The Centers for Disease Control and Prevention's long-awaited guidance on how to safely reopen schools during the pandemic could end up keeping kids out of the classroom longer than necessary, four doctors who reviewed the guidance told CNBC.
Many public health specialists applauded the agency last week for releasing the clearest and most comprehensive federal guidance yet on whether and to what extent schools should reopen. The 35-page document defines "essential elements" of reopening that include social distancing, universal masking and some testing. It also lays out a set of parameters to gauge how widely the coronavirus is spreading within a community and whether schools should fully reopen for in-person learning or maintain a partial or fully remote learning schedule until the outbreak subsides.
However, doctors who spoke with CNBC pointed out notable shortcomings of the guidance, saying that it would keep more than 90% of schools, including in almost all of the 50 largest counties in the country, from fully reopening.
If the CDC guidance is strictly followed, these doctors said, schools might not fully reopen for in-person learning for months — even if doctors think they could reopen safely much sooner.
At the heart of the criticism is the CDC's decision to tie reopening decisions to how severely the virus is spreading in the surrounding county. The guidance says schools can fully reopen for in-person learning only in counties with low or moderate levels of transmission, which means fewer than 50 new cases per 100,000 residents over seven days or a test-positivity rate lower than 8%. Schools in counties that don't meet that threshold should shift to hybrid learning, when students spend just some time in the classroom, with the priority on getting elementary students into the classroom, the guidance says.
Based on those measures, though, the overwhelming majority of schools in the U.S. should not bring students into the classroom five days a week. CDC Director Dr. Rochelle Walensky acknowledged in a call with reporters Friday that more than 90% of K-12 schools in the country are currently in areas of high transmission.
More than 40% of K-12 schools, however, are already operating in-person full time, according to data from Burbio, a service that tracks school opening plans.
Only a handful of counties, including Honolulu County, Hawaii, and Cass County, North Dakota, meet the CDC's criteria to fully reopen schools. Los Angeles County, California, Cook County, Illinois, Harris County, Texas, and almost every other city in the country wouldn't make the cut. In fact, they fall into the CDC's most restrictive requirements to reopen schools based on high levels of community transmission there. But doctors who spoke with CNBC said schools in those counties can safely reopen for full-time in-person learning even with high levels of spread if the correct protocol is followed.
"Something we know one year out in this pandemic is that you can keep schools safe even if you have high rates of community transmission," said Dr. Syra Madad, senior director of the systemwide special pathogens program at New York City Health + Hospitals. "Those benchmarks will probably put more pressure on schools than needed."
Walensky has defended the agency's approach.
"We know that the amount of disease in the community is completely reflected as to what's happening in school. If there's more disease in the community, there will be more in school," she said Sunday on CNN. "So, I would say this is everybody's responsibility to do their part in the community to get disease rates down, so we can get our schools opened."
Dr. Megan Ranney, an emergency physician and director of the Brown-Lifespan Center for Digital Health, said the CDC is in a "tough spot." She acknowledged that most of the country lands in the CDC's most restrictive tier for reopening, but added that "most of the schools also are absolutely unable to put the safety precautions in place."
The necessary precautions are costly and require more funding, Ranney said. Without additional funds, it's unrealistic to think most schools will be able to ensure desks are six feet apart in classrooms, improve ventilation and safely reopen in communities with substantial spread. She added that the concern in areas with high levels of spread is not that schools will contribute to the outbreak, but that school staff will become infected, leaving schools short-staffed.
Ranney noted that in her home state of Rhode Island, all public elementary schools, including that of her own kids, have been open five days a week for in-person learning. Middle and high schools have been conducting hybrid learning, she said, "so basically following the CDC guidelines."
But Dr. Bill Schaffner, an epidemiologist at Vanderbilt University, said the CDC should have made it easier for K-12 schools to reopen. He said the guidance was "not bad" overall, but the CDC should have been less restrictive on its community transmission guidelines, given the need to reopen schools right now.
"Not only do parents want their children back in school learning more effectively, many of those children get a meal at school, children who come from impoverished neighborhoods," he said. "The parents then, whether they work at home or go to work, could address the economy and their work in a more coherent fashion."
Schaffner said the CDC should have focused more on ensuring that schools know what infection-prevention measures to implement and less on the level of community spread.
Dr. Leana Wen, former Baltimore health commissioner, noted that some of the CDC's infection-prevention recommendations give her pause.
Notably absent from the CDC's guidance, Wen noted, are ventilation measures. Evidence has been mounting since the beginning of the pandemic that the coronavirus can spread efficiently through the air. Airborne pathogen specialists and epidemiologists have called on the federal government to incorporate air safety standards in schools and workplaces.
The CDC's guidance has just one paragraph on ventilation, saying "improve ventilation to the extent possible such as by opening windows and doors to increase circulation of outdoor air." The four doctors CNBC spoke with said the ventilation guidance doesn't go far enough. Wen said the CDC should have issued guidance on portable air filtration systems, if not recommendations on how to overhaul school HVAC systems, which would be enormously expensive.
Wen said she felt the omission of guidance on classroom ventilation is a sign the CDC is pursuing expediency over school safety, but others who defended the agency said it was likely an attempt to combine science with reality.
Additionally, Wen, Schaffner and Madad all said the CDC should have further emphasized the importance of vaccinating not just teachers but all school staff. While none of the doctors said teacher vaccinations were necessary to reopen schools, they said the CDC should have urged states to prioritize teachers.
"If the CDC had come out and said really strongly, 'This is a critical part of reopening,' it would have put pressure on these governors to prioritize teachers," Wen said. "That to me is the single biggest oversight, and I truly do not understand why they want to spark this debate."
— Graphic by CNBC's Nate Rattner.