Schools and state health officials should go beyond CDC guidelines to ensure continued access to in-person learning

The author says North Carolina officials should not let down their guard in protecting public school students from COVID-19. Photo: Getty images

As students returned to school across North Carolina this week, school leaders are facing a daunting challenge: how to academically support students knocked off track by the pandemic while still navigating an ongoing COVID pandemic that puts student and staff health in jeopardy.

This critical challenge is heightened by lack of strong guidance from the Centers for Disease Control and state agencies. Once again, it’s our school leaders who are being asked to serve the role of our community’s leading public health practitioners. Luckily, we now know what steps schools should be taking to protect students and staff from COVID infection. These actions will, in turn, protect the continuation of in-person learning that’s critical for boosting academic outcomes.

CDC Guidelines for 22-23

Federal and state health agencies continue to adopt a lasses faire approach more focused on the short-term health of the economy rather than the long-term health of its citizens. Guidelines have been loosened for this school year despite continued community spread and increasingly grim news about the long-term impacts of COVID infections.

In general, the updated CDC guidance for schools this year consists of loose recommendations rather than mandates. The CDC’s recommendations for schools vary based on a measure called “COVID-19 Community Levels.” COVID-19 Community Levels ranks counties based largely on ICU bed availability. These measures were unveiled by the CDC in in February after corporations complained about worker shortages during the Omicron wave. The measures have been roundly criticized by public health experts, mostly for putting the focus on minimizing hospital bed shortages instead of focusing on limiting COVID transmission, and relying on lagging indicators that only raise alarms after community spread is already at dangerously high levels.

The CDC only recommends universal masking when the COVID-19 Community Levels are high. Students with immunocompromised family members are largely on their own. The guidelines state that such students should wear a mask at medium and high COVID-19 Community Levels, but there’s no requirement to mask placed on their non-immunocompromised classmates.

The CDC no longer recommends screening testing. They only recommend diagnostic testing of students or staff with symptoms or who have been exposed to people with confirmed cases.

Students who test positive are supposed to isolate for just five days and wear a mask for another five days.

Students who are exposed to positive cases are no longer expected to quarantine.

The CDC recommends that schools “optimize ventilation” but provides no mandatory standards. Open windows and outdoor classrooms are only recommended when the school is having an outbreak or when the COVID-19 Community Level is high.

North Carolina’s Department of Health and Human Services does not place any additional requirements on schools or make stricter recommendations. They simply defer to the CDC.

Why schools need public health leadership

It is both unfair, and bad public health policy, to place these decisions on school officials.

School leaders have enough on their plates without also having to moonlight as public health experts. In addition to academics (no small task), schools have already been burdened with helping children overcome the obstacles created by capitalism and a fraying, insufficient social safety net. For many students, schools are the primary providers of nutrition and access to physical and mental health services. The CDC is adding to this overflowing plate in asking school leaders to also make daily assessments and implement policy changes in reaction to changes in local COVID rates.

The unfairness is compounded by a loud, vocal minority that is stridently opposed to public health measures to limit the spread of COVID. School leaders have regularly been subjected to vitriol, including death threats, for recommending steps such as student masking.

This deference to local decision-making might be somewhat understandable if we all self-selected into communities based on our mitigation preferences and risk tolerance levels. But every community includes folks who are immunocompromised. Every community includes workers who can’t afford to get sick and miss several days of work. And no community exists in a bubble. The policies of high-risk communities affect their neighbors.

A better framework for ensuring healthy, in-person learning

Ultimately, our students, school workers, and our communities deserve collective action to help minimize the spread of a disease with potentially life-altering long-term impacts. Individualistic approaches – like the CDC’s school guidelines – are also inherently inequitable. Reducing COVID transmission in schools reduces COVID hospitalizations, deaths, and missed work and paychecks that disproportionately affected people of color. Strong standards also help keep schools open, helping to reverse racial test score gaps that widened during the pandemic.

We can’t forget that it is still quite dangerous for children to acquire COVID. While COVID deaths are rare, at least 1,200 children have died from the virus, each of which is a tragedy. We must also act with an abundance of caution as medical experts are still learning about long COVID. The best estimate is that a full quarter of children develop long-COVID, causing a wide range of scary symptoms and chronic conditions. Children are at significantly more risk for life-threatening diagnoses after COVID infection such as myocarditis and renal failure. And, of course, children are capable of spreading COVID to those outside of school buildings.

To that end, public health experts from across the country have developed the Equity Schools Policy Plan provides school safety standards aligned with evidence, equity, and inclusion. Highlights of the Plan include:

Vaccinations – Schools should be encouraged to partner with local public health agencies to host free vaccine clinics for students, their families, and staff. Less than a third of children aged 5-11 are fully vaccinated

Masking – Mask should be mandatory when Community Transmission Levels (which are different than COVID-19 Community Levels) are high and in the week immediately following a vacation break. Schools should provide students with free KN95 or equivalent masks.

Masking is a vital, proven intervention. A recent study from Massachusetts found that schools which removed mask mandates had an average increase of 44.9 cases per 1,000 people over a 15-week period compared to if they had not removed their mask polices. It’s important to note that the American Academy of Pediatrics confirms there is no evidence that masks harm children’s language development.

Ventilation – All classrooms should be tested to ensure they achieve 5-6 or more air changes per hour (ACH). CO2 monitors to measure air exchange and HVAC systems should be equipped to handle filters above MERV 13. Newton, Massachusetts – the school system serving the children of CDC Director Rochelle Walensky and White House COVID Response Coordinator Ashish Jha – serves as a promising model on ventilation. They have created a ventilation data dashboard to show which classrooms meet ASHRAE 62.1 guidelines.

Testing – Regular surveillance testing should be continued to identify students who are infectious. If regular, universal surveillance testing is infeasible, schools should at least conduct tests before and after school breaks. Students participating in indoor sports should also be prioritized for regular surveillance testing.

Quarantine – Students and staff who test positive should isolate for at least 5 days and until they consistently test negative on rapid tests for 24 to 36 hours (while I’m not a medical expert, I would recommend a slightly longer isolation period as recent studies indicate two-thirds of positive cases continue to shed infectious viruses on day five and nearly a third continue to shed on day seven). Staff should be paid for time isolating. Isolating students should be provided additional supports to bring them quickly up to speed with missed lessons.

Remote academies – Students who are immunocompromised or who reside with people who are immunocompromised should be provided access to remote instruction.

These strong, layered protections will reduce disruptions to in-person learning caused by outbreaks and limit community spread. But they are unlikely to be implemented without mandates or incentives from federal and state public health officials. The start of this new school year would be a great time for those officials –not school leaders – to take responsibility for public health.

Kris Nordstrom is a Senior Policy Analyst for the North Carolina Justice Center’s education & Law Project.

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Schools and state health officials should go beyond CDC guidelines to ensure continued access to in-person learning