Several new studies find schools holding face-to-face classes often have lower rates of COVID-19 transmission than the communities around them. An author of one such study points to a key explanation: “We know schools are really good at enforcing rules, and that really is the difference.”
Schools have been diligent in enforcing mitigation rules including mask-wearing, hand-washing, and social distancing, said Duke University School of Medicine associate professor of pediatricis Kanecia Obie Zimmerman, who evaluated transmission of COVID-19 in 11 North Carolina school districts that held in-person instruction in the first nine weeks of the school year. The study found minimal COVID-19 transmission in the schools, much lower than the rate of community spread.
“Mitigation strategies work,” said Ibukun Christine Akinboyo, a medical director of pediatric infection prevention at Duke University Medical Center, on a media webinar last week. “We saw minimal transmission in school settings regardless of the community rate. The data suggest in-person education in context can occur safely.”
Similar findings by the Atlanta-based Centers for Disease Control and Prevention in Mississippi and Wisconsin have led to a growing call for schools to reopen, especially at the elementary school levels where there has been little evidence of transmission among students or from students to their teachers.
The new CDC guidance issued Friday prioritizes in-person instruction. In a press call Friday, CDC Director Rochelle P. Walensky said, “The decision to go back to in-person instruction is not one that any of us take lightly. Believe me, I know. At CDC, we have thoroughly reviewed the science and engaged with stakeholders as we worked to produce an operational strategy to support safe, in-person instruction and protect teachers, students and other school staff.”
In the Mississippi study, attending social events such as parties, weddings or play dates was a far greater factor in children testing positive for COVID-19 than attending school or a childcare center. In rural Wisconsin schools where mask-wearing was prevalent, the CDC found the occurrence of the virus was nearly 40% lower than in the surrounding community, with no infections acquired at school among staff members.
In its updated and color-coded guidance, the CDC said elementary schools can open and remain open even if COVID-19 transmission levels reach the red zone, indicating high community transmission. However, while in the red zone, the CDC recommends elementary schools reduce the number of students in the building through a hybrid model, which mixes building classes with online ones.
For older students who appear to have a greater ability to transmit the virus, the CDC takes a different tack, advising, “Middle and high schools (should be) in virtual only instruction unless they can strictly implement all mitigation strategies, and have few cases; schools that are already open for in-person instruction can remain open, but only if they strictly implement mitigation strategies and have few cases.”
More than 90% of U.S. students live in red zones with significant transmission occurring in their communities, said Walensky. “In-person learning in schools has not been associated with a substantial community transmission ... most school outbreaks are the result of breaches in mask-wearing and lax mitigation.”
The CDC lays out five key mitigation strategies: masks, physical distancing, handwashing, cleaning facilities and diagnostic and rapid contract tracing, in combination with isolation and quarantine. Not on the top five are vaccinations for school staffs, a step the CDC wants to happen but does not deem a requisite to reopening. States are not getting sufficient vaccines, and a few, including Georgia, have prioritized health care workers and residents 65 and older before teachers, even as school buildings reopen to students.
“We strongly encourage states to prioritize teachers and other school staff to get vaccinated. If we want our children to receive in-person instruction, we must ensure the teachers and school staff are healthy and protected from getting COVID-19 in places outside of schools where they might be at higher risk,” said Walensky.
A failure to insist on vaccines for teachers before resuming on-site classes spurred criticism, including from Brian Perkins, associate professor of education practice at Teachers College, Columbia University, who said, in a statement, “We have gotten this so wrong. Sound public health practice dictates that we should first protect the people who are making the most contact with others. So, there should be a program to vaccinate teachers across the board, and also school bus drivers, cafeteria workers, coaches, and children, too. If those people aren’t protected, you don’t open the school.”
Health experts acknowledge the data may not be enough to allay fears in communities hardest hit by the pandemic. “People’s experiences over the last year may have differed significantly, and that would impact their decision to choose in-person education or not. Some have thrived; some may not have thrived,” said Akinboyo.
Knowing and seeing people in your own family or neighborhood infected, hospitalized and dying from COVID-19 is different than observing the disease’s devastation from a distance through TV news reports, said Akinboyo. “That will impact how people will come back to school. It will impact how people will interpret school guidance.”
While the number of new daily cases in the United States fell from 250,000 a month ago to 100,000 now, medical experts fear new variants of the disease, which appear to be more contagious and more deadly. Those variants have been identified in more than 39 states, including Georgia, according to Walensky.
“It’s not whether or not kids are going to get infected; people are going to get infected,” said Zimmerman, who is co-leading a pilot project funded by the National Institutes of Health studying the safe reopening of schools. “Can we put them in an environment where there are guidance and rules in place to help prevent transmission at really high rates? I don’t think schools necessarily need to shut down if there’s one case that comes into the building or a couple of cases. We know there will be cases coming into the building. That’s why the mitigation strategies are in place. We’re treating everyone as if they’re infected.”
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