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Nurses, Teachers, and Experts Push Back Against Rush to Reopen Schools as Covid-19 Cases Spike

"The studies commonly cited as supporting school reopening are deeply flawed."

A first grade student sits at her desk at South Boston Catholic Academy in South Boston on September 10, 2020. (Photo: David L. Ryan/<em>The Boston Globe</em> via Getty Images)

A first grade student sits at her desk at South Boston Catholic Academy in South Boston on September 10, 2020. (Photo: David L. Ryan/The Boston Globe via Getty Images)

Students, educators, and parents still relying on remote or hybrid learning are itching to get back into classrooms, but with Covid-19 cases rising in several states, nurses, teachers union leaders, and other experts are expressing alarm over what they warn are short-sighted efforts to rapidly reopen schools and new federal guidance that may be putting economic concerns ahead of public health.

The nation's two largest teachers unions responded cautiously after the U.S. Centers for Disease Control and Prevention announced Friday that, as long as mask-wearing continues, students in K-12 classrooms can be just three feet apart—relaxing the previous six-foot recommendation that prevented some schools from reopening.

"This is another example of where social, political, and economic pressure to send kids back to school as soon as possible is, unfortunately, driving public health decisions instead of science and reality."
—Zenei Triunfo-Cortez, NNU

National Nurses United (NNU), the largest union for the profession in the country, has also put out a statement raising concerns that "the CDC's guidance was based on studies that failed to account for several critical factors, including no differentiation between facilities' ventilation levels, self-reporting of infection data or not testing all contacts of cases, and exclusion of schools that were closed due to need to quarantine or fully remote—especially in denser, urban areas and areas with more Black, Indigenous, and people of color."

As NNU president and registered nurse Zenei Triunfo-Cortez put it: "This is another example of where social, political, and economic pressure to send kids back to school as soon as possible is, unfortunately, driving public health decisions instead of science and reality."

Jean Ross, RN and another president of NNU, emphasized that "we should have more data before we put kids' and their families' lives at risk."

"We understand the need for school," Ross said, "but also must think long term: If you don't protect your health, you won't be able to learn, won't be able to continue with your education, won't be able to graduate and become a healthy, productive adult. And that also applies to all the staff and family members these kids come into contact with daily."

NNU executive director Bonnie Castillo, RN, warned in a tweet that the three-foot recommendation "will unnecessarily put millions at risk."

American Federation of Teachers (AFT) president Randi Weingarten and National Education Association (NEA) president Becky Pringle had shared concerns last week about the three-foot recommendation, with Pringle saying that "the CDC has changed one of the basic rules for how to ensure school safety without demonstrating certainty that the change is justified by the science and can be implemented in a manner that does not detract from the larger long-term needs of students."

Weingarten said that "while we hope the CDC is right and these new studies convince the community that the most enduring safety standard of this pandemic—the six-foot rule—can be jettisoned if we all wear masks, we will reserve judgement until we review them, especially as they apply in districts with high community spread and older buildings with ventilation challenges."

On Tuesday—as the U.S. death toll from the coronavirus pandemic topped 543,400 amid national vaccination efforts—Weingarten sent a letter (pdf) to CDC Director Rochelle Walensky and Secretary of Education Miguel Cardona questioning the recent revision to distancing guidance.

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The AFT leader wrote in part:

We appreciate that the body of knowledge regarding the impact of Covid-19 in school environments is expanding, but we are not convinced that the evidence supports changing physical distancing requirements at this time. Our concern is that the cited studies do not identify the baseline mitigation strategies needed to support three feet of physical distancing. Moreover, they were not conducted in our nation's highest-density and least-resourced schools, which have poor ventilation, crowding, and other structural challenges.

One thing the studies were clear on is the need for layered mitigation if there is a shift to reduce physical distancing. Now that we have had a chance to review the research, we conclude that any shift from six feet to three feet must be accompanied by, at a minimum, universal and correct masking; effective ventilation; thorough cleaning of buildings; regular Covid-19 testing of teachers, staff and students; effective contact tracing and quarantine/isolation protocols; and the availability of vaccines to all people in schools who are eligible.

"Weakening one layer of layered mitigation demands that the other layers must be strengthened," the letter adds while urging federal officials to insist on strict adherence to other mitigation strategies, requesting responses to a list of immediate logistical questions, and calling for studies in urban, densely populated schools lacking updated ventilation systems.

Weingarten cited a critical article from a trio of experts published by the Institute for New Economic Thinking that warned the CDC's new guidance could be "dangerous."

Deepti Gurdasani, Phillip Alvelda, and Thomas Ferguson wrote that "the studies commonly cited as supporting school reopening are deeply flawed; they are based on having only tested students who showed symptoms, rather than applying broad screening tests either universally or with true random samples capable of catching the otherwise undetectable asymptomatic spreaders and infected."

"Another lingering concern testifying to the persistent impact of outdated science," they added, "is that so much of schools' reopening guidance remains aimed at hygienic measures, surface wipe-downs, and plexiglass barriers, all of which are completely ineffective in limiting what we now know is the primary mode of indoor transmission, airborne aerosols."

"The latest CDC guidance suggesting that the risks to students are similar at six-foot or three-foot distances and thus that schools can safely reopen with more-or-less normal student seating density and populations in the classrooms completely misses the point," they noted. "A close analysis of the 'three-foot paper' the CDC cited shows it to be riddled with errors in protocol, most importantly, that it again relies on data from primarily symptomatic carriers; that it improperly conflates infectious susceptibility with contact rates; and is based on a flawed sampling methodology."

As the trio explained: "Contrary to the notion that even three feet of distancing is sufficient protection, and six feet is overkill, the critical safety issue is that students are all uniformly at risk in poorly ventilated rooms no matter where they are or how they distance."

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