It is no secret that I believed that the CDC and then Director Dr. Robert Redfield had effectively abdicated their responsibility during the coronavirus pandemic of 2020.  Flash forward to a new administration, a new year and a new director – but strangely the missteps at CDC continue.

In an interview yesterday on MSNBC, new director Dr. Rochelle Walensky (who is a well respected HIV clinician and researcher but has no formal public health experience) doubled down on her opinion that teachers do not necessarily need to be vaccinated should “proper” mitigation efforts be in place.  She cites “the science” that shows that there is “very little” transmission in schools providing adequate ventilation, masking, handwashing, “de-densification” (echos of Alexander Haig – is this even a word?) among other efforts.

https://www.msn.com/en-us/news/politics/mitigating-measures-key-to-opening-schools-without-vaccinating-teachers-cdc-director/vi-BB1dncwG

But let’s look at her argument – starting with ‘the science’. This is often a mistake that physicians (but not researchers) make, trying to sum the totality of evidence with a sweeping generalization or relying on a single seminal paper to support a viewpoint. Point in fact, there have been only a few studies of COVID-19 transmission in schools and early childhood education and these give conflicting results. One study in New South Wales Australia (link: https://doi.org/10.1016/S2352-4642(20)30251-0) showed that the 27 coronavirus cases identified in schools spread to only 18 of 1448 close contacts (1.2%).  But these very low rates of infection need to be interpreted with caution, because most educational facilities were closed after case identification, and close contacts were expected to home quarantine for 14 days.  A similar phenomenon was seen in Ireland (Heavey et al., Euro Surveill. 2020; 252000903) where 6 school-based cases led to zero secondary cases. So these studies do lend support to Dr. Wallesky’s argument.

On the other hand, an outbreak centred in a high school in northern France (link: https://doi.org/10.1101/2020.04.18.20071134) showed high secondary infection attack rates were high in students (aged 14–18 years) at 38% and staff 49%.  Rates were much lower among parents and siblings (11% and 10%, respectively) suggesting that infection was concentrated within the school environment.

Dr. Walensky notes that schools should be “the first things to open and last things to close” but we all know that such a belief is pure fantasy.  Opening of schools goes hand in hand with reopening of restaurants, bars, retail and workplaces in general. Surely a year into the pandemic we don’t seriously believe that we would open schools to the exclusion of other venues, do we?

And this is the fatal flaw in Dr. Wallensky’s argument – and the reason why teachers most certainly do need to be vaccinated before returning to school (and “the science” supports the counterargument).  

Reopening of schools will, of course, increase work-related contacts among teachers.  In addition, it is accompanied by an increase in other contacts because of the wider lifting of restrictions. In fact, Panovska-Griffiths and colleagues (link: https://doi.org/10.1016/S2352-4642(20)30250-9) found that reopening schools (even partially) and the accompanying return to more normal contacts is likely to lead to a second wave of infections, unless testing is scaled up significantly. Unfortunately, it is not clear from their analysis whether the increase in cases that occurs when schools are reopened in the model is due to increased contact between children or increased contact between adults who can now return to work and leisure activities.