Covid: CDC Issues New Guidance on Opening Schools

by ZviDon't Worry About the Vase16 min read17th Feb 202111 comments

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Covid-19
Personal Blog

Author’s Note: This was originally the title topic of this week’s Covid post (as ‘School Daze’), but the post was getting long and this is its own issue, so I’m moving the guidelines discussion to its own post. 

As usual, all discussions of school are confusing for me, because I consider 21st-century American schools as they currently exist to mostly be a dystopian nightmare, obedience factory and prison system. That makes it hard to root for the resumption of in-person education. 

Still, I do root for it, for two reasons. First, I recognize that this is what almost all parents want for their kids, and second, that the alternative that is being implemented in practice is not home unschooling or kids getting to be kids again. It is ‘remote learning’ and it is a toxic cesspool that drives large percentages of kids into depression, makes it impossible for many parents to work or relax, and generally makes standard schooling look like paradise while also neither teaching the few things school successfully teaches nor offering contact with fellow human beings. It’s the absolute worst in every way other than not catching Covid, and it is saddening to me that more children are not withdrawn from school even under these conditions. 

Thus, I am increasingly comfortable treating ‘get kids back in school’ the same way I would if I thought of school the way (for example) my parents think of schools.

The controversy over how to deal with schools continues. Few on any sides are showing much sanity. It’s understandable, as children are not a sanity-friendly topic in modern America.

One school is doing this with five million dollars of plexiglass (link has video, this is a still frame):

Then between classes they plan to require disinfecting, while they do nothing about airflow, and I don’t have any more idea how the hell to teach students under these conditions than the teacher who made the video does. It doesn’t seem possible. 

To be fair, that’s in no way recommended by anyone. It’s certainly not what the CDC’s guidelines from last week say. 

Those guidelines also aren’t intentionally suggesting this insanity, which is also happening:

Isn’t it great that we can get all the disadvantages of school without the pesky advantage of perhaps sometimes having someone to teach a student something, or the safety of not putting a bunch of people into the same room for hours at a time? 

The best part is that there’s still the same number of humans in the rooms with children, except that the person isn’t a teacher, it’s a not-even-glorified babysitter that doesn’t have the political power to demand not being in that room, while the students all log on remotely to different virtual classroom dystopias, now with physical control reasserted. Lovely. 

This is the kind of thing that happens when choices are focused around requirements, guidelines and demands, with it being suspicious when someone advocates that which might benefit a human

I also don’t understand this if it’s not generic ‘schools are good so we should find ways to spend more on schools’ given the fiscal year ends in September, by which time schools shouldn’t need the help whereas they kind of really need it as soon as possible now:

Where is the public, in broad terms?

Let’s take a look at those CDC guidelines.

I’ve seen worse starting aspirational principles. Masks and physical distancing are jobs one and two. Contact tracing has been a dismal failure in the United States, and it seems odd to tell schools to do it when no one else ever does it, but contact tracing is still worth doing. 

Weird word choice (‘respiratory etiquette’) aside, handwashing is overrated in importance but still very much worthwhile. Cleaning has been highly overrated the whole way because humans have purity instincts around it and there wasn’t much effort to train us out of that.

The big missing point of emphasis here is ventilation, which is mentioned almost offhand in the ‘cleaning’ section, and oh boy do schools have issues here. When we looked at potential schools for our son Alexander, the default was that none of the windows opened due to safety and liability concerns. The one place where they did open was when they somehow were ten plus feet above the floor. The continued failure to emphasize ventilation remains puzzling, since there’s no sacred cows involved beyond admitting that we were ignoring it the whole time. So then again, I guess it’s understandable. 

I’d also like to see the simple suggestion of holding class outdoors whenever possible. There are places and times where it won’t be possible, but also plenty of places and times where it would make sense, especially if we (hopefully temporarily) moved the school schedule from summer vacation to winter vacation accordingly based on this kind of being an emergency. Pretty sure we know why that particular fence is there so it’s fine to tear it down for a while.

The first problem with this is that these guidelines are not going to be treated as aspirational. It’s a communication that schools everywhere and always need all students six feet apart in masks. That’s basically a non-starter (WaPo article, parent rant). You literally cannot do six feet apart at all times for most schools and have all children there all the time. So what are these guidelines saying?

Technically they’re saying six feet to ‘the greatest extent possible’ in the blue and yellow zones, rather than saying it is required. The problem is that this is mostly being interpreted as a de facto requirement, and saying ‘this was the greatest extent possible’ seems unlikely to be a successful blame-avoidance technique when accused of violating the guidelines if someone catches Covid at your school and your head is demanded on a pike.

