CDC Early Childhood Guidance on COVID

Several weeks ago, I wrote a piece in The Atlantic about the irrationality of continuing to require toddlers to mask when older children and adults were not doing so. At the start of that piece, I referred to the CDC guidelines on masking, saying that the agency continued to recommend masking in this group. That claim was based on a reading of its early-childhood-education guidance, accessible here. Shortly after the piece came out, I was contacted by someone I’d worked with in the past at the CDC who let me know that, in fact, what I wrote wasn’t right. The CDC was no longer suggesting masking for toddlers in areas where it suggested relaxed masking for older individuals (which, at this point, is most of the U.S.). The confusion comes from the website, which I’ve screenshotted below. The old guidance is what I have crossed out in blue. The red circle is around the new guidance, which suggests the alignment with guidelines for other age groups. The issue, of course, is that on the actual website, there are no blue or red lines, and you can see why this might be confusing. Following this email, I talked about the clarification on Instagram, and it was covered in other media, where the CDC confirmed this update to its guidelines. However, the website hasn’t changed. And confusion remains. A New York Times article a couple of weeks later made the same mistake, and also had to be corrected afterward. This discussion was focused on masking. But it’s emblematic of the confusion around many issues in child care and COVID. Parents write to me about still dealing with quarantines for exposure, classroom closures, out-of-state travel quarantines, etc. Despite a lot of loud discussion on masking, I’d venture to say that people’s lives are much more disrupted by not being able to go from Connecticut to New Jersey to see grandma without a seven-day quarantine on the other end. The CDC guidelines are mostly unhelpful and nonspecific on these issues too. All these things have left the parents of children under 5 feeling abandoned. It’s still totally unclear when we’ll get vaccines for this group, and I hear from so many people who feel the world has just decided to move on without them. This sucks. I do not have any solutions, but as time has gone on and the CDC has not updated its website, I got curious to see if I could get to the bottom of all this — and to the question of how much it matters for actual practice. So today, we’re going to do two things. First, I’ll report on some information from you, readers, on what your child care is doing. And second, I asked the CDC for some concrete answers. Your survey responses A couple of weeks ago, I put out a survey for U.S.-based parents of children under 5 in child care. This wasn’t a random sample! It’s a survey of the readers of this newsletter, about 5,100 of whom wrote in. I asked three questions: (1) What’s your child care’s masking policy for kids over 2?; (2) What’s the policy with a COVID exposure?; and (3) What’s the policy for travel quarantine? Here are the results: On masking: About 70% of child-care centers are now not requiring masking in this age group (note that nearly all of these will be “mask optional”). This is consistent with CDC guidance, given the pandemic situation throughout the U.S. at the moment. Twenty percent require masks indoors. It is worth noting that a full 10% of people report that their child-care setting is requiring masking for kids over 2 both inside and outside. This is despite the fact that the CDC guidance has not recommended outdoor masking for almost a year. On exposures: Half of respondents say that a full quarantine is required after an in-school exposure. Thirty percent have a “test to stay” or “monitor to stay” option, and 18% have no quarantine rules. Several people noted that test-to-stay may be feasible only for children over 2 (although monitor-to-stay is not dependent on age, as it just refers to the practice of not sending your child to school with symptoms). On travel: Finally, 77% percent of respondents have no travel quarantine restrictions, although 13% still report a quarantine requirement for out-of-state travel (and an additional 10% for international travel only). What to make of these numbers? I’m not sure. I suspect they may be a little surprising on both sides. The restrictions are highly correlated. If you’re in a child-care setting with mandatory outdoor masking and a seven-day quarantine for visiting grandma, it may be surprising to learn that 70% of settings have no masking and almost 90% have no out-of-state quarantine. On the flip side, I suspect there are people who will be extremely surprised to learn that there are a substantial portion of child-care centers still requiring toddlers to mask outside. As I’ve written before: to understand each other’s frustration, sometimes it is useful to see the other side. What guidelines does the CDC actually have? I asked! I tried to be very specific, and I am tremendously appreciative to have gotten a response from a CDC spokesperson. I’ve printed it in full below. My questions are in bold. 1. For ECE programs operating in areas considered low and moderate transmission, where the CDC has suggested optional masking in K-12 environments, can you confirm previous statements indicating that the same masking-optional policy is recommended for ECE environments? Yes, this is correct. Anyone who chooses to wear a mask should be supported in their decision to do so at any COVID-19 Community Level, including low. At a medium COVID-19 Community Level, people who are immunocompromised or at high risk for severe disease should talk to their health-care provider about the need to wear a mask and take other precautions (for example, avoiding high-risk activities). Since wearing masks or