Research released by the Centers for Disease Control and Prevention is adding fuel to the Biden administration’s push for school districts to return to in-person instruction, even amid the latest wave of the pandemic.
However, at least one of the new studies warns against governors’ moves to restart high school indoor sports in several states.
A handful of new studies, including one released Tuesday in the CDC’s Morbidity and Mortality Weekly Report, add to evidence that students and teachers may be able to safely return to in-person instruction, even in communities with widespread coronavirus infection, if the schools use key health and safety practices such as mask-wearing, social distancing, sanitation, and keeping students in small groups or “cohorts” to limit interaction.
“As many schools have reopened for in-person instruction in some parts of the [United States] as well as internationally, school-related cases of COVID-19 have been reported, but there has been little evidence that schools have contributed meaningfully to increased community transmission,” wrote CDC researchers led by Margaret Honein in an accompanying viewpoint essay in the Journal of the American Medical Association (JAMA).
“The preponderance of available evidence from the fall school semester has been reassuring insofar as the type of rapid spread that was frequently observed in congregate living facilities or high-density worksites has not been reported in education settings in schools.”
Schools used clear health protections
For example, researchers tracked COVID-19 cases among the more than 5,500 students and teachers at 18 schools in rural Wood County, Wisc., during the fall semester of this school year. All the schools had returned to in-person instruction for nearly 88 percent of students, separating them into cohorts of 11 to 20 students of the same grade level. These cohorts did not interact with other groups.
With help from a local grant, each student received three to five face masks of two to three cloth layers, as recommended by the CDC. Teachers reported more than 92 percent of students wore their masks whenever they were indoors or closer than six feet from another person outdoors.
The schools also used a broad approach to quarantining potential coronavirus exposures. In addition to asking anyone who tested positive or who came within six feet of someone who was infected for more than 15 minutes during a 24-hour period to quarantine, the schools also required the siblings of anyone asked to stay home to stay home also.
The measures seemed to work. While Wood County’s community infection rate topped 1,100 cases per 100,000 people in some weeks from the end of August through the end of November, infections among students and staff in the schools never went above 699 cases per 100,000 people. The school system’s infection rate averaged 37 percent lower than that of the community at large. By the end of the study, only 3.7 percent of all of those who tested positive for the virus had contracted it at school.
The Wisconsin study was done before new, more contagious variants of COVID-19 were introduced in the United States. But it comes on the heels of others in North Carolina and internationally that similarly suggest in-person learning can be safe for students and staff if leaders are rigorous with safety procedures.
Across56 North Carolina school districts serving some 90,000 students and staff, researchers found 770 cases of COVID-19 infections that children or adults caught in the larger community, but those infections rarely caused outbreaks in schools. Only five of those districts had one or more cases of secondary infection spread within the schools. Across all grade levels, researchers identified 64 secondary infections, none of which involved children infecting adults, and no schools had to close because of an outbreak. However, the community infection rate was 10-20 cases per 100,000, significantly lower than in Wisconsin.
All of the North Carolina districts were part of a state collaborative that ensured schools implemented pandemic safety procedures such as mask-wearing and social distancing.
Experts advise against indoor sports
In contrast to the potentially positive findings on in-person learning, the CDC’s study on transmission at school athletic events offers a cautionary tale. It concluded that during periods of moderate or high COVID-19 community transmission, schools should postpone high-contact sports where masking and physical distancing aren’t possible.
On Dec. 4 and 5 of last year, a Florida high school held a two-day wrestling tournament that was attended by 130 people, including coaches and students from 10 teams, as well as spectators. At the time of the tournament, according to the report, 7.7 percent of COVID-19 tests in the unnamed county were positive over the previous 14 days, and the county’s statistics placed in the CDC’s category for the highest risk of transmission.
On Dec. 7, one of the tournament’s attendees tested positive for COVID-19. Over the next few days, 13 wrestlers from the home school and 24 other tournament attendees tested positive as well. Only 54 of the 130 attendees were tested.
An investigation by the state public health department subsequently identified nearly 450 additional people—including K-12 students, teachers, and family members—who were in close contact with tournament attendees who had tested positive. Forty-one of those contacts tested positive for the virus as well. More than half of those people had symptoms. At least one adult, older than 50, died.
The Florida outbreak highlighted by the CDC isn’t the only one. Public health officials in Louisiana have urged more than 1,400 people who attended a high school wrestling tournament on Jan. 15 and 16 to “consider themselves exposed to COVID-19” after more than 20 people involved in the event tested positive.
The debate over school sports during the pandemic has been contentious. Proponents of continuing athletic activity to some degree have said they believe these events can continue safely with a minimal number of new COVID-19 cases, especially with precautions like masking and physical distancing when possible. In some cases, school athletes have been allowed to continue practicing and competing even while classrooms and school buildings remain closed.
Public health directors have been under pressure from some students, parents, and coaches to permit school sports to continue, even as others have said the risks aren’t worth the reward. When Ngozi Edike, Illinois’ director of public health, announced Monday that high-contact winter sports could continue in some regions, she said she had received “countless emails, letters, phone calls,” as well as an organized protest in October at her home, urging permission for school sports to resume.
“I take very seriously the value that recreational outlets offer the physical and the mental health of our children,” Edike said. “I also take very seriously the need to protect them.”
In Michigan, meanwhile, the state government’s decision to extend the ban on high-contact sports through Feb. 22 has drawn outrage, including the threat of lawsuits from Let Them Play, a group that formed in August and recently developed into a nonprofit to advocate for school sports to fully return. One coach told the news outlet Bridge Michigan that some coaches are considering moving basketball games to Indiana, where high-contact sports are currently permitted, or hosting them in Michigan, defying the government’s decision.
Inconsistent approach to school athletics
States and school districts have pursued widely varied strategies for handling permission for school sports during the pandemic. Some have allowed all of them to continue, some have banned them entirely, and many others have fallen in between. On Friday, New York Governor Andrew Cuomo gave local health departments the power to approve school sport activities based on community health metrics. Other states have drawn distinctions between high-contact sports, like wrestling and basketball, and low-contact sports such as swimming.
Many sports programs have shut down temporarily after someone involved with the team tested positive for the virus.
In North Carolina’s Charlotte-Mecklenburg district, for instance, the superintendent earlier this month paused all school sports—with the exception of cross-country and volleyball teams, who were allowed to compete but not to practice. Several clusters of COVID-19 cases have been identified among the district’s athletic teams, according to district administrators. But some parents have been frustrated to see sports proceed differently across county lines.
The CDC report builds on the agency’s existing guidance for youth sports administrators. It also highlights the ripple effect a single outbreak can have.
“Outbreaks among athletes participating in high-contact sports can impact in-person learning for all students and increase risk for secondary in-school and community transmission with potentially severe outcomes including death,” the report says.
Six states have yet to permit high school sports of any kind this school year, according to the National Federation of State High School Associations. Thirteen states have mandated that people participating in school sports wear masks except during athletic competitions, and twenty states have mandated mask wearing at all times.
Three states have canceled school wrestling for the remainder of the school year, while 11 states have made no changes to this year’s wrestling schedule for schools.