As Schools Reopen, Experts Say Quarantines Are Still Necessary To Stop The Spread Of COVID-19
(CNN) -- Millions of children are back in the classroom for the new school year, but most aren't vaccinated yet. With children now accounting for more than a quarter of weekly COVID-19 cases nationwide, many communities are turning to a familiar public health tool: quarantines.
Health experts agree that quarantines work, but also stress the importance of in-person learning for children's development. Now many communities are struggling to toe the line between keeping schools open and keeping those who are potentially infectious at home.
Additional layers of protection, like vaccination, testing and masking, can limit the need for quarantines, but those who are against one often push back on all.
Union County Public Schools in North Carolina announced Monday that it will no longer enforce contact tracing and quarantining policies for students and staff who are asymptomatic or test negative after exposure to COVID-19. Masks are optional in the school district.
Angie McCray, a parent in the district, told CNN's Brianna Keilar on Tuesday the decision is "upsetting and disappointing," and she's debating whether to send her first grader back to class in-person. McCray is a pharmacist who stepped back from work to teach her child at home last year; she's not eager to do it again, but says she has to think about safety first.
"I'm currently pregnant and I'm concerned for my family's safety," McCray said. "We were so excited to go back to public school and be able to let her have somewhat of a normal education, and the school board has just made decisions that are not logical and are affecting my family, and so many families in the county."
The spread of COVID-19 has created disruptions and challenges for schools already this year.
At least 44,556 students and staff have quarantined in Florida's major school districts since the start of the new school year.
One middle school in Fulton County, Georgia, transitioned from in-person to remote learning last week, just one month since classes began, after an increase in COVID-19 cases.
Some schools around the nation are offering remote instruction to students in quarantine or isolation, but some parents and politicians, like Florida Gov. Ron DeSantis, are resisting.
"I think quarantining healthy kids deprives these kids of an ability to get an education," DeSantis said in August. "Now maybe a parent would want a healthy kid to be quarantined, if there's an exposure, but I think that should be the choice of the parent."
The experts disagree. Allowing people to choose whether to quarantine defeats the purpose of having one.
Doctor: Actions that 'imperil' others shouldn't be a parent's choice
"If you are trying to stop a disease that is rampaging through a community, killing people who don't have to die, you really have to use quarantine," Dr. Christoph Diasio, a North Carolina pediatrician, told CNN.
"Deciding what color shoes your child wears to school, that's maybe a reasonable parental choice," he added. "But when your action can imperil other people, it doesn't feel to me like that should be in the realm of a parent's choice."
Choosing not to quarantine a child who has been exposed to the virus can indeed imperil other people, experts say.
"It's not just about our child's health. It's about the health of the other kids in the school," US Surgeon General Dr. Vivek Murthy told CNN's Brianna Keilar last month, in response to DeSantis' comments.
Murthy said he worries about states that are trying to block evidence-based prevention measures.
"The science tells us that tried-and-true methods, like contact tracing; like isolation and quarantine, when required; like improved ventilation; regular testing -- these are all the layers of precaution that we can take to reduce the risk to our children," Murthy said.
Known exposure requires quarantine in schools
"Kids who are sick shouldn't be in school, and kids who've had a known exposure do need to quarantine until we know for sure that they're not infected -- and more importantly that they're not infectious," Shira Shafir, associate professor of epidemiology at the UCLA Fielding School of Public Health, told CNN.
The American Academy of Pediatrics says that remote learning earlier in the pandemic highlighted inequalities, exacerbated mental health issues and was detrimental to the education of all students. The group has advocated for a safe return to in-person learning this school year, guided by safety measures -- including quarantining.
Research has shown that quarantine measures can help reduce the spread of the virus in school and community settings. A research review, which included 32 studies focused on COVID-19, found that with quarantine, the number of people infected with coronaviruses could be reduced by between 44% and 96%.
