Making sense of the COVID strategy in America's schools
As omicron surges, scenes of chaos at schools across the country:
“Everyone is just running around pulling their hair out most of the time, as these cases come up,” teacher Katie Osgood said.
The Biden administration and some public health officials think testing is a big part of stopping the spread of omicron in schools.
But others say testing in schools may not be the best strategy.
Today, On Point: CDC director Dr. Rochelle Walensky and other health experts join us to make sense of what’s happening in America’s schools.
Dr. Monica Gandhi, professor of medicine and associate division chief of the division of HIV, Infectious Diseases and Global Medicine at the University of California, San Francisco. (@MonicaGandhi9)
Katie Osgood, Chicago Public Schools teacher. (@CTUSpecialEd)
Dr. David Rubin, primary care physician and director of PolicyLab at Children’s Hospital of Philadelphia. (@davidrubinmd)
Adan Meza, Chicago Public Schools teacher.
Transcript: An Interview With CDC Director Dr. Rochelle Walensky
MEGHNA CHAKRABARTI: First of all, let’s just dive right into some of the CDC’s latest recommendations for schools. One of the things is the recommended reduction of quarantine, of a quarantine period to five days. Can you just quickly explain why that is?
ROCHELLE WALENSKY: Maybe it would be helpful first to rewind and say, you know, one of the highest priorities here has to be to keep our children in school. We recognize that. I’ve frequently said schools have to be the last place to close, and the first place to open. And so really, it’s with that priority in mind. And I think it’s probably also important to remind people that we were able to keep over 99% of schools open for in-person learning across the country during the delta wave. And that was actually before we had pediatric vaccinations.
So here we are now in a very large omicron wave. And what we’re working to do is make sure that we can retain those children being safely in school, and teachers being safely in school. Now what we did when we updated our isolation and quarantine guidance — And I remind you that isolation is for people who’ve been infected, and quarantine is for people who’ve been exposed. For isolation, we were standing on the shoulders of years of data that had now demonstrated that most of your infectivity is really in those days a day or two before you have symptoms, and the two to three days after you have symptoms.
So it was that isolation time that we shortened and said, really, if you’re feeling better after five days, that you can return to activities. If your fevers are gone, your symptoms are gone, you can return to your activities as long as you’re wearing a mask. It turns out for quarantine, we actually have updated guidance as well for schools. And what we’re really trying to do here, again, is to limit time out of school and have kids back in school. And we have a new, really promising strategy called ‘test-to-stay’ where if you’ve been exposed, but you are able to do frequent testing, that you don’t need to quarantine. But you can instead come to school, as long as you’re doing this frequent testing.
CHAKRABARTI: OK, so then the quarantine period of of five days is for people who have not been infected, but exposed. Are you saying that that does not apply anymore if the testing program is in place?
WALENSKY: If the testing program is in place, then one could say instead of quarantining that you could do this ‘test-to-stay’ program. And what that means is a test every other day, or a test twice a week for those who have been exposed. And what we’ve shown in several scientific papers now is … our children and our teachers, when we do that ‘test-to-stay’ protocol, not only are they safely in school, not only are there not really disease outbreaks associated with that protocol, but we save now hundreds of thousands of person days, children in school, because there’s this ‘test-to-stay’ protocol in place.
CHAKRABARTI: Now if I understand correctly, though, if you’re vaccinated, and boosted and you’re very much protected from severe disease and from hospitalization, more importantly. So I wonder is ‘test-to-stay’ even necessary for children who have been vaccinated?
WALENSKY: Well, so we have information on … quarantine for our older adults who are eligible for boosting. I think really important here is something that you’re commenting on, and something that we’ve been working really hard on. And that is currently in our demographic of children between the ages of five to 11, our grade school children. Right now, we have about 19% of them who fully receive their primary series.
And so vaccination absolutely has to be an important part of our layered prevention strategies to keep our schools safe, to keep our children safely in them, and our teachers safely in them. And as you note, for our ‘test-to-stay’ protocol, we’re actually not discriminating between vaccine status until we get more and more children vaccinated.
CHAKRABARTI: OK, well, let me ask you about that. Because we have vaccinations available, fully-approved vaccinations available for adults. The Pfizer vaccine for children is still approved under EUA, not full FDA approval. It’s the only one for kids thus far. There are some parents out there who wonder … aren’t actually, in a sense, schools some of the safest places for kids?
Like I was looking at what Professor Joe Allen at the Harvard School of Public Health. … And he said the evidence of the low risk to kids has been consistent throughout the pandemic with each variant. He said hospitalization rates [have] hovered at less than one per 100,000 through the alpha wave, the delta wave and even the omicron wave. And that’s important context because, you know, according to Professor Allen, that’s a level of risk that we accept all the time for kids.