respirators can prevent spread of COVID-19, people who have a household or social contact with someone at high risk for severe disease (for example, a student with a sibling who is at high risk) may also choose to wear a mask when COVID-19 Community Level is medium. At a high COVID-19 Community Level, universal indoor masking in schools and ECE programs is recommended, as it is in the community at large. When the COVID-19 Community Level is high, people at high risk for severe disease should also wear masks or respirators that provide greater protection, such as N95s. As always, masks should not be worn by children under the age of 2 years, or by people with certain disabilities that prevent them from safely wearing a mask. 2. For ECE programs operating in areas considered low and moderate transmission, does the CDC still suggest a 5- (or 10-) day quarantine for any exposure among unvaccinated children? Is this also suggested for unvaccinated children in K-12? Quarantine recommendations have not changed. Recommendations for close contacts to quarantine, wear a well-fitting mask, and get tested vary depending on vaccination status and prior COVID-19 infection history. They are not affected by the COVID-19 Community Level. People who have come into close contact with someone with COVID-19 should follow the recommendations outlined on the COVID-19 Quarantine and Isolation webpage. This includes in K-12 schools and ECE settings. It is safest for children not yet eligible for COVID-19 vaccination who cannot wear a mask, or who may have difficulty consistently wearing a well-fitting mask, to quarantine for a full 10 days. For more information, see Isolation and Quarantine in Early Care and Education Programs. 3. Do the CDC guidelines indicate that unvaccinated children under 5 should quarantine away from school after visiting a neighboring state? CDC’s Domestic Travel website indicates travelers who are not up to date with their COVID-19 vaccines should self-quarantine for a full 5 days after travel. This recommendation is currently under review given the COVID-19 community level recommendations and will be updated soon. In the meantime, when making decisions about implementing prevention strategies, ECE programs should consider the educational needs and social and emotional well-being of children and the importance of children’s access to learning and care. 4. The CDC guidelines for these programs were updated on January 28 to add a banner at the top indicating that guidance should be aligned with the community and that the overall page would be updated soon. Many people find this confusing, given that it is followed by guidelines that do not echo the overall population. Do you have a timeline for when this will be fully updated? Has the CDC considered removing the outdated materials or otherwise communicating its new guidance to early childhood programs? Recommendations for K-12 schools and ECE programs now align with the new COVID-19 Community Levels. CDC is currently updating guidance for K-12 schools and ECE programs to provide additional context for these settings. CDC hopes to release this guidance along with an accompanying FAQ page in the coming weeks. Page banners give us the opportunity to communicate changes in a timely manner while CDC works on updating specific pages to be consistent with updates that affect multiple pages. I did follow up after this last question to ask something that’s on the mind of many parents, which is how they can communicate this information to their child-care settings or local health departments. The response was “CDC regularly communicates information about guidance updates to health departments and we strongly encourage all settings, including ECE settings, to consult with their local health officials.” I tried reaching out to some local health officials to see about this communication. In at least one case, they indicated their impression that the CDC had not updated their guidance, suggesting some missing communication step. I also contacted Head Start, where masking is still required according to their website, to understand why it differed from the CDC guidelines. They told me: “Following CDC’s update, the Office of Head Start (OHS) notified programs on Monday, February 28 that it will not be evaluating compliance with the requirement during monitoring visits. OHS is reviewing the new CDC recommendations and will issue updated guidance.” Interpretations and final thoughts I am very grateful to the CDC for its response, and I hope this is (a little) helpful. For me, there are three big takeaways. First: For those who wanted clarity on masking that they could communicate, it’s there. Second: Quarantines remain a huge and intractable problem. Most child-care centers are still requiring quarantines for exposure, and that is consistent with CDC policy. But it’s also unsustainable, especially since we’ve seen nothing specific on when vaccines might become available. There is a huge need — by the CDC or local public health departments — to try to figure out a solution here. Whether that is test-to-stay, monitor-to-stay, or simply treating these exposures like other illness exposures, I am not sure. But something must be done. Please. Finally: The last part of the discussion here makes clear to me that the CDC communication infrastructure is, at best, incomplete. I recognize that there are many moving parts, but the fact that the website is still extremely confusing months after the guidelines changed is a problem, even if there are multiple web pages that need updating. This is reflective of some of the overall communication issues the CDC has faced in the past two years. In the upcoming CDC re-evaluation, this seems a top priority to me, and I suspect I am not alone.

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