Phewwww, the CDC is mostly on target in rules for opening school this fall

The health agency focuses on getting ventilation right and backing off all that 'deep cleaning.'

Joseph G. Allen
Opinion contributor

The CDC has issued its much anticipated guidance on schools for the Fall, with nothing less than the fate of millions of kids – and their parents – hanging in the balance.

We can all breathe a sigh of relief because the new guidance is good.

First and foremost, CDC places primacy on in-person schooling. To many of us, this seems obvious, but it actually represents a landmark shift in how CDC has been talking about schools. The rest of the report talks about what controls and testing are necessary (and I’ll get to that in a minute), but CDC reiterates several times that none of this should be a barrier to schools being open.

The second big thing CDC got right was that they recognize that a one-size-fits-all approach is no longer appropriate for this phase of the pandemic. Vermont – where vaccinations rates are high and case counts are low – should not have to abide by some top-down Federal rules on schools that may be more appropriate for areas experiencing localized rise in cases due to low vaccination rates. (This is exactly why I supported the change to CDC mask guidance in May, even though it was not popular in public health circles.)

What does CDC says about masks in school?

Perhaps the biggest question many parents have is what will CDC require in terms of masks. I wrote in May, and again in June with my colleague Michael Mina, that kids shouldn’t be required to wear masks in schools this Fall. The reasons are several fold, but the main one is that the risk of severe disease or death to kids is extremely low. The most salient feature of this virus is the vast differences in risk by age group. A case in an 8-year old is very different from a case in an 80-year old. Also, now that the groups with higher risk - teachers and parents - have had the chance to be vaccinated, this threat is greatly diminished.

In this June 10, 2020, file photo, Olivia Chan's father helps her with a new mask she received during a graduation ceremony for her Pre-K class in front of Bradford School in Jersey City, N.J.

We don’t require masks in schools for things like influenza, despite the number of deaths in kids from influenza in prior years being similar to the number of tragic child deaths from Covid this year. This is not to say there is not risk, but it is a useful marker when evaluating what level of risk our society has previously "accepted" without shutting schools or implementing strict controls.

At first read, it seems CDC is mandating masks in schools for those who are unvaccinated. At a minimum this means that all kids  under 12, because the vaccines are not authorized for this group yet, as well as those teens who have not yet gotten the vaccine. (CDC says those  under 2 don’t need masks.)

But a more close read reveals that CDC left a lot of nuance. In several places in the new guidance, CDC says that decisions on masking and other controls should be based on multiple factors, including level of community transmission, level of vaccination coverage in the community and local outbreaks.

Some might read this as problematic because it’s ambiguous, but it actually reflects the fact that the system needs this sort of flexibility because local conditions are vastly different.

The right ventilation prevents COVID

As far as the other controls CDC mentions, I was glad to see that ventilation had its own line item. As someone who was been writing about the importance of ventilation for control of COVID-19 since February, 2020, it’s great to see that airborne transmission, and the power of better ventilation and filtration, finally being explicitly acknowledged.

CDC also gets it right in terms of being explicit that the risk from surfaces is low, which means that schools can pull back on all of the "enhanced" cleaning and disinfection. This should finally put an end to the senseless closing of schools for a day of "deep cleaning." Promoting good hand hygiene is enough.

There are some things CDC could have done a bit better. It’s not clear to me that aggressive testing is necessary because the risks to kids are low and the costs of testing are high. Wouldn’t all that money be better spent on improving ventilation and filtration, which helps against COVID-19 while also providing YEARS of benefits? The testing will also lead to widescale and unnecessary quarantining of close contacts, which goes against what CDC says is of primary importance – keeping kids in school. The better approach is to scale up the use of on-site rapid tests so kids can stay in school even if they are a close contact, provided the rapid test is negative, meaning they are not actively infectious.

On the question of whether this new guidance will help schools, I don’t think so, but it’s not their fault. My guess is ‘red’ states that mostly opened up without controls last year will do the same, and ‘blue’ states that had schools closed will open, but will keep (overly) strict controls in place. But the big picture here is that CDC placed an important marker – kids need to be in school.

Joseph G. Allen is an associate professor and director of the Healthy Buildings Program at the Harvard T.H. Chan School of Public Health.