WALENSKY: Yeah, I think that this is actually really important to understand. So of course, with the delta wave and even with the omicron wave, we’ve seen increased rates of hospitalizations among our children. Some of the highest rates of hospitalizations we’ve seen through this pandemic. But of course, we’ve seen more disease in our communities throughout this pandemic with omicron now, as well. And we are still now just learning about the severity of omicron vs. delta, and it took us some time to understand delta vs. alpha.
But I think the thing that’s really important to understand now is we have given hundreds of millions of doses of these vaccines, actually billions around the world. And we have given millions in our children over the age of five. And that is really one of the reasons why we have spent so much time in our Advisory Committee [on] Immunization Practices, demonstrating the data publicly and transparently, showing the data of how safe these vaccines truly are.
We still have a lot to learn about these variants with regard to how sick it is getting our communities, how the impact of long COVID, the impact of this multisystem inflammatory syndrome in our children. And so given the incredible safety of these vaccines that we’ve publicly displayed and publicly shown, we really are working to make sure that we get our children vaccinated.
CHAKRABARTI: Are you concerned, though, that CDC guidance and overall fear out there is still leading to children unnecessarily missing school, right? I mean, we hear frequently from teachers saying, I’m afraid. I do not feel safe in schools. But I was looking at the CDC websites just this morning, citing like a dozen different studies from 2020 to now, showing that transmission rates in schools is negligible. But it’s really correlated to how much community transmission rates are. But schools are safer than their communities. Can you think of any reason why it might still be appropriate ever to close schools or revert to remote learning, which is still happening in some districts?
WALENSKY: Yeah, it’s really important. … As we update our guidance and as we provide more and more science, and as we learn more and more about the variants that keep throwing us curve balls, we update the science, and we provide guidance that has to be applicable across the country. Urban schools, as well as rural schools, as well as Indian Country … throughout the country. That said, I go back to what I said [earlier]. With the Fall of 2021, we were able to safely keep our children in school with our layered prevention strategies, during the delta surge. 99% of our schools were open during that time, and they were safely open. And what we could see through the science of that time was that if schools chose not to use masks, for example, those schools were more likely to have to close, due to outbreaks.
So what we have seen time and time again, is if we impose these layered mitigation strategies, and I would say now vaccine is one of them, that we can vaccinate our children and our staff, that we can put these masks in place. And even during a time where we have so much transmission, we are able to keep our children safely in school. And that’s really the purpose of the guidance, is to provide that menu of things that can and should be done in order to keep those schools safely open. And I entirely agree with you, that is really our highest priority, is to make sure schools are safe, in-person learning environments for teacher and student alike.
CHAKRABARTI: Are they safe, though? They are safe, schools are safe, are they not?
WALENSKY: When practicing the layered mitigation strategies, the schools are absolutely safe.
CHAKRABARTI: And why do you think teachers keep saying they don’t feel safe?
WALENSKY: There’s a lot of disease out there. There’s a lot of disease in the community, and so I can’t speak to any given school as to whether those layered prevention strategies are actually in place. But that was really the purpose of our guidance, to say are students and teachers vaccinated? Are masks being used? Are ‘test-to-stay’ … policies being used? Are ventilation strategies being used? All of the things, we’ve had $10 billion that have gone out to schools to be able to use testing as a prevention strategy. And all of these things in place provide those layers that give schools a really safe place to be.
CHAKRABARTI: Dr. Walensky, we’ve just got about two minutes left with you here. This has been a rough time for the CDC, for several years now in the Biden administration. Because people keep saying they are confused by CDC guidance, and that there’s chaos out there. What’s your response to that?
WALENSKY: I have a responsibility to review rapidly emerging data, oftentimes before it is peer reviewed. To use the scientific expertise of the agency to follow those data, sometimes imperfect, sometimes gray, and to look at the epidemiology of what’s happening. And to provide guidance in the context of what is implementable, and what’s feasible across jurisdictions around the country. That’s complex.
It’s sometimes scientifically gray, and it sometimes requires redirection when a new variant comes. So that’s the responsibility of me and of the Centers for Disease Control and Prevention. And it’s an imperfect time right now. And what I would say is we are working really hard to make sure that our guidance is reflected by all of the science that we know, and what we have ahead of us.
CHAKRABARTI: Well, Dr. Walensky, last question for you. You’ve got about 30 seconds left here. This is a question I’ve asked every member of the Biden administration that’s been on the show. Regarding schools, do you have a metric or a threshold in mind where if we pass that metric or threshold, schools can completely return to normal and kids can get their lives back?
WALENSKY: You know, I think if we have the layered prevention strategies in place, we can do so now. Certainly, I would look to a time in the future soon, I hope, where we can get more and more children vaccinated, lesser and lesser disease and ideally get those masks off.
This article was originally published on WBUR.org.
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