"Quarantine is a key function of public health, especially in this disease, where people are actually infectious before they know they're sick," Dr. Ali Khan, dean of the University of Nebraska College of Public Health, told CNN.
The US Centers for Disease Control and Prevention's school guidance recommends unvaccinated people and vaccinated people with symptoms quarantine for 14 days if they've been in close contact with an infected person. This means close contacts who are vaccinated and showing no symptoms can continue to attend school -- as long as they are masked for 14 days or until they receive a negative test result -- but currently, no students under the age of 12 are vaccinated.
The agency says close contacts who are not vaccinated should get tested. Depending on guidelines from local health authorities, the CDC says the quarantine period may be shortened to 10 days without testing or seven days with a negative test.
The CDC defines close contact as being within six feet of someone for a cumulative total of 15 minutes a day -- though the agency notes an exception for students in K-12 classrooms, if the students involved are wearing masks.
Transmitting without symptoms
Even a seemingly healthy child who is exposed to the virus can place others at risk and increase the chance of a school shutting down, experts say.
"One of the things, unfortunately, we know about COVID-19 is that people can transmit the virus for a couple days before they begin to manifest any symptoms," said Shafir. "It becomes really important to comply with quarantine, because by the time a child has symptoms of infection, it is entirely possible that they have been infecting and exposing others already."
Shafir said quarantine measures can be used in combination with testing and isolation for those who are infected.
The CDC has cited research from North Carolina and Chicago showing safety measures, including quarantining and masking, helped schools maintain lower COVID-19 transmission rates than those of the surrounding communities.
Increased risk as Delta spreads
The Delta variant is more than twice as contagious as previous COVID-19 variants, and some data suggests that it can cause more severe illness too, the CDC warns.
"It's one of the reasons that we are seeing kids transmitting more often than they did with the ancestral strain," Shafir said.
Kids are not just transmitting this variant more readily; they are getting sick themselves, a fact reflected in rising numbers of pediatric COVID-19 cases and hospitalizations in the US. The American Academy of Pediatrics reported more than 500,000 COVID-19 cases among children in the past two weeks.
Still, experts say that in-person learning is important for kids' development -- as long as it can be done safely.
"We've got to maintain the safety of the children as, at the same time, we provide them with an education in a way that does not hinder them in the way virtual learning does," Dr. Anthony Fauci recently told CNN's Jake Tapper.
Layers of protection may prevent need for quarantines
While quarantining can be a useful tool to respond to the spread of COVID-19 in schools, health experts say that when other preventive strategies are in place, it's less likely that students will need to quarantine at all.
Those strategies include masking, physical distancing, testing, improved ventilation and vaccination for those who are eligible. The COVID-19 vaccine is currently available for everyone ages 12 and up in the US.
Los Angeles Unified Public Schools, the nation's second largest school district, is requiring all eligible students to be vaccinated by the end of the calendar year. Students who decline the vaccine will be able to participate in an online study learning program.
Indiana Gov. Eric Holcomb recently issued an executive order relaxing the quarantine requirement for students and staff who are close contacts of coronavirus-positive people -- but only in schools that enforce mask mandates.
President Joe Biden called on governors last week to require vaccination for all teachers and staff in schools, and announced funding to increase testing in schools.
Regular testing can help ensure students don't miss class time unnecessarily, former US Food and Drug Administration Commissioner Dr. Scott Gottlieb said last week. He described how a "test-to-stay" strategy, which schools in states like Illinois and Kentucky are trying this year, can help prevent entire classrooms of people from having to quarantine.
"There's a whole movement around designing protocols that actually allow kids to stay in school, even after a positive case is turned over," Gottlieb said. "Rather than quarantining large cohorts of children, what you do is you just implement serial testing around the exposure."
Fauci, director of the National Institute of Allergy and Infectious Diseases, says the goal is to create a safe environment for children in schools, with both masks and vaccination.
"One of the most important ways is to surround the children with people who are vaccinated, if they're eligible to be vaccinated -- and that means teachers and personnel in the school," he said.
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