{"id":314,"date":"2020-07-27T02:43:00","date_gmt":"2020-07-27T02:43:00","guid":{"rendered":"https:\/\/covidqanda.org\/?p=314"},"modified":"2020-11-09T02:45:49","modified_gmt":"2020-11-09T02:45:49","slug":"is-there-a-threshold-for-community-transmission-that-schools-should-consider-for-closing-reopening","status":"publish","type":"post","link":"https:\/\/covidqanda.org\/?p=314","title":{"rendered":"Is there a threshold for community transmission that schools should consider for closing\/reopening?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\" id=\"04f6\"><strong>Question:<\/strong>&nbsp;Is there a threshold for community transmission that schools should consider for closing\/reopening?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"0548\"><strong>Answer:<\/strong>&nbsp;CDC released its&nbsp;<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/community\/schools-childcare\/prepare-safe-return.html\">updated school return guidance<\/a>&nbsp;late last week. I\u2019ve copied a few key portions below for ease of reference&nbsp;<strong>(Table 1)<\/strong>. CDC suggests school closing only in the context of:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>substantial, uncontrolled [community] transmission \u2014 \u201cIf there is substantial, uncontrolled transmission, schools should work closely with local health officials to make decisions on whether to maintain school operations.\u201d; and<\/li><li>someone in the school tests positive \u2014 \u201cIf someone within the school community (e.g., student, teacher, staff) tested positive for SARS-CoV-2, assessing the level of risk is important to determine if, when, and for how long part or all of a school should be closed.\u201d<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"40c7\">With regard to \u201csubstantial, uncontrolled transmission,\u201d CDC describes levels of community transmission&nbsp;<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/community\/community-mitigation.html\">here<\/a>&nbsp;<strong>(Table 2)<\/strong>, but these levels do not include specific numeric thresholds. Within its guidance, CDC suggests that school systems use \u201cindicators such as healthcare capacity (e.g., staffing, ICU bed occupancy), changes in newly identified COVID-19 cases, and percentage of people testing positive for SARS-CoV-2 infections in the community might be useful to determine whether to maintain or modify school operations.\u201d This is moderately helpful, but for me, the challenge is that without numeric thresholds, it\u2019s much harder for us to understand school return decisions; the criteria are not transparent. For example, what does \u201csubstantial, controlled transmission\u201d look like? Would a given leader define their community\u2019s substantial transmission levels \u201ccontrolled\u201d or \u201cuncontrolled\u201d and how would that description be weighted based on political, economic, health, and welfare concerns (among others)?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"a187\">If we were to consider as numeric thresholds\/benchmarks the<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/downloads\/php\/CDC-Activities-Initiatives-for-COVID-19-Response.pdf\">&nbsp;indicators CDC suggested for phased reopening<\/a>&nbsp;<strong>(Table 3)<\/strong>, then indicators of \u201csustained, controlled transmission\u201d would include downward trajectory of new cases; downward trajectory of % tests positive; tests positivity at &lt;\/=20%; and tests returned within 4 days. Other groups, like Resolve to Save Lives and the Pandemic Response Network have drafted pandemic severity\/alert criteria (see&nbsp;<a href=\"https:\/\/preventepidemics.org\/wp-content\/uploads\/2020\/05\/Annex-2_Example-of-an-alert-level-system_US_FINAL.pdf\">here<\/a>). Interestingly, they suggest that in-person learning be curtailed in the context of both \u201csubstantial, uncontrolled transmission\u201d&nbsp;<em>and<\/em>&nbsp;\u201csubstantial, controlled transmission\u201d (e..g \u201chigh alert\u201d and \u201cmoderate alert\u201d respectively). With regard to this component of the debate \u2014 whether to have in-person learning at \u201csubstantial, controlled transmission\u201d \u2014 I don\u2019t know which is the right answer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"1f20\"><strong>Table 1.&nbsp;<\/strong><a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/community\/schools-childcare\/prepare-safe-return.html\"><strong>CDC Guidelines<\/strong><\/a><strong>&nbsp;for Making Decisions about School Operations<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/miro.medium.com\/max\/1648\/1%2A8r3mfxPfQO649y58lnpUeA.png?w=723&#038;ssl=1\" alt=\"Image for post\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"2ec7\"><strong>Table 2. Levels of Community Transmission&nbsp;<\/strong>(from&nbsp;<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/community\/community-mitigation.html\">CDC<\/a>)<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/miro.medium.com\/max\/2212\/1%2AlSs7V4OtO1c3-9pGWJONSw.png?w=723&#038;ssl=1\" alt=\"Image for post\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"8eb0\"><strong>Table 3. Gating Criteria for Phased Reopening&nbsp;<\/strong>(from&nbsp;<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/downloads\/php\/CDC-Activities-Initiatives-for-COVID-19-Response.pdf\">CDC<\/a>)<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/miro.medium.com\/max\/1392\/1%2AWV7GAN9YKkhb5r9aONlrqA.png?w=723&#038;ssl=1\" alt=\"Image for post\"\/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Question:&nbsp;Is there a threshold for community transmission that schools should consider for closing\/reopening? Answer:&nbsp;CDC released its&nbsp;updated school return guidance&nbsp;late last week. I\u2019ve copied a few key portions below for ease of reference&nbsp;(Table 1). CDC suggests school closing only in the context of: substantial, uncontrolled [community] transmission \u2014 \u201cIf there is substantial, uncontrolled transmission, schools should [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":315,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[50,17,13],"tags":[14],"class_list":["post-314","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guidelines","category-risk-reduction","category-school","tag-reopening","fallback-thumbnail"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/July-28.png?fit=696%2C720&ssl=1","_links":{"self":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/314","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=314"}],"version-history":[{"count":1,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/314\/revisions"}],"predecessor-version":[{"id":316,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/314\/revisions\/316"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/media\/315"}],"wp:attachment":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=314"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=314"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=314"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}