Check out this picture in their factsheet:

There’s lots of detail to appreciate here, but if nothing else, think about there being only six desks.

The other problem with these guidelines is that they don’t adjust to other circumstances. 

In particular, they don’t adjust to vaccinations. With many places looking to follow CDC guidelines to the letter to avoid liability and blameworthiness, and as the only way to satisfy the demands of teacher’s unions (which also means that such places are likely to ignore ventilation issues entirely), there’s a real risk that requirements incompatible with reasonable operation of a school could become effectively permanent. Fully vaccinated children, in rooms with fully vaccinated teachers, could show up in September and sit six feet apart while wearing masks. That’s insane, and there’s no reasonable way to run a school like that.

Can you imagine what would have happened if there wasn’t a pandemic, and it was proposed we send someone’s child to a school where everyone had to wear a mask all day and children couldn’t come near each other? There’s no way that school’s going to work or cost a reasonable amount to run. If that was the local public school, then every parent who could possibly do so would move. If it was a private school it would have zero children.

But, you say, that’s not going to happen. Once vaccinations are readily available to all who desire them, the guidelines will change. 

To which I say, maybe you are right. Maybe you are not. Guidelines do not automatically change unless they are set up to change automatically, and changed guidelines don’t always get followed. I wouldn’t count on anything. Even if they will eventually change, they might depend on all the children being vaccinated, which might not happen so soon. 

Also, there are places where vaccination should matter now, and the guidelines do not care:

Thus, as written, someone fully vaccinated would still need to do full quarantines on exactly the same basis as everyone else, which by default will be 14 days regardless of test results. 

That’s what you do if you’re open. Are you open? That depends:

Local transmission is defined as total new cases per 100,000 persons in the past 7 days (low, 0-9, moderate 10-49, substantial, 50-99, high >100) and percentage of positive tests in past 7 days (low <5%, moderate 5-7.9%, high >10%). 

The second test isn’t that bad, as the United States is currently averaging about 5% positive test rates. 

The first test is a bit harder. The United States currently averages closer to 200 cases per week per 100k people than it does to 100. Most places are going to currently be in red. Even elementary schools can only be fully open in yellow, and very few places are currently yellow let alone blue.

And that’s… reasonable if you care about levels and want to make a control system and we applied the same standard to other things? You can get angry about schools not being open at the moment all you want. Biden explicitly says he thinks schools should be open and most parents seem to agree. But that doesn’t change that the Covid-19 situation now is still worse than it was for most of 2019. That likely won’t be true in the fall, and could be true long before that if we pick up our vaccination pace or the new strains aren’t as impactful as I expect, but it’s true now. 

The issue is in part that this combines with lack of future-proofing in the form of vaccine accommodation, but also it doesn’t make sense to be reinforcing the control system here nor does this match up with the way we’re operating other things. In the CDC’s own words:

That’s a very strange place to be. Schools are defined as the most essential non-essential part of the community. One could make a reasonable case that this is where they should be, in that one could argue that lack of school is a long-term issue rather than a short-term issue, but the value proposition on school opening (in terms of risk vs. reward) is better than it is for anything else that doesn’t keep society running in the short term. 

So let’s accept the premise. Schools get in line behind ‘essential’ things (and oh my is that term loose in many places) but ahead of non-essential things.  

That’s not at all what these guidelines mean in practice. For that to line up with what’s being suggested would imply that all non-essential businesses should be closed in what is defined as the yellow zones above, let alone orange or red.

That’s clearly not remotely the case. New York, for example, is currently reopening arenas and indoor dining. 

Effectively these guidelines are an Isolated Demand for Rigor. In a context where we were holding the rest of society to these same standards, or the guidelines would only be followed in places where that was the case, this would all make some sense and we could talk about details. Instead, this holds schools to a completely different standard, because of the inertial forces pushing schools towards adopting the guidelines wholesale. 

My suggestion for zones is that the zones be defined in terms of other community restrictions. Thus, if indoor dining or other non-essential activities are permitted, K-12 schools are fully open to the extent they can otherwise follow guidelines. Period. If we’re scared enough to shut down all the inessential economic activity, then okay, you are acting like it’s an emergency, so we can talk about closing the schools, and we can look at other metrics. Rank order as the CDC suggests.

