Updated CDC Guidelines for School and Child Care

At the end of last week, the CDC released new guidelines for COVID, both for the overall population and for schools and child care settings. I want to discuss that today, in the hopes of making clear what it means for parents. I asked on Instagram what questions people had, and for the most part, these questions were captured by the person who said, “Can you put it in English?” CDC guidelines tend to be long and somewhat opaque. So let’s unpack them. A note: These guidelines apply to both schools and child care centers. I’ll often use “schools” as shorthand here, but the guidelines make no distinction, so this all applies everywhere. Purpose, impact, and overall frame The goal of the CDC guidelines is to help state health departments, school districts, and individual schools and child care centers make decisions about COVID protocols. These guidelines are not binding, and, in fact, they explicitly make statements about using local expertise, doing what works for the area situation, etc. At least half of U.S. school districts are already back at school by this point, so many of these decisions have already been made. In addition, the approach of individual school districts tends to be heavily determined by state policy and local politics. My guess is that these guidelines are more important for the more COVID-conservative areas of the country and for early childhood centers, which often must make their own decisions. In general: these new guidelines take a significant step toward a pre-COVID world. They work to eliminate a lot of the COVID-specific disruptions that we do not see for other illnesses. Specific guidelines The CDC guidelines start with some advice for schools and early childhood centers, including, importantly, an emphasis on improving ventilation and staying home when sick. These early parts of the guidelines are notable for having dropped any discussion of physical distancing or cohorting, both of which were emphasized in the last version. They then turn to the parts that are most important in terms of impacting the lives of parents: Quarantines for exposure Vaccination requirements What to do if you test positive Masking guidelines Testing Quarantines for exposure This is the big, exciting, change. The new guidelines suggest no quarantine for COVID exposure (this includes both in-school and out-of-school exposure). Prior guidelines suggested a 10-day quarantine or test-to-stay as an alternative. So doing away with this is huge, especially for parents of children under 2, where test-to-stay has been less of an option. There is a wrinkle to this: the guidelines suggest that after an exposure, individuals remain masked for 10 days and test after day 5. These guidelines have been in place for everyone for a long period and haven’t changed. I am unsure of the extent to which most schools will enforce this, especially as contact tracing becomes less common. But it did lead to concern from parents of the under-2 set. In particular, since that group cannot mask, the guidelines are a bit ambiguous about whether they still need to quarantine. A lot of you sent me panicked messages about that. I have good news. I wrote to the CDC directly about it, and a CDC spokesperson replied officially: Those who are exposed do not need to quarantine, including those who cannot mask (e.g., children 2 years and younger, students with disabilities who might have difficulty masking). Schools and ECE programs can determine if they would like to use testing in these scenarios. Or, the other options include: masking of those who are able to and would be close contacts or implementing other layers of prevention, including distancing, ventilation. No quarantine. Possibly do some kind of testing, or just do other things like better ventilation. So, yay! No more quarantines. (FAQ below if your child care isn’t following this change). Vaccination requirements The CDC encourages vaccination, and it emphasizes that schools and child care centers have an opportunity to encourage vaccination of children. The agency also points to the role of schools in vaccine equity and notes the importance of other childhood vaccines, where rates have been lower in the pandemic. However, nothing in the guidelines suggests that schools or child care centers should mandate vaccines, nor do they differentiate any of the advice they give between vaccinated and unvaccinated children. What to do if you (or your child) test positive For a positive test, the new guidelines say: stay home for 5 days, followed by 5 days of masking on return. The significant change here is that the last set of guidelines suggested that schools require a test to return to school. The guidelines continue to suggest the use of a test-based strategy if masking is not possible (i.e. for children under 2). Masking The CDC recommends masking in schools in areas that it designates high-transmission. (This designation is based on factors like case rates and hospitalizations, and you can find your county level here.) This is in line with its overall recommendations about masking in indoor spaces. Burbio is collecting data on who is requiring indoor masking, and it is worth noting that most districts are not requiring masking even if they are in a high-transmission area. The CDC also (see above) recommends masking for 10 days following a known exposure. Again, I’m not sure of the extent to which this will be enforced in most school settings. Testing Testing for diagnosis (when someone has symptoms) is recommended in schools (and in general) using widely available rapid tests. The new guidelines move away from screening testing. They say, explicitly: “CDC no longer recommends routine screening testing in K-12 schools.” This is a change from prior guidelines. It has been among the more contentious changes, but the logic is that this testing is expensive and logistically challenging. It also causes missed school among children who are completely asymptomatic and unlikely to spread COVID. Schools may consider doing widespread testing either during an outbreak or before a large event. FAQ The above is the TL;DR of the guidelines. A few specific questions… Should I send my child in a mask even if it is not required? The CDC is clear that schools and child care centers should support individual masking if that’s the parent’s choice. In terms of COVID protection, this is a complicated question. A well-fitting N95 or KN94 mask, worn consistently at all times, is very protective against COVID-19. Health-care workers wear these, or respirators, and they provide great protection. So if your child is able to wear a tight KN94 mask all the time at child care, this could lower their risk of getting COVID. However: most children struggle to do this, and in any case masks are likely to be removed at lunch, for napping, etc. In addition, masking can make your child more difficult to understand, which could impact their experience. The way I would frame this is to first ask if mask-wearing in the way that it would be required for protection is feasible. If yes, then there is a more complicated choice. If not, there is no real benefit. If you are looking to lower your child’s risk of serious COVID illness, a vaccine will help with that. What if my child care center doesn’t believe the guidelines eliminate quarantines for the under-2 set? I have heard this a lot. First, try forwarding this newsletter — hopefully the quote from the CDC above will help! If it doesn’t, I’d encourage them to reach out to the agency directly (the media address is media@cdc.gov). I do wish the guidelines were just a bit clearer on this. If your child care center has communicated in a way that seems confused here (i.e. if they have kept quarantines) please consider sending us any communications from them (email here, with subject “CDC Guidelines”). I’ll try to bring to the CDC attention. My child care center or school still requires masking (even outside). Is this in line with CDC guidelines? CDC guidelines do not suggest outdoor masking. In terms of indoor masking, they suggest masking only in areas of high transmission. They do note that some child care centers (yours, I guess) will choose to enact stronger masking guidelines. This leaves some open space, so it is hard to argue that this choice is inconsistent with their guidelines. But it is definitely more conservative. D.C. public schools are requiring a test to return to school. Is this reflecting these guidelines? No. Screening testing is no longer recommended. Moreover, a single test at the start of the year in an open school system is likely to do almost nothing for COVID prevention. Bottom line The big win here is the elimination of quarantines. Yay! Here is hoping for a less disrupted school year, more time to work, and happier and more relaxed parents.

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