Summary

The CDC's statement on reopening schools during the COVID-19 pandemic has been criticized for lacking scientific rigor and potentially compromising public health credibility.

Abstract

The author, a physician and parent, expresses deep concern over the CDC's guidance on school reopenings, which they argue is presented in the form of a blog post rather than a scientific paper. The CDC's downplaying of the health risks to children, including the rare but serious multisystem inflammatory syndrome (MIS-C), is seen as a serious departure from the agency's usual scientific standards. While acknowledging the challenges of e-learning and the importance of in-person education, the author points out that the CDC's statement seems to overlook the potential for children, especially those aged 10-19, to transmit the virus to adults. The author also notes that the CDC's guidance may have been influenced by political pressure, citing reports that the CDC's input was sidelined in favor of a working group convened by the Department of Health and Human Services. This has led to a significant loss of trust in the CDC and raised concerns about the agency's future guidance.

Opinions

The CDC's school reopening guidance is perceived as a blog post rather than a scientifically rigorous document.
The author believes the CDC has inappropriately downplayed the risks of COVID-19 to children, including the serious condition MIS-C.
There is skepticism about the CDC's assertion that children transmit COVID-19 less than adults, especially given evidence that older children can transmit it similarly to adults.
The author is alarmed by the potential political influence on the CDC's guidance, which may have compromised its scientific integrity.
The CDC's statement has significantly damaged its credibility in the eyes of the author and potentially the public.
The author values the importance of in-person schooling but emphasizes that it should not come at the expense of safety, advocating for a cautious approach based on local COVID-19 spread and expert guidance.

CDC’s Statement On Opening Schools Is Not Science…It’s A Blog Post

This “paper” has dealt a serious blow to the CDC’s credibility

I have read many papers by the CDC. They are full of science; they are sophisticated, and they don’t mince words. I have published more than a dozen scientific papers myself. I know what a scientific paper is. This latest guidance from the CDC on opening schools is not a scientific paper. It is a blog post.

I know firsthand the anguish over whether to start school next month. Not only am I a doctor who is taking care of COVID-19 patients firsthand, but I am also a parent of school-aged kids. I know that e-learning has tremendous challenges, and it is not the perfect solution for many, many children. I could see it in my own children. I get it.

In addition, it is important to note that many of the suggestions about how to make in-person schools safer made in the packet released by the CDC are useful. Even some epidemiologists tweeted in favor of the suggestions:

That said, the statement released on the CDC’s website, this “paper” they called it, is a serious and frightening departure from the high standard to which I, as a physician, have become accustomed. This “paper” was laughable if was not a sad embarrassment.

What was most concerning was how the health risks to children were downplayed:

The best available evidence indicates that COVID-19 poses relatively low risks to school-aged children. Children appear to be at lower risk for contracting COVID-19 compared to adults. To put this in perspective, according to the Centers for Disease Control and Prevention (CDC), as of July 17, 2020, the United States reported that children and adolescents under 18 years old account for under 7 percent of COVID-19 cases and less than 0.1 percent of COVID-19-related deaths…Additionally, some children with certain underlying medical conditions, however, are at increased risk of severe illness from COVID-19.*

Do you see that asterisk? It links to an article — at the very bottom of the statement — about the terrifying multisystem inflammatory syndrome (MIS-C) that has afflicted some children in many states across this country. While, yes, it is a very small number, some of these children get very, very sick. As a father, I am terrified of this illness afflicting any one of my children, no matter how rare it is.

So, what is the CDC saying here? Is it saying that, since kids — thank God — do not get as sick if they get infected with the SARS-CoV-2 virus, we should just open schools no matter what, no matter the risk? Is the CDC saying that, since kids are at a “lower risk for contracting COVID-19 compared to adults,” that there should be no concern about kids bringing COVID-19 back home to their families?

While a recent study from South Korea suggests that young children do not transmit COVID-19 as much as adults, the study did find that children between 10–19 (i.e., 5th grade through high school) do transmit the virus as much as adults. And this places not only the kids, but their teachers, the staff in the school, and everyone’s families potentially at risk.

Again, I am not saying that no schools should be opened again in the fall. Again, as a parent, I understand how important school is to my kids. More important, however, is that my kids are safe from this horrible disease. Even if their risk of getting sick is lower, I still don’t want them to get it at all. Young people can get sick and die from COVID-19. I have seen it personally before my very eyes. It is horrible.

When I read this “paper” from the CDC, I was extremely disappointed. It seriously damaged the credibility of the organization in my eyes, and it made me wonder whether I can trust any guidance that comes from the CDC ever again.

Yet, perhaps I may be judging the CDC too harshly because according to the NY Times:

The new statement came from a working group convened by officials at the Department of Health and Human Services after Mr. Trump made his critical comments. A federal official familiar with the group said it included minimal representation from the C.D.C., which had already written most of the other material released on Thursday.

The official, who spoke on the condition of anonymity, said the Substance Abuse and Mental Health Services Administration, an agency within the Health and Human Services Department, took the lead in writing the statement, which focuses heavily on the positive impacts on children’s mental health from going to school.

Experts on the subject at the C.D.C. were cut off from direct communication with the working group after their input on the statement was interpreted as being too cautious, the official said. Instead, the group communicated directly with the office of Dr. Robert R. Redfield, the C.D.C. director, which did seek input from experts at the agency. But the C.D.C. was by no means in charge, the official said.

If this is truly the case, this still batters the CDC further in my eyes.

Many point to the statement of the American Academy of Pediatrics about having kids in school this fall. Even that statement did not downplay the risks of COVID-19 to kids, like this “paper” from the CDC, and it did not say all schools should open no matter what:

Returning to school is important for the healthy development and well-being of children, but we must pursue re-opening in a way that is safe for all students, teachers and staff.

[…]

Local school leaders, public health experts, educators and parents must be at the center of decisions about how and when to reopen schools, taking into account the spread of COVID-19 in their communities and the capacities of school districts to adapt safety protocols to make in-person learning safe and feasible. For instance, schools in areas with high levels of COVID-19 community spread should not be compelled to reopen against the judgment of local experts. A one-size-fits-all approach is not appropriate for return to school decisions.

I wanted to title this post “RIP CDC” after first reading the statement. I have since toned down my anger after learning more about what happened in the background. Still, the day this statement was released was a very sad day for the CDC. It has further deteriorated the credibility of this once-hallowed public health institution, and it makes me very nervous as the pandemic continues to rage unabated in our country.