Mostly I don’t think using schools as part of the control system, outside of a true emergency, makes sense at all. Schools provide some amount of increased community transmission risk versus everyone hiding out at home. That number doesn’t change when there’s more or less virus. With teachers vaccinated (soon, if not now) and students themselves mostly immune, what matters is stabilizing spread, and trading schools off against other transmission sources, so why should it much matter (outside of an all-hands-on-deck-close-everything scenario) how much spread there is? We want to beat this thing, not perpetually fight to a draw. In most circumstances, either schools are Worth It, or they’re not. They either spread Covid a lot if someone brings Covid into school, or they don’t. 

It’s also worth noting that this ‘hybrid’ system, where everyone has to rotate where they go and what they do all the time, technically does a better job checking off some blame-avoidance boxes, but when you think about what kids will actually do, it might not be the way to ensure that a pandemic gets contained

I would be mildly surprised if hybrid was actively worse, in the sense that it isn’t what I would guess, but it definitely would not shock me and I do not get any sense the CDC took that question seriously. Nor do they offer an estimate of how much better such systems are for transmission, or take non-school transmission risk in the same way they take school transmission risk. Again, isolated demand for rigor.

This makes a strong but not airtight case that the schools don’t spread Covid that much (WaPo). The error here is that, if there was zero transmission in school, you’d expect much less than community average transmission because everyone would be spending their days not catching Covid. This still shows that schools aren’t riskier than baseline ways to exist under current conditions, which isn’t bad at all, but that’s different from saying they’re not sources of spread.

I don’t consider this proof of anything, but it’s certainly worth pointing out:

The six foot rule is good as a rule of thumb, but as a universal rule that will effectively be a hard requirement in many places due to how guidelines, children, blame and teacher’s unions interact, I strongly agree with Tyler Cowen that this is effectively an announcement that schools are not safe to fully open under any circumstances, and may never be again. 

The CDC director understands this and says that there’s flexibility on the six foot rule when community spread is low:

And technically, she’s right, the rules do say that. But that isn’t worth much. What matters are the written guidelines and how they will be interpreted in practice. Much of the discussion around the guidelines is interpreting the 6 feet as effectively mandatory at all levels, to the extent that I had to do a double take when I was reminded that this wasn’t what the guidelines actually said

There’s also this other bit, which mentions ventilation as a key point of failure (which the guidelines mostly hide, but at least do mention under cleaning) and also has a quite telling tidbit:

 And. There. It. Is.

Walensky is the Director of the CDC and is making the ultimate CDC power grab. She is saying that now that we’ve established our level of safety concern trolling, and our willingness to shut everything down that isn’t fully safe, why stop with Covid? Why not demand equal safety with regard to everything else? We need to crack down on these unprincipled exceptions. Why, indeed, did we let people ever leave their houses?

If you are a beaurocrat seeking power, and your job is the director of the Centers For Disease Control, your natural instinct is to assert maximum rules regarding disease control, as that increases your power and authority, no matter the impact on society. That’s a different department.

At what point do we say, enough? 

Biden says he wants the schools open. Assuming that’s true and he does think they should be open, given these guidelines, he’s utterly failed to do his job in creating conditions where that can happen, and shown he is unable to get his agencies to do things to benefit humans. It’s becoming a pattern.

My hope is that this is sufficiently over the top that many places will either treat the guidelines as purely aspirational during the pre-vaccination period (at which point, sure), or disregard them entirely, or at least only follow them to the letter or follow the blue or yellow zone rules to the letter. My worry is that this will happen at most for schools that are already open. 

My other hope would be that, to the extent that students cannot attend school, that we can stop pretending that ‘remote learning’ that ties students to a screen all day lest they ‘get out of’ something be recognized as insanity, and students be given tasks and projects to do instead, plus some amount of zoom time in smaller groups. The current remote learning system seems based on viewing school as some sort of either necessary punishment and/or mystical requirement, that must be mimicked and enforced at all costs. Maybe we could stop doing that?

As another piece of the whole puzzle, Walensky said this prior to issuing the guidelines, which is really weird if you try to square it with the guidelines being based on a physical world model:

This thread offers an attempt at a nominally even-handed perspective, where the CDC is compromising and bothsidesism is in full effect (surprise, it’s a NYT reporter), so one can see the perspective that views this as a compromise, if one wishes. I can see the argument for this, if we were in a different blame and liability regime (so the things that aren’t technically required really wouldn’t be de facto required), and the zones weren’t so strict.

It would be remiss not to tie all of this back to the previous moral panic over child safety that crippled the mobility of children and parents alike, and which continues to do so to this day.

There was a time when children, often quite young children, were trusted to play outside on their own or with friends, walk to and from school and otherwise live out their lives largely unsupervised by any particular adult. This was called childhood. 

