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Child & Teen Health
New school guidelines around COVID-19: What parents need to know
- By 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, hand washing, distancing, ventilation, and cleaning are key
The CDC recommends that everyone wear masks that cover the mouth and nose, wash frequently, and set a goal for physical distancing of six feet.
In areas of low or moderate spread, they recommend distancing "to the greatest extent possible." They also encourage ventilation (such as by opening windows and doors) and cleaning of shared surfaces.
This is an area where the devil is very much in the details. 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.
About the Author
Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
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