The Washington Post
Uncertain guidelines, covid surge test schools
Many large districts lack robust screening, Post survey finds
As more than 55 million children and teens pour back into classrooms this fall, a real-life experiment is taking place: Can schools stay open safely amid the aggressive spread of the delta variant?
President Biden said he would do everything in his power to get as many students as possible back in school. But that promise is being tested by the highly transmissible variant of the coronavirus, which has infected more kids in the opening weeks for some schools than in all of last year while forcing nearly 1,700 temporary closures, according to Burbio, a data firm that tracks school reopenings.
The Biden administration crafted its guidance for schools before the delta variant began ripping through the country this summer, upending months of progress. Senior administration officials said they are confident schools that follow guidance from the Centers for Disease Control and Prevention can remain open safely, even with the spread of delta. Officials in New York City, where the nation’s largest district began school Monday, said they are confident they can operate safely.
But a quarter of the nation’s 200 largest school districts are ignoring the agency’s No. 1 recommendation to mandate masks, according to Burbio. Even some compliant districts are struggling to implement what they say are vague guidelines on testing and quarantining — and many are not rigorously adhering to the federal recommendations.
“It’s critically important for CDC to be engaging on a regular basis with schools that are trying to do the right thing — to identify where the shortcomings are because any plans you put forward will have shortcomings and will need to be adjusted and adapted,” said Richard Besser, former acting director of the CDC and chief executive of the Robert Wood Johnson Foundation, the nation’s largest health-care philanthropy.
Meanwhile, some health experts and school officials worry the guidelines, which were devised before the delta variant became dominant, are insufficient to protect students, teachers and others.
Administration officials say they are prioritizing policies that keep as many children in class as possible, even as cases arise. They are urging vaccinations for everyone eligible, universal masking and social distancing to minimize infections. And if cases do arise, officials hope schools will aggressively trace contacts to avoid big closures.
They say they are hoping adherence to these guidelines will minimize the damage and disruptions caused by remote learning — a point Biden emphasized in remarks Friday celebrating the reopening of schools. That will be a challenge for even districts willing to comply, however, with more than 150,000 new infections daily and children making up a skyrocketing number of them. Since the start of the pandemic, children have represented about 15 percent of infections, according to the American Academy of Pediatrics. That rate has climbed to about 27 percent for the week ending Sept. 2, although severe illness continues to be uncommon, especially among younger children, and it is unclear how much transmission of the delta variant occurs in schools.
Experts at the CDC say they are monitoring those numbers to see whether changes are needed.
“What we do know and what we have seen is the layered prevention strategies continue to work, even against delta,” said Erin Sauber-schatz, a team lead at the CDC who helped write the school guidelines.
But many districts are not actually implementing many of these strategies. A Washington Post survey of the nation’s 20 largest school districts found that just four are following CDC recommendations to screen asymptomatic students, who can infect others even though they have no symptoms. Separately, a review by the Center for Reinventing Public Education at the University of Washington found 14 out of 100 large and urban districts were screening students routinely.
Another CDC guidance — which the agency updated in early July, when cases were at an all-time low — loosens the definition of who qualifies as a “close contact” and would need to be quarantined, and it provides no metrics for when schools or classrooms should shut down. It was written when 13 percent of counties had high transmission; today, more than 90 percent of counties have high transmission.
“There is not a really clear kind of trigger point here around what it means and what level of spread would be a cause to change course,” said a senior White House official, who spoke on the condition of anonymity because they were not authorized to speak publicly. “We’re trying to work additional guidance around the fact that there will be cases.”
That has caused uncertainty for many schools and teachers writing guidelines for which children need to quarantine after possible exposures and when it is safe for them to return.
“When do you probably need to shut your class [and go] to virtual [learning]?” asked Kavita Patel, a primary-care physician and nonresident fellow at the Brookings Institution who advises Prince George’s County schools in Maryland on covid-19 protocols. “It was too complicated to talk about community rates and transmission. I said one positive [coronavirus test result] quarantines your class — period. I know that’s hard, but that’s the kind of decision they have to make.”
Heeding last year’s lessons
After a tumultuous year and a half of the pandemic, there is widespread agreement among parents, teachers, administration officials and experts that students should be back in the classroom, despite some risks. Remote learning caused undue stress on families, and studies show that it took an enormous toll on students’ mental health and caused many to fall behind academically and socially.
Administration officials said they sought to avoid the overly onerous guidelines that effectively kept many schools closed last year.
Some warn that it is a mistake to be less prescriptive given the delta variant’s threat.
“The current guidance is not based on scientific reality,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of Biden’s covid-19 transition team. “There’s pre-delta and delta. We’ve seen such a dramatic change in transmission. ... There’s no such thing as a safe school today with covid. There are safer schools, not safe.”
Administration officials and many school leaders strongly disagree.
“If you really follow all the guidance to a T, you can open schools and keep them open,” said Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials, which represents state and local public health agencies.
But Plescia acknowledged that not all are doing so. Asked whether delta would change that calculation, he said, “I don’t think we know right now.”
Nine Gop-led states have tried to bar school districts from requiring masks, though some have been blocked in court. And those states are all but certain to ignore Biden’s call that they mandate vaccinations for all teachers and staff members.
Administration officials defend their decision not to be more prescriptive as an effort to keep more kids in school. The CDC provided no metrics, for instance, about when school officials should shutter schools or classrooms. Sauber-schatz said the agency concluded that a single metric did not make sense for the entire country. And a senior White House official said much of the focus is to minimize the number of students who need to be sent home.
“Getting our students back to in-person learning while closely monitoring the situation, we think, is the best thing for students,” Sauber-schatz said.
