Vital signs cannot be taken remotely. Injections cannot be administered remotely. Teaching can be done remotely. It may be slightly degraded and has some drawbacks- but it can largely be done.

      And lets be real- while normal in-person classrooms may be far better than remote learning, that is not the option that is even on the table if you go back now. COVID in-person means masks and social distancing. Most of the teaching practices that would make in-person learning better than remote (small group discussion, teacher circulating and checking over your shoulder etc) cannot happen in a COVID classroom. Normal in-person classrooms may be best, but COVID in-person is so constrained it is arguable that remote tools may provide a better education.

      But then lets be honest. People arent demanding teachers return to the classroom for education, are they. What people really want is that thing teachers provide that cannot be done remotely– child care. Most people just dont want to admit it (but many are starting to or getting real close). Its become very clear that the main social benefit from schools that adults care about is child care. We could save a lot of money if we stopped hiring trained and educated professional teachers and just hired high school grads with basic common sense to provide day care services.

  2. Stephanie E

    As a high school teacher is Washington State, I am getting ready to head back to school in a hybrid model.

    You speak of flexibility and that not all schools or districts have access to the same resources mostly due to finances. Our Governor is not using the new guidelines, and we are returning to school with a community spread of transmission rate of 137 / 100,000, and a 7 day % of positive COVID-19 tests at 14%.

    Our back to school hybrid plan has students going to 3 different classes daily. The classes are 85 minutes in length with 5 minute transitions. Our HVAC is set at a minimum of 13% outdoor air let in and the rest recirculated. The filters used are MERV 7. We have been informed that we are allow students to eat in the classroom during class which will involve temporary unmasking. They are attempting to keep desks 6 feet apart “as much as possible.”

    In my opinion, this is not a safe return plan. My community is ignoring the governor’s mandates. Many churches are operating at full capacity, and our two local gyms have openly stated that they will not close, limit capacity, or require masks. Our grocery stores will request for patrons to mask, but do not enforce it. Thus, you regularly see unmasked shoppers at the store.

    This is what is happening in my community. We are offered no place to air our concerns. If we object, we are vilified. Teachers are being asked to take unneeded risk because none of the recommendations are mandates. Until there are mandated requirements, schools will sacrifice their teachers to please politicians and parents.

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