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In New Guidance for Schools, CDC Warns Against Universal Symptom Screenings

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Updated.

The Centers for Disease Control and Prevention does not recommend K-12 schools screen all students for symptoms of the coronavirus, the agency said in a stack of new guidance on a range of precautions it posted on its website Thursday evening.

That guidance comes well after many states and districts had already developed policies to ask students about symptoms like cough and fatigue before they board a school bus or enter a school building. And it seems to contradict previous guidance from the agency that recommended schools conduct daily health checks if feasible, checking for fevers or symptoms of the virus.

"The number of reported children with SARS-CoV-2 (the virus that causes COVID-19) infection who experience symptoms, the types of symptoms they experience, and the severity of those symptoms differs from adults," the CDC says in its new recommendations. "Additionally, the consequences of excluding students from essential educational and developmental experiences differ from excluding individuals from other settings."

Citing new understanding of the virus, the guidance cautions that in-school screenings won't catch asymptomatic cases of COVID-19, and that they may flag other illnesses, like the common cold. It recommends that schools "strongly encourage" parents and guardians to monitor their children "for signs of infectious illness every day."

The guidance also includes recommendations about isolation and quarantine for students who are symptomatic or may have been exposed. "Excluding students from school for longer than what is called for in existing school policies (e.g., fever free without medication for 24-hours) based on COVID-19 symptoms alone risks repeated, long-term unnecessary student absence," it says.

New CDC Guidance for Schools

The screening recommendations were included in a series of new documents posted Thursday that reiterate the Trump administration's position on the importance of in-person instruction, provide more clear recommendations about wearing masks in schools, outline additional guidance for administrators about preparing to reopen buildings, and provide checklists for parents and guardians to help decide if they should send their children back to school.

After President Donald Trump made an aggressive push to reopen schools and criticized the agency's previous recommendations as impractical and costly, some education advocates feared the agency would replace it. The new guidance heavily emphasizes the importance of reopening, but it appears to add to the previous document, referring back to it at times.

"Scientific studies suggest that COVID-19 transmission among children in schools may be low," says a statement on the importance of reopening schools included in the new release. "International studies that have assessed how readily COVID-19 spreads in schools also reveal low rates of transmission when community transmission is low."

Trump has frequently pointed to other countries to suggest it would be safe to open schools in the United States, but critics of his push argue those countries have lower rates of the virus and more aggressive protocols to trace its spread and isolate cases. At a White House briefing Thursday, Trump acknowledged that schools in hotspots may have to delay physical reopening for "a few weeks."

The new documents echo Trump's assertion that children may be less likely to have severe cases of COVID-19 and less likely to pass it on to others, but it does so with less certainty.

"There is mixed evidence about whether returning to school results in increased transmission or outbreaks," says another document for administrators on preparing to return to school. "For example, Denmark initially reported a slight increase in cases in the community after reopening schools and child-care centers for students aged 2-12 years, followed by steady declines in cases among children between ages 1 and 19 years. In contrast, Israel experienced a surge of new cases and outbreaks in schools after reopening and relaxing social distancing measures; it is unclear what caused the increase ... In summer 2020, Texas reported more than 1,300 COVID-19 cases in child-care centers; however, twice as many staff members had been diagnosed as children, suggesting that children may be at lower risk of getting COVID-19 than adults."

A single case of COVID-19 does not warrant closing down an entire school, the guidance says, especially in areas with low rates of community spread, a term that refers to the rate at which the virus is passed from person to person locally. The documents frequently recommend the use of cohorts, which keep students together in smaller groups within a school to limit chances for greater spread.

"If the transmission of the virus within a school is higher than that of the community, or if the school is the source of an outbreak, administrators should work collaboratively with local health officials to determine if temporary school closure is necessary," the recommendations say.

Masks in Schools

New CDC guidance on face coverings and masks in schools includes examples of when masks may be most necessary for students and adults, including indoor settings "when social distancing of at least 6 feet is difficult to implement or maintain."

"While cloth face coverings are strongly encouraged to reduce the spread of COVID-19, CDC recognizes there are specific instances when wearing a cloth face covering may not be feasible. In these instances, parents, guardians, caregivers, teachers, and school administrators should consider adaptations and alternatives whenever possible. They may need to consult with health-care providers for advice about wearing cloth face coverings."

The recommendations say clear face shields are not an adequate substitute for masks, but they recommend "clear face coverings that cover the nose and wrap securely around the face." The CDC says such coverings may be necessary for:

  • Staff who interact with students who are deaf or hard of hearing;
  • Teachers of young students learning to read;
  • Teachers of students in English as a second language classes;
  • Teachers of students with disabilities.

The document says schools can encourage mask wearing by playing games with young students, by sending videos home to older students about how to wear them properly, and by including masks on school supply lists, in communication to parents, and on posters in the hallways.

Guidance for Parents

New guidance for parents and guardians on when to return students to school includes the considerations of factors like:

  • the level of community spread in the area;
  • the child's health conditions;
  • health concerns for members of a child's household who may be exposed;
  • whether parents are satisfied with their school's precautions;
  • the feasibility of remote learning for the family.

The guidance also includes a checklist to help parents prepare for returning to school or for remote learning.

Photo: Regina Jones disinfected a school bus in Vicksburg, Miss. as schools there closed to slow spread of the coronavirus. --Courtland Wells/The Vicksburg Post via AP


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