Many say the CDC has also failed to give school leaders sufficient recommendations about how to implement in-school testing programs — an issue Biden raised in his speech last week, urging districts to use the billions of dollars allocated by Congress earlier this year for that purpose.
The issue for schools, however, is not only money, experts say. Those with fewer resources do not have the personnel and wherewithal to regularly test a large number of students.
“There’s a call out to do testing, but not really a tool kit to do it in an easy way, so I would hope to see more come from CDC in that regard,” said Besser, the former acting CDC director.
The Post survey found that the three largest school systems — New York City, Los Angeles and Chicago — are conducting regular screening of students without symptoms or known contacts of covid cases, as is Montgomery County, Md. But large districts across Florida and Texas, as well as in Las Vegas, Philadelphia, Charlotte, Hawaii and Gwinnett County, Ga., have no programs to test asymptomatic students.
“What seems to be holding back many schools are the political and practical challenges — how do they handle positive cases and false positives, how do they address angry parents who don’t want to see their kids tested, or identified as a positive case, and children who don’t want to be swabbed,” said Scott Gottlieb, former Food and Drug Administration commissioner and a Pfizer board member.
The most rigorous program in the country appears to be in the Los Angeles Unified School District, the nation’s second largest, where every student — including those who are vaccinated — must be tested weekly. Those who refuse are not allowed in school.
In Chicago Public Schools, the third-largest district, all students whose parents have provided consent will have the option of being tested on a weekly basis, though not in every school, despite promises from district officials. And in New York City, officials have promised to test 10 percent of unvaccinated students and staff members every other week. That is less than was done last year, when the district tested 20 percent of students and employees weekly.
Asked whether this year’s plan is sufficient, New York Mayor Bill de Blasio said Wednesday that testing is not the most important safety measure and that it can be ramped up if needed.
“We’re going to have plenty of testing,” de Blasio said. If adjustments are needed, he added, “We can make them very, very quickly.”
‘A rude awakening’
Complicating readiness on issues like testing was officials’ “intense desire to return to normalcy” heading into this year, when it looked like the pandemic was waning, said Sasha Pudelski, advocacy director of AASA, the School Superintendents Association.
As a result, she said, some places were less prepared for another round of intense virus mitigation. “There was in many communities perhaps a false sense of security that masking and quarantining and remote learning wouldn’t be part of this school year. And they’re getting a rude awakening with delta that it is, and it has to be, to protect kids.”
Many, for instance, scaled back or even shut testing programs put in place last year, said Randi Weingarten, president of the American Federation of Teachers, the second-largest teachers union in the country.
“Testing isn’t the only tool — we need people to get vaccinated — but it is important, and now local health departments have to work with school districts to get programs going again,” she said.
Last spring, Fairfax County, Va., officials ran a four-week pilot program in four schools, and not a single test came back positive, Sloan Presidio, the district’s chief academic officer, told the school board in June, before the delta variant was dominant and coronavirus infections were waning.
“When we see our community transmission rates continue to decline and reach the low level, we do not recommend the need to continue with any diagnostic or screening testing in our schools next year,” he said.
Now, a spokeswoman said, the district is reconsidering.
Most school districts do not have the tools to do it themselves and need partnerships, many officials said.
Those with appropriate testing programs are primarily “rich schools that know how to work a system, rich schools that have money to throw at the problem,” said Zeke Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who was on Biden’s covid-19 transition team. Less affluent schools that have successfully set up programs have typically partnered with a foundation or other group with the necessary expertise, such as the Rockefeller Foundation.
Some states, such as Massachusetts, North Carolina, Georgia and Utah, have provided guidelines or policies that make it easier for districts to set up testing programs, said Sauber-schatz, of the CDC. But without such assistance, most schools have struggled to create regimens that identify cases early or clear policies about how to treat them and their close contacts. And maintaining the supplies for such testing programs has proved to be an added challenge for some schools.
At the Connally Independent School District outside Waco, Tex., officials offered widespread testing for the first time since the start of the pandemic after two junior high school teachers died of covid last month, following the start of school. The district had offered the tests on request in the past but never to a large swath of people. Some 600 students, parents and others in the community were screened, and more than 16 percent of them tested positive for the virus, many without symptoms.
The results, combined with other data, led the Connally district to require masks despite Texas Gov. Greg Abbott’s directive not to do so. Even so, the district is not continuing to test students without symptoms, said Jill Bottelberghe, an assistant superintendent with the district, because the mass testing depleted the district’s supply. It is now asking for more tests and reconsidering whether its protocols need to change, she said.
Other districts offered a range of reasons to explain why they do not have testing programs. Some said routine testing had not been recommended by local health authorities.
A spokesperson for CharlotteMecklenburg Schools in North Carolina said a testing protocol is being developed but has not yet been approved. And schools in Gwinnett County, Ga., plan a voluntary pilot program in 11 schools, to begin later this month.
Jhumka Gupta, a public health researcher at George Mason University, sent her second-grade daughter back to school last week, but with trepidation. Her daughter has a medical condition that puts her at higher risk for severe covid, but remote learning went poorly for her, and the child wanted to be back in class with other kids.
The family’s Montgomery County, Md., school district is requiring masks, a great relief to Gupta. But she worries its testing program is inadequate. The program requires parents to opt in, which Gupta fears will severely limit participation. And it tests just 10 percent of the children who have opted in each week.
“It’s not just me. A lot of families with kids who would fall into the higher risk category” are concerned, she said. “It’s just the idea that we have a more transmissible variant ... it’s impacting more kids in terms of infection, and we have less mitigation measures in place.”
After long discussion, she said she and her husband decided to send their daughter back to school. “We’re kind of taking it day by day, to be honest.”
“There’s a call out to do testing, but not really a tool kit to do it in an easy way, so I would hope to see more come from CDC in that regard.” Richard Besser, former acting director of the CDC