CDC study suggests that with proper mitigation, kids can go back to school, but schools have often been accused of noncompliance

Illustration by Hannah Brown, Kaiser Health News, Kaiser Family Foundation

By Melissa Patrick

Kentucky Health News

A new study shows that rural schools holding in-person classes with heavy masking, social distancing and limited group sizes had few transmissions of the novel coronavirus. But a separate analysis shows that such precautions are not always being taken.

The Centers for Disease Control and Prevention's 13-week study involved 4,876 students and 654 staff from 17 rural K-12 schools in Wisconsin. Data was collected between Aug. 31 and Nov. 29.

The study found that only seven of the 191 coronavirus cases in the groups resulted from in-school transmission, and no infections among staff members were found to have been acquired at school.

It also found that there was no in-school transmission between separate classroom groups, and that case rates among students and staff were 37 percent lower than those in the county overall.

"These findings suggest that, with proper mitigation strategies, K-12 schools might be capable of opening for in-person learning with minimal in-school transmission of SARS-CoV-2," the report says, using the scientific name of the virus. "These findings suggest that attending school where recommended mitigation strategies are implemented might not place children in a higher risk environment than exists in the community."

Student masking compliance was reported as greater than 92%, but only 54% of the teachers filled out the weekly survey on this topic. Staff masking compliance was not measured. 

A foundation gave the districts money to buy two- to three-layer cloth face coverings for all students, who were given three to five masks apiece. All schools were under a district and statewide mask mandate during the study period, and students were asked to wear masks when within six feet of others outdoors and at all times indoors. Classroom cohorts were created, ranging from 11 to 20 students, and all classes and lunch periods were held indoors, with efforts made to seat students near the same cohort. School staff also wore masks, kept their distance, and limited their time in shared indoor spaces. 

The researchers acknowledged that some states, like Kentucky, have set thresholds for reopening schools based on the percentage of positive test results in the community. They said that the percentage of positive test results in the school district's county ranged from 7% to 40%. 

Kentucky's recommendations for "mode of instruction" are based on each county's incidence rate, asking counties with 25 or more cases per 100,000 residents to move to a "more aggressive hybrid" plan or to "consider remote learning." As of Jan. 26, all but nine Kentucky counties met that criteria.  

The researchers noted that their study had several limitations, including dependence of the mask data on voluntary teacher response, no data being collected on the school's ventilation systems, and the lack of routine screenings to measure spread of the virus by people who had no symptoms of Covid-19.

Citing several other studies, including an international one, all with similar results, three of the CDC researchers said in a "Viewpoint" article for the Journal of the American Medical Association, "As many schools have reopened for in-person instruction in some parts of the U.S. as well as internationally, school-related cases of Covid-19 have been reported, but there has been little evidence that schools have contributed meaningfully to increased community transmission." 

They added, "Preventing transmission in school settings will require addressing and reducing levels of transmission in the surrounding communities through policies to interrupt transmission (such as restrictions on indoor dining at restaurants). In addition, all recommended mitigation measures in schools must continue: requiring universal face mask use, increasing physical distance by de-densifying classrooms and common areas, using hybrid attendance models when needed to limit the total number of contacts and prevent crowding, increasing room air ventilation, and expanding screening testing to rapidly identify and isolate asymptomatic infected individuals. Staff and students should continue to have options for online education, particularly those at increased risk of severe illness or death if infected with SARS-CoV-2." 

All of these suggestions have been recommended in Kentucky, with state guidance calling for schools to follow the "Guidance on Safety Expectations and Best Practices for Kentucky Schools (K-12), which includes masking, social distancing, handwashing and sanitation protocols.  

Compliance is the challenge

Regardless of official guidelines, many schools are not taking such precautions, says a Kaiser Health News analysis of federal and state workplace-safety data. It found more than 780 Covid-related complaints covering more than 2,000 public and private K-12 schools, Laura Ungar reports for KHN. 

The number of complaints is likely under-reported, Ungar notes, because a federal loophole prevents public-school employees from lodging complaints in 24 states that lack their own Occupational Safety and Health Administration agencies or federally approved OSHA programs.  Even when complaints are made, she reports the vast majority are closed without an inspection. 

"Still, the complaints filed provide a window into the safety lapses: Employees reported sick children coming to school, maskless students and teachers less than six feet apart, and administrators minimizing the dangers of the virus and punishing teachers who spoke out," Ungar reports. 

Also, KHN found that "practices contradicting safety experts' advice" are often codified: About half of states don't require masks for all students, including 11 that have exempted children of various ages from mandatory masking in school. 

“The response to the virus has been politicized,” Dr. Chandy John, an expert in pediatric infectious diseases at the Indiana University School of Medicine, told Ungar. “There’s a willingness to ignore data and facts and go with whatever you’re hearing from the internet or from political leaders who don’t have any scientific knowledge.”

Another challenge is that the scope of infection in schools across the nation remains unknown because states are not collecting uniform data, although President Biden's new orders call for tracking it on the federal level, Ungar reports. She adds that Biden's orders also call for OSHA to bolster enforcement and work with states and local governments to ensure workers are protected from the virus.  

That's certainly true in Kentucky. While Kentucky provides a school dashboard that schools are asked to self-report cases and quarantine data daily, compliance is sketchy, with 182 of the state's schools having never reported any data and 332 of them in the prior week failing to submit data -- which means the case and quarantine numbers are likely low. 

In the week ending Jan. 22, 1,419 students and 632 staff had newly tested positive for the coronavirus, resulting in 5,786 students and 828 staff being quarantined. 

A "very promising" study

Despite the gaps and pitfalls, state Sen. Max Wise, R-Campbellsville, who chairs the Senate Education Committee, called the CDC study "very promising." 

State Sen. Max Wise

"I think this points in the direction, of the push, to get students and teachers and staff back in the school walls and in the classroom," he said. "The study is very encouraging. I think it's even pushing for five days a week. And I know many students and school districts right now are trying to make that push to get students back into in-person [classes] and with as normal a routine as possible."

Wise said he thinks it is important to get Kentucky's children back into classrooms, not only because of their learning outcomes, but also because of their mental health. 

"I think when children do not have relationships, when they don't have that accessibility to mental-health counselors, I think the push for in-person learning is one of those things that can't hurt at all with what we're going through with mental health issues and teenagers," he said. 

Further, he said it is important because it is affecting the state's workforce, especially related to child-care issues.

Asked if he supports Biden’s request for $130 billion to improve school safety, federal guidance for making schools safer and improving workplace protections to safeguard teachers and other workers from the virus, Wise said that that is a question best suited to the state's school superintendents. 

But he added that he hopes that any federal money that comes to the state's schools is used wisely, and with the understanding that it is only available for a short time. 

All that said, Wise said that when schools open to in-person learning, just like the CDC study indicates, it will still be important for them to follow public health guidelines to keep everyone safe. 

"You don't want to put your guard down," he said. "We need to stay vigilant, following those CDC guidelines of what the school rules are. It's, you know, masks up, mask when your mobile, six feet separation, and washing hands. We'll still have to do those things."