New CDC School Guidance Calls for In-Person Classes, With Caveats

Damian McNamara

July 09, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

School may be out for summer, but the Centers for Disease Control and Prevention (CDC) is still in session. The agency released updated guidance July 9 that promotes in-person learning when K-12 students return in the fall, and relaxed mask recommendations for those fully vaccinated against COVID-19.

"Children and adolescents benefit from in-person learning, and safely returning to in-person school in the fall of 2021 is a priority," the July 9 CDC statement reads.  

Why now? The CDC cites "widespread availability of safe and effective COVID-19 vaccine for people aged 12 and older [as well as] recent reductions in cases, hospitalizations, and deaths."

Masks are still recommended for anyone aged 2 years or older, including students, who is not vaccinated. "While fewer children have been sick with COVID-19 compared with adults, children can be infected with the virus that causes COVID-19, can get sick from COVID-19, can spread the virus to others, and can have severe outcomes," the CDC statement notes.

"As a parent and ID physician, I am concerned. I had a feeling that this decision was coming soon. I have children under 12 years old who are not yet eligible for vaccine and it's unclear to me when the [FDA's emergency use authorization] will be expanded to the entire pediatric population. Adolescents rank among the lowest in terms of vaccine uptake," Priya Nori, MD, an infectious disease physician at Montefiore Health System in the Bronx, New York, told Medscape Medical News. 

"This group as well as other unvaccinated populations are driving the spread of the delta variant throughout the US. Based on low vaccine uptake, and increasing rates of the highly transmissible delta variant, how can we feel confident that lifting masking in schools is the right decision?  It also puts our educators in an unfair position. These decisions also have not been backed up with mandates to ensure vaccination status in schools," she said.

Together but Apart

The federal agency still calls for at least three feet between student desks — down from the six feet recommended prior to March 2021.

"Using a distance of at least 3 feet between students in classrooms could provide a feasible definition of physical distancing so long as other prevention strategies are maximized," the agency notes on its updated Science Brief addressing transmission of SARS-CoV-2 in schools.

This guidance continues calls for a layered approach to COVID-19 prevention, including the familiar strategies such as proper ventilation, hand hygiene, and staying home if symptomatic or when exposed to someone who likely has COVID-19.

A Lesson in Controversy

Like previous moves the CDC has taken that relax their COVID-19 guidance, this one is not without controversy.

"I'm somewhat disappointed by this decision and would hope the CDC would at least recommend a hybrid approach — masking during respiratory viral season between fall and spring," said Nori, who is also an associate professor of medicine and orthopedic surgery at Albert Einstein College of Medicine in the Bronx. 

On Twitter, reactions to the CDC's post about the new guidance ranged from outrage to applause.

Becky Cunningham, a mother with two children, for example, questioned how the guidance for the unvaccinated to keep wearing masks in schools will be enforced. "Hard to trust that folks will just do the right thing & follow the rules/be honest!!" she tweeted.

Another tweet raised the issue of enforcing the honor system for mask wearing. Ana Mercedes appeared to back the new guidance: "That's great since my 17yr old is vaccinated."

Other parents of children with underlying medical conditions or below the 12-year-old minimum age for vaccination were more concerned.

For example, "Eve" tweeted that the CDC's new guidance "is ridiculously irresponsible."

The CDC is not calling for proof of vaccination for teachers or students. Nor does the agency specifically outline how schools can determine which students are vaccinated and which are not, or how to enforce mask wearing among the unvaccinated.

The CDC, instead, said it is providing enough flexibility for local districts and schools to adapt the guidance as needed based on local conditions.

Sources:  Prevention in Kindergarten (k)-12 Schools / CDC and  Science Brief: Transmission of SARS-Cov-2 in K-12 Schools and Early Care and Education Programs – Updated / CDC, both updated July 9, 2021.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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