639 Operating Schools During COVID-19: CDC Guidelines

Transmission Risk in Schools

Analysis of pediatric COVID-19 hospitalization data from 14 states from early March to late July 2020 found the cumulative rate of COVID-19–associated hospitalization among children was more than 20 times lower than adults (8.0 versus 164.5 per 100,000 population).

Although the cumulative rate is low, one in three children hospitalized with COVID-19 was admitted to an intensive care unit, so the risk is not negligible. Similarly, the death rate among school-aged children is much lower than the rate among adults.

The risk of teachers, school administrators, and other staff in the school is expected to mirror that of other adults in the community if they contract COVID-19.

The best evidence from countries that have reopened schools indicates COVID-19 poses low risks to school-aged children – at least in areas with low community transmission.

Continuum of Risk

In general, the risk of SARS-CoV-2 spread in schools increases across the continuum of virtual, hybrid, to in-person learning.

While not exhaustive, this stratification from Operating schools during COVID-19: CDC's Considerations attempts to characterize the risks of spread among students, teachers, and staff across this continuum:

Lowest Risk

• students and teachers engage in virtual-only classes, activities, and events

Some Risk

• Hybrid Learning Model: Some students participate in virtual learning, and other students participate in in-person learning
• small, in-person classes, activities, and events
• cohorting
• leveraging all available safe community spaces, including outdoor spaces
• alternating schedules and staggered schedules are applied rigorously
• no mixing of groups of students (i.e., cohorts) and teachers throughout/across school days
• students and teachers do not share objects
• students, teachers, and staff always follow all steps to protect themselves and others, including proper use of face masks, social distancing, hand hygiene, and respiratory etiquette
• regularly scheduled cleaning and disinfection of frequently touched surfaces implemented consistently

Medium Risk

• Hybrid Learning Model: Most students participate in in-person learning, some students participate in virtual learning
• larger in-person indoor classes, activities, and events
• cohorting, alternating schedules, and staggered schedules are applied with some exceptions
• some mixing of groups of students (i.e., cohorts) and teachers throughout/across school days
• students and teachers minimally share objects
• students, teachers, and staff follow all steps to protect themselves and others, such as proper use of face masks, social distancing, hand hygiene, and respiratory etiquette
• regularly scheduled cleaning and disinfection of frequently touched surfaces largely implemented consistently

Higher Risk

• students minimally mix between classes and activities
• students and teachers share some objects
• students, teachers, and staff follow some steps to protect themselves and others at all times, such as proper use of face masks, social distancing, hand hygiene, and respiratory etiquette
• irregular cleaning and disinfection of frequently touched surfaces

Risk in Youth Sports

The more people a child or coach interacts with, the closer the physical interaction, the longer that interaction, and the more sharing of equipment there is by multiple players, the higher the risk of SARS-CoV-2 spread. The risk of spread of the virus that causes COVID-19 increases in youth sports settings as follows:

• Lowest risk: Performing skill-building drills or conditioning at home, alone, or with family members.
• Increasing risk: Team-based practice.
• More risk: Within-team competition.
• Even more risk: Full competition between teams from the same local geographic area.
• Highest risk: Full competition between teams from different geographic areas.

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