Robin Cogan

In case you have not seen the new Centers for Disease Control and Prevention (CDC) guidelines for schools, published on August 11, 2022, here they are: Operational Guidance for K-12 Schools and Early Care and Education Programs to Support Safe In-Person Learning.

Key changes in CDC guidance for schools.

The CDC has chosen the path of least resistance as schools are about to reopen or are in their first few weeks of the new school year. Although the word “prevention” is included in the CDC’s name, this central goal seems to have been removed from these guidelines, including crucial pieces of the mitigation strategies that in the past prevented the school-level spread of the virus:

  • The recommendation to cohort has been removed—its absence will increase class sizes, removing a layer of mitigation.
  • The recommendation to conduct screening focused on high-risk activities during times of high COVID-19 spread or an outbreak has been changed, mostly leaving it up to individual districts to determine what constitutes an outbreak, with little guidance from local health departments.
  • The recommendation to quarantine has been removed, except in high-risk congregate settings. I would suggest that schools are congregate settings. We can quibble about use of the term “high-risk,” but we certainly do have high-risk staff, students, and community members who deserve to be protected.
  • The CDC removed information about Test to Stay, so we will not know who is safe to be in school each day. No more pooled testing either.
  • Contact tracing seems to be off the table unless there is a school-based outbreak with no indication of community spread.

Here’s a quote from the guidelines on the rationale for removing Test to Stay programs:

“Quarantine is a key component of Test to Stay programs. Since quarantine is no longer recommended for people who are exposed to COVID-19 except in certain high-risk congregate settings, Test to Stay is no longer needed.”

And here’s a statement that reflects and accommodates itself to the deep divide in this country about masking, which has been banned in some states:

“Schools and ECE programs should consider flexible, non-punitive policies and practices to support individuals who choose to wear masks regardless of the COVID-19 Community Level.”

This statement in the new guidelines, released just in time to sow more confusion as we return to school, is hard for me get past. I think it’s the fact that the CDC actually had to say this out loud! It’s clear that such vague language as “should consider” will be easy for some states/districts to disregard. Such a sentence illustrates what happens when public health is politicized—punitive actions can be taken against those who choose to mask to protect themselves or their loved ones.

Lifting effective mitigation strategies.

Most of our layered mitigation strategies are now being lifted, layers of protection that actually kept our schools open last school year. The only line of defense is a “well-fitted mask.” If an outbreak is determined or if a school decides to implement indoor masking during high transmission, do school administrators know that this means wearing a KF94/KN95/N95 mask, and are we providing them? Just because you sprinkle a document with the word ‘equity’ does not mean it exists.

While my observations suggest that local health departments are readily available to help schools prioritize protective strategies, as the COVID school years have piled up, direct guidance from local health departments has waned. Some school nurses have been barred from contacting their health departments; decisions are in most cases at the discretion of each school district. Another quote:

“Schools and ECE programs, with help from local health departments, should consider the local context when selecting strategies to prioritize for implementation.”

The remarkable fact that we’re losing sight of is that schools have remained open, with few exceptions, during surges. In those cases, individual classes or even buildings were closed, but very few full school districts. We have been open to in-person learning for quite some time. So why remove the strategies that helped us stay open?

I did find one helpful document though, buried in the new guidelines. There is a standardized definition of clusters and outbreaks!

Five recommendations.

In light of all of the mixed messaging and the seeming lack of population health focus for safely returning our students and staff to school, here are five recommendations that I hope readers find useful:

  1. Be sure that your school has a full-time school nurse in the building. According to the National Association of School Nurses, 25% of schools do not have a nurse at all, and 35% only have a part-time school nurse. Advocate for a full-time school nurse in your child’s building all day, every day.
  2. The school nurse and the parents are on the same team. We want to keep our students safe, healthy, and able to learn. We are your partners in school health and safety. Our goal is to keep our schools open and limit disruptions in learning. Please ask what your school’s COVID response plan is for this school year. Will they be implementing universal masking if the COVID levels are rising and what is the data the school is monitoring to make that decision?
  3. Please keep your children home if they are not feeling well. Fevers over 100.4 degrees are one indication of not feeling well. Congestion with an excessively runny nose is another example. Keep your children home until they are fever free or free from other common ailments like vomiting or diarrhea for 24 hours without fever-reducing medication.
  4. Please, please vaccinate your children for COVID and all other vaccine-preventable childhood illnesses. We have taken a bit of a backslide on vaccinations for our children; we can reverse that negative trend this school year.
  5. Keep your school nurse informed of any changes that could impact your child’s mental and/or physical health. We are a safe space to help with care coordination and are a wealth of resources should you need confidential assistance. Remember, we share the same goal: a safe, healthy learning environment for all children to flourish.
  6. Sleep is your child’s best strategy for a successful school day. Our students require a solid night’s sleep in order for their bodies to function properly. Quality sleep is fleeting and we must do everything we can to protect our own and our children’s sleep. This might mean making specific changes to bedtime routines that ensure ten to 12 hours of rest each night. Sleep hygiene may be the missing link in your child’s ability to maintain high performance in school.

A host of other concerns as a school year begins.

We are all walking the proverbial tightrope this year, as we enter our fourth school year impacted by COVID, with both monkeypox and polio lurking in the background. I cannot forget to include the impending threat, whether real or perceived, of gun violence in school. Our plates are overflowing with concerns, and our workforce is understaffed and overburdened.

What we need is full parental cooperation, because school nurses are caring for the health and well-being of everyone’s children. We must learn to care about other people’s children because we are a community, not an island. We can do this with grace, space, cooperation, and clear communication. Here is to as healthy a school year as we can create together as a full-fledged team.

Robin Cogan, MEd, RN, NCSN, FNASN, FAAN, is in her 22nd year as a nurse in the Camden City (New Jersey) school district. The New Jersey State School Nurses Association director to the National Association of School Nurses, she is also a Johnson & Johnson School Health Leadership Fellow and past program mentor. Robin teaches in the school nurse certificate program at Rutgers University-Camden School of Nursing, and writes a blog called The Relentless School Nurse. Email: robin.cogan@rutgers.edu.