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The CDC issued for reopening K-12 schools on Friday that tie decisions around "phased" reopenings to rates of COVID-19 transmission in the community and that prioritize universal masking and physical distancing over other mitigation measures.

"I want to be clear, with the release of this operational strategy, CDC is not mandating that schools reopen. These recommendations simply provide schools a long needed roadmap for how to do so safely under different levels of disease in the community," said CDC Director Rochelle Walensky, MD, MPH, during a press call Friday afternoon.

She noted that the research has shown that schools that strictly adhere to mitigation protocols are able to open and remain open for in-person instruction.

A core principle of the CDC's strategy is "layered mitigation" and she recommended 5 key mitigation strategies:

• Universal and correct use of masks
• Physical distancing
• Hand-washing and respiratory etiquette
• Cleaning and maintaining healthy facilities
• Diagnostic and rapid and efficient contact tracing in combination with isolation and quarantine

When implemented as a whole, these mitigation measures provide "the greatest level of protection," however Walensky emphasized that two specific measures should be prioritized: "universal masking," which should be required of all teachers, students, and staff, and physical distancing of "at least 6 feet between people" which she said should be accompanied by cohorting and podding of students to reduce COVID-19 exposure across the school community.

"These two strategies are incredibly important in areas that have high ... community spread of COVID-19, which right now is the vast majority of communities in the United States," Walensky said.

The guidelines don't address how schools should pay for the recommended measures, but officials on the call said enactment of the Biden administration's "American Rescue Plan," which allocates funding to schools, is essential.

A Pathway to Reopening

The recommendations use a color-coded grid based on the level of COVID-19 in the community that are intended to steer schools into one of four modes of learning: fully in-person, hybrid, reduced attendance, and remote-only.

A underscores that "[a]t any level of community transmission, there are options for in-person instruction."

Blue and Yellow: According to the CDC's color coded grid meant to guide the implementation of mitigation strategies, K-12 schools are placed in the "Blue" zone for low community transmission and "Yellow" for moderate, and in both categories, full reopening of in-person learning is recommended with physical distancing of 6 feet or more "to the greatest extent possible." When 6 feet of distancing is not feasible, then schools should focus on distancing between classes, pods, and cohorts, the fact sheet noted.

Low transmission is defined as a community in which the total new cases per 100,000 persons in the past 7 days is 0-9 per 100,000 persons; moderate transmission is defined as 10-49 new cases per 100,000.

The agency also uses percentage of positive tests in the past 7 days to track transmission, and defines low transmission as 5% positive tests in the past 7 days and 5-7.9% deemed moderate.

Orange: Schools with "substantial transmission" are placed in the "Orange" zone, in which the CDC recommends a hybrid teaching model for elementary students with a requirement of 6 feet or more of physical distancing and a hybrid or reduced attendance model for middle and high school students, also with 6 feet of physical distancing.

Substantial transmission in the community is defined as 50-99 total new cases per 100,000 in the past 7 days. For the percentage of positive tests in the past 7 days, that is defined as 8-9.9% considered substantial.

Red: For schools in the "Red" zone of "high transmission," the agency recommends that middle and high schools conduct remote-only classes unless those schools can "strictly implement all mitigation strategies and have few cases."

However, the agency makes an exception for elementary schools which it recommends remain in hybrid mode in the Red zone and that schools require 6 feet of physical distancing.

A high transmission rate is defined as one in which there are 100 or more total new cases per 100,000 and the percentage of positive tests is 10% or higher in the previous 7 days.

Mitigation measures around sports and extra-curricular activities grow more stringent as community transmission increases on the grid.

In the Orange zones, sports and extra-curricular activities are only encouraged if they are happening outdoors with masking and with a requirement of 6 feet of distance. In the Red zone, sports and extra-curricular activities are only recommended if done remotely.

Currently, Walensky noted, "less than five percent of our nation's counties" meet the threshold for the Yellow zone of low community spread, the zone which encourages full in-person instruction.

Regarding the vaccination of teachers and staff, Walensky noted that the guidance characterizes these immunizations as "an additional layer of protection" that can be integrated with the other 5 key mitigation protocols.

She also reaffirmed the recommendation of which deems teachers "essential workers" and recommends that they be eligible for the vaccine in phase 1B of states' vaccination program.

"We strongly encourage states to prioritize teachers and other school staff to get vaccinated. If we want our children to receive in-person instruction, we must ensure that teachers and school staff are healthy and protected from getting COVID-19 in places outside of schools where they might be at higher risk," she said.

Asked whether 6 feet of physical distancing would be required in areas of low to moderate transmission, Walensky said the CDC would not make it a sticking point.

In areas of low to moderate transmission, she said, "we're worried that people will not be able to get back to full in-person learning if we mandate 6 feet ... of physical distance... and we believe that at such levels of low transmission, that schools could be kept safe simply with universal masking and all of the other ... three mitigation strategies, while doing their best to limit interactions."

With regard to school screening and testing, Walensky said that "If school screening with antigen testing, rapid screening, or pooled PCR testing is possible, then in areas of high transmission we would advocate for weekly testing both of teachers and of students."

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