School Nursing

The Relentless School Nurse: The CDC Chooses the Path of Least Resistance

In case you have not seen the new guidelines, published on Thursday afternoon, August 11, 2022, here they are:
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.
  • They removed the recommendation to cohort, which will increase class sizes, removing a layer of mitigation.
  • The CDC changed recommendations to conduct screening testing to focus on high-risk activities during high COVID-19 Community Levels or in response to an outbreak. It has been mostly left up to individual districts to determine what constitutes an outbreak, with little guidance from local health departments.
  • They removed the recommendation to quarantine, except in high-risk congregate settings. I would suggest that schools are congregate settings, perhaps we can quibble about high-risk, but we certainly 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. 
  • It seems that contact tracing is off the table unless there is a school-based outbreak with no indication of community spread. 

Here is the exact quote: 

Quarantine is a key component to 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 (TTS) is no longer needed. 

But there is one statement from the CDC that reveals how deeply divided this country is where masking 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.” I can’t move beyond this statement from the CDC in their new guidelines released just in time to create more confusion as we return to school. –  CDC
They actually had to say this out loud! The language of “should consider” will be easy for those states/districts to disregard. But this one sentence illustrates what happens when public health is politicized. Punitive actions can be taken against those who choose to mask during a pandemic.
It seems that most of our layered mitigation strategies are now being lifted. The only line of defense is a “well-fitted mask.” If an outbreak is determined or if a school decides to implement in-door masking during high transmission, do school administrators know this means a KF94/KN95/N95, and are we providing them?  Just because you sprinkle a document with the word equity does not mean it exists…
My few final observations are the suggestion 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 at the discretion of each school district in most cases.
Schools and ECE programs, with help from local health departments, should consider local context when selecting strategies to prioritize for implementation. – CDC
The irony of the latest guidelines is that are lifting the very layers of protection that actually kept our schools’ open last school year. It’s as if there is no recognition that schools have remained open with few exceptions during surges. In those cases, individual classes were closed or even buildings, but very few full school districts. We have been open for 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! 
Sending best wishes to my amazing colleagues, those legions of Relentless School Nurses who are about to enter (or are already there) our 4th school year impacted by COVID! Stay in touch, stay connected, circle your wagons, and we will make it through. Please remember to set healthy boundaries and do your best not to fall into the traps of previous school years. Do not tolerate intolerable work conditions. 

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