CDC School Return Guidelines, An Incomplete Prescription

The World Health Organization (WHO) reported a record daily high number of COVID-19 cases worldwide of 284,186 on July 24. The United States continues to contribute a disproportionate share to this number. The virus clearly continues to rage in our country. The WHO has advised that the positivity rate (meaning the percentage of individuals tested who have positive tests) be no more than 5% for 14 consecutive days to safely reopen. Today, thirty-four of our 50 states have positivity rates above 5% with 12 of those states with rates above 10%. The US number of deaths is starting to rise again showing more than 1, 000 daily deaths for each day from July 21- July 24. Our total number of deaths is over 146,000. Based on antibody testing, our CDC is reporting that the number of infected Americans is 2-13 times higher (depending on the geographic area analyzed) than the recorded number of cases, which by the way has reached roughly 4.1 million. Researchers are now saying that the death rate of infected individuals is 0.5- 1.0%. This is at least five times higher than the seasonal influenza but lower than Ebola. An extremely important update by the CDC is that the duration of quarantine for people with mild and moderate disease, who have tested positive, is now TEN days instead of 14. This timeframe applies after the onset of symptoms and requires that any temperature elevation has resolved for 24 hours without the use of fever reducing medications if symptoms have improved. People who test positive and have no symptoms should remain quarantined for 10 days after the test, as well. The need to retest individuals who have previously tested positive has now been eliminated. If you have been in close contact with someone who has COVID-19 then your quarantine is 14 days because of the potential incubation period of the disease. To stem the tide of this resurgence, fortunately several new states have implemented the mandatory use of face coverings. This viral surge in the US has also caused numerous states to roll back or delay of phased reopening of their economy. The economic devastation manifests itself as 1.4 million new US jobless claims this week.

The CDC school return “decision tool” https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/decision-tool.html was released this past week. This decision tool fails to provide an even-handed recommendation for online instruction. In our opinion the option of not being in the classroom is one that needs to be explicitly available because of the science and reality of too much disease in many school districts. The CDC position misses the mark as it fails to clearly designate a specific minimal positivity rate above which the well-established benefit of in classroom instruction is outweighed by the risk of increasing the spread of the virus. Not opening the school was a clear and unambiguous recommendation in the initial guideline that was suppressed by the White House a few weeks ago. In this new tool it is stated that “limited data about COVID-19 in children suggests that children are less likely to get COVID-19 than adults”. This ignores a study out of S. Korea of nearly 65,000 people which concludes that children under 10 have a lower risk of spreading this infection, albeit not zero risk. Children age 10-18 were shown to spread COVID-19 at rates like adults. Ironically, this study is to be published in a CDC journal in October 2020. For those who might question the S. Korea relevance, note that the US and S. Korea had the same number of fatalities in mid-March and they have less than 300 people now! Lastly, our children’s needs for school resources to allow facilities to reopen more safely are not being addressed. Congress and the President have left town without addressing the $200 billion price tag (American Academy of Pediatrics) needed to make our schools open more safely, once medically acceptable criteria for return is reached.

The medical science tells us that a treatment plan needs to be followed to completion. As a country, we did not accept the diagnosis and prognosis, WEAR masks, WASH hands, WATCH the distance between us, or have a coordinated unified message prescribed for effectively fighting this virus. This current resurgence is the unnecessary price that we are paying. We need to follow a science-based prescription for getting our kids back to school and not a revised version based on perceived political expediency, lest history repeats itself.

Clyde E. Henderson, MD
Treasurer,
Cincinnati Medical Association