In new Covid-19 guidance, CDC recommends 5 key strategies to reopen schools

By Jacqueline Howard and Elizabeth Cohen, CNN

    (CNN) -- The US Centers for Disease Control and Prevention on Friday released guidelines for reopening schools, including "five key mitigation strategies" for returning to in-person school safely.

Those five key strategies are: the universal and correct wearing of masks; physical distancing; washing hands; cleaning facilities and improving ventilation; and doing contact tracing, isolation, and quarantining.

The new recommendations come amid a national debate about when and how to reopen schools safely, as fear of spreading the coronavirus has closed them and forced classes online -- and push to prioritize teachers for vaccinations grows.

The CDC says vaccination and testing "provide additional layers of COVID-19 prevention in schools," but don't describe them as key strategies.

"I want to be clear, with this operational strategy, CDC is not mandating that schools reopen. These recommendations simply provide schools a long-needed roadmap for how to do so safely under different levels of disease in the community," CDC Director Dr. Rochelle Walensky said in a news briefing on Friday.

"We also know that some schools are already providing in-person instruction and we want them to be able to continue to do this, but we know that some are not following the recommended mitigation strategies we know to work," Walensky said. "For these schools, we are not mandating that they close; rather, we are providing these recommendations and highlighting the science behind them to help schools create an environment that is safe for schools, students, teachers and staff."

CDC urges mask-wearing, distancing in schools

Walensky added that while each strategy is important, CDC recommends "prioritizing the first two" -- wearing masks and physical distancing.

"These two strategies are incredibly important in areas that have high community spread of Covid-19, which right now is the vast majority of communities in the United States," Walensky said.

President Joe Biden has said he will work to reopen most K-12 schools within his first 100 days in office but has stressed he will rely on health and medical experts to dictate the national guidance in order to reopen safely.

"It is a challenge to guarantee, or to say that our schools could open in 100 days -- because of the deep investments that need to be made around what it takes to get schools ready and prepared to reopen," Annette Anderson, a professor in the Johns Hopkins University School of Education and serves as deputy director for the new Center for Safe and Healthy Schools, told CNN on Friday.

"What I'm struck by is this notion that, even with the layered mitigation that they are suggesting is really an important strategy, that the CDC is not mandating that schools reopen -- that's a critical piece of this conversation because I think there was this expectation that after the 100 days, there was going to be some kind of opening that would mean all students would go back immediately," Anderson said.

"We now know that this is going to be a much more nuanced process, and it will take time," she added. "I think we can be hopeful that if schools adopt these strategies and as they continue to gradually reopen, that by fall, we will see more of our students in the classrooms for face-to-face learning."

What CDC says about vaccinating teachers

In the new guidelines, the CDC does not list vaccination as a "key" strategy for opening schools, focusing instead of measures such as masks and physical distancing.

"Our operational strategy specifically includes a component on vaccinations for teachers and school staff as an additional layer of protection," Walensky said.

She added that the CDC's Advisory Committee on Immunization Practices recommends that frontline essential workers, -- a group that includes educators -- be prioritized for Covid-19 vaccination.

"As such, we strongly encourage states to prioritize teachers and other school staff to get vaccinated," Walensky said. "If we want our children to receive in-person instruction, we must ensure that teachers and school staff are healthy and protected from getting Covid-19 in places outside of schools where they might be at higher risk."

Anderson said that vaccines are important to help rebuild trust with families, especially those who are skeptical that schools are ready to reopen.

"That's the work of our of our federal government right now, to help to convince families that they have provided the support for reopening, and that they have a tiered strategy that is going to help the schools to systematically follow a protocol that can be trusted. That was missing a year ago," Anderson said.

"When you layer in this whole notion of vaccines, what you're seeing is that there has been some inconsistency around the availability and the demand," she said. "So I think you're going to have to figure out what the vaccine strategy for teachers has to be. They have to answer the question about whether vaccines should be required for teachers or not, or whether this is going to be something that's decided on a case by case basis."

What does the science say?

Walensky on Friday said that the CDC grounded its new recommendations in science and "the best available evidence." The agency also released a scientific brief to accompany its new strategies for schools. The brief includes references to CDC data and separate studies published in journals such as Archives of Disease in Childhood and Lancet Infectious Diseases, as well as some pre-print research.

A version of the scientific brief provided to CNN on Friday notes, "Based on the data available, in-person learning in schools has not been associated with substantial community transmission."

Rather, "when community rates of COVID-19 are high, there is an increased likelihood that SARS-CoV-2 will be introduced to, and potentially transmitted within, a school setting. Evidence to date suggests that when schools implement mitigation strategies with fidelity, transmission within schools can be limited," according to the scientific brief.

"We have engaged with many education and public health partners to hear first-hand from parents and teachers directly about their experiences and concerns and have conducted an in-depth review of the available science and evidence to guide our recommendations," Walensky said.

Previous studies suggest that some schools have managed to implement full or part-time in-person learning, without the kind of Covid-19 spread seen in crowded offices or long-term care facilities. Transmission has occurred, but CDC researchers say there is little evidence that it has contributed meaningfully to increased community spread.

In one CDC study, mitigation measures, including social distancing, contact tracing and wearing masks -- provided to students through a grant from a private foundation -- helped 17 rural schools in Wisconsin achieve transmission rates that were 37% lower than those of the community at large. Of 191 Covid-19 cases, just 3.7% were contracted in school.

Those mitigation measures can make a big difference. Another CDC study detailed how two Florida high school wrestling matches -- a high-contact sport that does not allow for masking or social distancing -- became superspreader events that led to the loss of an estimated 1,700 in-person school days.

'This is not a one and done'

Overall, more research on the public health impacts of holding in-person learning during the pandemic remains needed, said Anderson of Johns Hopkins University.

""The challenge is that we've had so many stops and starts around what research to follow. ... We've heard research that suggests that schools are safe and kids are not super spreaders, and then you hear that because of the Covid-19 variants, maybe kids are super spreaders," Anderson said.

"The research will continue to come out and over time as we start to see more consistency in all of the research and the studies that are done, it will build up the confidence of families," she said. "This is not a one and done. I think it's the beginning of a great rebound and response, but we have work to do and so we should focus on what we need to do between now and the reopening of schools in the fall so that we can have more consistency in strategy and planning, and measuring the outcomes."

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