Then (as I understand events), due to a crime wave and the accompanying moral panic, we were told this was no longer safe, and the age at which children could be left unsupervised rose higher and higher. This was true even inside one’s home. Eventually this became enshrined in the law, and one could worry that leaving an eleven year old alone in one’s home, or letting them play in the local playground without direct supervision, was a legally dangerous thing to do. And people report you for such things, and tell themselves they are helping.

The crime rates have since dropped dramatically, but the panic has become permanent. It’s the new normal and it’s also unbelievably destructive and terrible. It’s even worse for the disadvantaged, who can get their child taken away from them when they have no choice but to briefly leave the child in the car to go on a job interview. It’s still plenty oppressive even for those lucky enough to enjoy the benefit of the doubt. 

That’s on top of forcing the kids to attend school and barring them from doing work or otherwise learning a trade in a more sensible fashion.

That’s important for understanding our current situation, because it informs and should inform our fears and expectations. We like to think that the system will at least return to normal once there’s no reason for it not to, but there’s no reason to assume that will be the case. Once we raise our level of concern trolling about health to the levels that involve not wanting vaccinated teachers in rooms with children because of a disease that puts no one involved in meaningful danger, where does it end?

It doesn’t end, unless we make sure it ends.

It’s also important because our de facto ban on children living their childhoods is both a gigantic tax on being a parent and a gigantic injury to every childhood. It drives our children crazy, makes them unable to learn self-reliance, and helps drive down birth rates to below replacement, especially among the most scrupulous people we’d most want raising more children. Arguably it is an existential threat to our civilization, and we really should use this opportunity to try and do something about it. Ending this terror will be a key part of my platform as a potential benevolent dictator.

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The big thing is that a clear majority thinks schools should not wait for teachers to get vaccinated, let alone for students to get vaccinated, before reopening.

Wait, how do you get this? Am I misreading the chart above this sentence? It looks to me like in the poll you quote, 55% thinks schools should wait, which seems in contradiction with your sentence.

Wow that's... really, really weird, cause I remember reading it the other way. I took out the related paragraphs, and will let the graphs speak for themselves.

In terms of concrete measures for lower-covid-risk school reopening, I think it's worth underlining massive use of HEPA filters. They are not that expensive, and should reduce aerosol density and thereby covid risk rather a lot. Worth trumpeting also for grocery stores, pharmacies, offices, etc.

I like your overall point more though, and feel a bit innane commenting about something else without responding to that.

From my personal perspective, there is absolutely no Slack in the schools; they're struggling to do whatever it is they're trying to do now.

Asking anyone to retrofit all the HVAC systems in schools just ... doesn't seem like something that's possible for these organizations to do.

I decided to write my local school district's superintendent after reading the CDC's guidelines. I basically told her she's been receiving crap advice and offered to help her reduce coronavirus transmission in her schools (phrased more nicely obviously). I went to this school district growing up; it's well-resourced and managed unlike the typical hellscape of a public school. I've even met this superintendent before as a high school student, my impression of her then combined with the relative sanity she's been leading with so far give me hopes she might respond. 

Why do this? I had a small insight: write emails to the CDC and you're a random crackpot among thousands of crackpots. Contact your local school district which you yourself are a product of and you're a concerned and helpful citizen. (Well, that's my theory. We'll see.)

Let us know how this goes.

We have a call scheduled Monday (the district is on winter break so I think they want to be back in the office). I'm shocked I got a reply at all.

I think you corrected your self later, but there was a sentence earlier about vaccinated children in classrooms.

That is not likely to happen this year. Vaccine trials for children are just getting under way

Vaccine supply will be ready for them the moment the studies are done, so this year seems realistic for getting children vaccinated. Chances seem very high the vaccines work on children, with the caveat that they aren't as needed, of course. 

It's months away but I see no reason we couldn't make a September deadline if that was something teachers needed in order to come back. 

One thing I haven't seen worried about as much is: are children going to suffer from long COVID? After it became clear that children were basically safe from severe COVID, long COVID became my next concern. If I had children, I certainly wouldn't want them suffering e.g. long-term fatigue... But I don't recall reading much about this question in your posts. 

Without digging into the details right now, a quick Google returns Evidence that long COVID affects children:

The average period from diagnosis to evaluation was ~163 days. Of the group, ~42% had a complete recovery. Within the group, 53% of children were reported to have one or more symptom 120 or more days after diagnosis, fitting the diagnosis of Long COVID. Strikingly, 36% of them had one or two symptoms at the time of evaluation, and 23% three or more symptoms.

(I haven't checked this study's methodology, or done a broader lit review yet)

The FDA must actually say that children are ok to vaccinate, do you think they'll do that by September?