CDC calls for reopening schools, says Covid-19 risk is low among kids and closures are harming them
The new guidelines caution that if there is substantial, uncontrolled transmission, schools should work closely with local health officials to make decisions on whether to maintain school operations
The long-awaited guidelines from the Centers for Disease Control and Prevention (CDC) on reopening schools emphasize on getting students back into the classroom, stating that the "best available evidence" indicates that Covid-19 poses low risks to school-aged children and that school closures can actually be harmful for them.
"It is critically important for our public health to open schools this fall. School closures have disrupted normal ways of life for children and parents, and they have had negative health consequences on our youth. The CDC is prepared to work with K-12 schools to safely reopen while protecting the most vulnerable," said CDC Director Dr Robert R Redfield.
Stating that children appear to be at lower risk of contracting Covid-19 when compared to adults, the CDC says that as of July 17, children and adolescents under 18 years in the US account for under 7% of Covid-19 cases and less than 0.1% of Covid-19-related deaths. "So far in this pandemic, deaths of children are less than in each of the last five flu seasons, with only 64. Some children with certain underlying medical conditions, however, are at increased risk of severe illness from Covid-19."
"School closure disrupts the delivery of in-person instruction and critical services to children and families, which has negative individual and societal ramifications," says the agency in the report titled 'The importance of reopening America's schools this fall'. It adds, "Reopening schools creates an opportunity to invest in the education, well-being and future of one of America’s greatest assets — our children — while taking every precaution to protect students, teachers, staff and all their families."
According to the CDC, scientific studies suggest that coronavirus transmission among children in schools may be low. International studies that have assessed how readily Covid-19 spreads in schools also reveal low rates of transmission when community transmission is low, it adds. "Based on current data, the rate of infection among younger school children, and from students to teachers, has been low, especially if proper precautions are followed. There have also been few reports of children being the primary source of COVID-19 transmission among family members. This is consistent with data from both virus and antibody testing, suggesting that children are not the primary drivers of Covid-19 spread in schools or the community," write authors.
Experts ask school administrators to work in collaboration with their state and local health departments and employ strategies that "best match the local conditions and actions". A separate advisory recommends implementing multiple mitigation strategies such as social distancing, cloth face coverings, hand hygiene and keeping children in cohorts or class "pods" to reduce the risk of spread, and staggering when students return to school facility, having the same teacher stay with the same group of students.
Repurposing unused or underutilized school (or community) spaces to increase classroom space and facilitate social distancing, including outside spaces, where feasible, develop a proactive plan for when a student or staff member tests positive for Covid-19, and creating a plan with state and local health department to conduct case tracing in the event of a positive case, are other suggestions.
The new guidelines, however, recommend that if there is substantial, uncontrolled transmission, schools should work closely with local health officials to make decisions on whether to maintain school operations. The advisory also acknowledges that there is mixed evidence about whether returning to school results in increased transmission or outbreaks. "It is important to consider community transmission risk as schools reopen. Evidence from schools internationally suggests that school re-openings are safe in communities with low SARS-CoV-2 transmission rates," says the CDC.
Impact of school closures
According to the agency, schools play a critical role in the wellbeing of communities by providing safe and supportive environments, structure and routines for children, as well as other needed support services to children and families. Schools also play a vital role in the economic health of communities by employing teachers and other staff and helping parents, guardians, and caregivers work, it adds.
The agency acknowledges that no studies are conclusive, but that the available evidence provides reason to believe that in-person schooling "is in the best interest of students", particularly in the context of appropriate mitigation measures similar to those implemented at essential workplaces. Stating that extended school closure is harmful to children, the CDC warns that it can lead to severe learning loss.
"According to the Northwest Evaluation Association, in the summer following third grade, students lose nearly 20% of their school-year gains in reading and 27 percent of their school-year gains in math. By the summer after seventh grade, students lose on average 39% of their school-year gains in reading and 50% of their school-year gains in math. This indicates that learning losses are large and become even more severe as a student progresses through school," says the report.
Schools also provide critical psychological, mental, and behavioral health services to children who may not have access to these services outside of school, and school closures have limited the availability of these services, the advisory emphasizes.
The CDC warns that extended school closures are also harmful to children’s development of social and emotional skills. "Important social interactions that facilitate the development of critical social and emotional skills are greatly curtailed or limited when students are not physically in school. In an in-person school environment, children more easily learn how to develop and maintain friendships, how to behave in groups, and how to interact and form relationships with people outside of their family. Such routine in-person contacts provide opportunities to facilitate social-emotional development that are difficult, if not impossible, to replicate through distance learning," the agency emphasizes.
The CDC says the need for in-person instruction is particularly important for students with heightened behavioral needs. Extended closures can be harmful to children’s mental health and can increase the likelihood that children engage in unhealthy behaviors, they caution. Among children aged 9-17, the CDC estimates that 21% or more than 14 million children experience some type of mental health condition. However, only 16% of those with a condition receive any treatment, and of those, 70-80% received such care in a school setting.
"School closures can be particularly damaging for the 7.4 million American children suffering from a serious emotional disturbance. For those individuals who have a diagnosable mental, behavioral or emotional condition that substantially interferes with or limits their social functioning, schools play an integral role in linking them to care and necessary support services," says the CDC.
Students who rely on key services, such as school food programs, special education and related services (speech and social work services, occupational therapy), and after school programs are put at greater risk for poor health and educational outcomes when school buildings are closed and they are unable to access such school health programs and service, says the CDC.
Disparities in educational outcomes caused by school closures are a particular concern for low-income and minority students and students with disabilities. Many low-income families cannot facilitate distance learning — such as limited or no computer access, limited or no internet access — and may have to rely on school-based services that support their child’s academic success, the guidance explains. "Finally, remote learning makes absorbing information more difficult for students with disabilities, developmental delays, or other cognitive disabilities," say experts.