Enlarge /. At an event, CDC director Robert Redfield focused on discussing how schools can be reopened safely.
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In the United States, the number of coronavirus infections increased dramatically less than two months before the start of the school year. With little evidence that the country has even started smoothing the curve, there are serious questions about in which areas of the country schools can be opened safely. For unclear reasons, however, the Trump administration has a clear answer: everyone.
In recent weeks, the administration has been putting pressure on disease control centers, introducing restrictive rules for overseas college students, and letting several senior administrators, including Trump himself, attend school openings. The move puts the administration in conflict with public health experts and their own CDC, who recommends a far more cautious approach, according to an internal document that leaked over the weekend.
At an event on Monday, President Trump repeated his government's message saying, "Schools should be opened – children want to go to school." In line with his government's health policy approach, an evidence-free and probably incorrect statement followed: "You lose many lives if you keep things closed."
Contrary to many of Trump's public statements, which often have few consequences, the initiative to reopen schools was supported by extensive political work. Last week, Trump threatened to cut federal funding for schools if it didn't open in the fall, making irrelevant comparisons to countries that, unlike the United States, had largely managed to control the pandemic. Minister of Education Betsy DeVos repeated this threat over the weekend. The risk of funding being limited is critical as the federal government has no authority over public schools that are largely under local control.
A potential obstacle to this move is the CDC, which has put together advice for educators on how to deal with the possibility that children may become infected with the virus and become ill, or act as vectors to pass it on to others. The CDC has bolded the phrase "stay at home" where appropriate, followed by advice on topics such as offering tele-learning and eliminating attendance and absence penalties for students and staff.
Trump saw the CDC council, formulated by public health experts, as an obstacle to his goal of reopening schools. "I disagree with @CDCgov about the very strict and expensive guidelines for opening schools," he tweeted, ending with the veiled threat, "I'll meet you !!!" In the end, however, the task of reconciling the CDC was delegated to Vice President Mike Pence, who promised that the agency would issue new guidelines for schools later this week.
But public schools aren't alone when it comes to opening despite the increase in infections. Last week, Immigration and Customs Enforcement announced that international students would be forced to leave the United States if their university classes were not held in person. This decision has led to lawsuits from hundreds of universities and over a dozen states trying to block their implementation.
What the experts actually think
This weekend, more comprehensive insight into the CDC experts' view of the problems with reopening schools was given when the New York Times received an internal CDC document that was to be shared with the federal health teams being sent to areas in which the COVID-19 cases flared up. On the very first page of the document, Trump's proposed full reopening "full-size personal classes, activities, and events" is identified as potentially in the "highest risk" category. In contrast, the distance learning that Trump is trying to oust schools is called the "lowest risk." Hybrid models with smaller groups of students who are present in shorter weeks, supplemented by distance learning, are moderately difficult.
The guidelines are in advance of the limits of our knowledge. We both know that younger children are less likely to have severe COVID-19 symptoms, as the document confirms, but we also know of cases in which they have become seriously ill; The CDC confirms both. Similarly, the document recognizes that there is uncertainty about the ability of young children to transmit the virus to others. "The universal SARS-CoV-2 tests of all students and staff at school have not been systematically examined," the authors write. "Therefore CDC does not recommend universal testing of all students and staff." Overall, it is reasonably provisional based on our current level of knowledge.
However, the CDC document contains comprehensive advice on limiting the spread of infections, which we know a lot about. This includes that schools can isolate anyone who shows symptoms and that they should consider what it would take to have someone able to coordinate virus testing and contact tracking. Schools should also be ready to close immediately for several days to allow for social detachment and disinfection when there is a person known to be carrying the virus. If there is any type of active dissemination in the community, several means of social distancing should be introduced, from more space between students in the classroom to restrictions on activities outside the classroom.
Similar advice is given to universities, with the additional complication that they may be responsible for dormitories and therefore may have to limit the number of people who can be accommodated in them.
However, most of the document contains outlines of the plans drawn up by various government departments of education, local school districts, community colleges, and universities of various sizes. This provides a wealth of information about options that are already tailored to schools of different sizes and needs, so that similar institutions get an idea of what to try. And the CDC helpfully points out some limitations of these plans (for example, some companies plan to use tests, but do not describe how the school will respond to a positive test).
Overall, based on our current state of knowledge, the document appears to be well founded both on the SARS-CoV-2 virus and on the plans of the educational institutions. Many of the public health officials with whom the Times shared the document thought it was well thought-out and possibly useful.
Separate politics / science
What the document is certainly not is a comprehensive confirmation of the idea that schools should revert to what appeared to be "normal" before January. For this reason, this document – and the opinion of public health experts in general – was a problem from the Trump administration's perspective. In fact, the American Academy of Pediatrics, a large group of health professionals who had supported school reopening, has withdrawn from this stance today.
As in other cases where science contradicted government policies (see, for example, climate change), the government's response was to ignore science and promote preferred policies. The notable difference is that with COVID-19, unlike climate change, the consequences of a non-science-based policy have become apparent in months – and sometimes weeks. And based on the graphs showing an exploding infection rate and ratings from public health experts, the U.S. response to the policy has been painfully lacking. It also seems to be obvious to the public, as surveys have repeatedly shown that Americans have more confidence in other officials than in President Trump – and why many school officials either clash when they reopen or do without them.
The concern here, however, is that Trump appears to be taking a post-Sharpie approach to academics and public health experts who are skeptical of his approach. In the previous case, where Trump treated a hurricane prediction card with a magic marker, science agencies were forced to undercut their own employees, threatening to lose jobs. The level of pressure exerted on the CDC in response to its school advice appears to be similar. Other recent reports have indicated that White House officials are collecting a set of criticisms against infectious disease expert Dr. Anthony Fauci, leaked based on statements he made at the start of the pandemic when our knowledge was less certain. Fauci also struggled to get approval for media appearances, possibly due to his history of contradicting the government's sunny views of the pandemic.
In other words, there are indications that the administration is no longer satisfied with pushing its policies towards the opposite advice from scientific and medical experts. Instead, these experts may be silenced and undercut to smooth acceptance of their policies.