Iowa Public Health abandons COVID-19 safety in schools

Governor Kim Reynolds told Iowans this week to “lean further into normal,” since “There’s no reason for us to continue to fear COVID-19 any longer.”

Iowa Department of Public Health Director Kelly Garcia obliged with new guidance urging schools and child care providers to “approach COVID-19 like other child illnesses.”

To justify abandoning precautions like mandatory face coverings and quarantines for children exposed to coronavirus, Garcia misrepresented the latest advice from the U.S. Centers for Disease Control.

In a May 14 letter (enclosed in full below), Garcia urged schools and child care centers to make masks optional. While she acknowledged “Cloth face coverings have been one of the tools in mitigating the spread of COVID-19,” the state’s top public health official implied it was time to move on from them, thanks to “additional tools to treat and mitigate the spread […] such as therapeutics and vaccines.”

Most children are not yet eligible for vaccines, and therapeutics are typically reserved for symptomatic adults at risk of severe illness. But Garcia wasn’t about to let reality interfere with her narrative.

Our response today does not, and should not, look the same as it did a year ago. In fact, yesterday the CDC announced updated guidance rolling back mask usage for adults. Our guidance is also evolving as we learn more information. This evolution allows people to hone in on what is risky and what is not—which ultimately keeps our collective public health response strong.

False.

The new CDC guidance applies to fully vaccinated people, who can for the most part “resume activities without wearing a mask or physically distancing.” The federal agency emphasized that a “fully vaccinated” person is two weeks beyond receiving the second dose of a two-dose COVID-19 vaccine, or two weeks beyond receiving a single-dose vaccine. “If you don’t meet these requirements, regardless of your age, you are NOT fully vaccinated. Keep taking all precautions until you are fully vaccinated.”

Whereas Garcia implies it’s not risky for kids to spend the day in crowded classrooms with no masks, the CDC disagrees. The agency’s guidance on “Essential Elements of Safe K–12 School Operations for In-Person Learning” did not change this week. It still recommends (emphasis in original),

Regardless of the level of community transmission, it is critical that schools use and layer prevention strategies. Five key prevention strategies are essential to safe delivery of in-person instruction and help to prevent COVID-19 transmission in schools.

Face coverings are first on that list. According to the CDC, “Universal and correct use of masks should be required” in schools providing in-person instruction. Iowa never mandated masks in schools, even as cases, hospitalizations, and deaths surged last fall.

The Iowa Department of Public Health also wants schools to ignore the fifth item on the CDC’s list: “Contact tracing in combination with isolation and quarantine.” Iowa has been out of step on that front since last September, when the state declared that children exposed to COVID-19 could remain in school if they were wearing a mask at the time of the exposure.

Under Garcia’s new guidance, kids won’t need to stay home even if they and the positive case were unmasked during the close contact.

Des Moines-based pediatrician Dr. Nathan Boonstra tweeted that the new guidelines would be a “A gut punch to getting teen immunization rates up, and an invitation for outbreaks.”

We’ll probably never know the extent of those outbreaks in the coming weeks and during the next academic year, because state officials recently turned down $95 million in federal funds for COVID-19 testing in schools.

Some school districts, like Waukee, rushed to ditch their mask requirements. (Update: On May 15 Waukee’s superintendent Brad Buck informed families the district was reversing that decision and will require masks for the remainder of the current school year.) Fortunately, not every school leader was swayed by Garcia’s ill-informed advice. The Des Moines Public Schools (the largest Iowa district by far) will retain its mask requirements for now, communications director Phil Roeder said in a statement.

For DMPS, the fact that very few students have received even the first dose of the vaccine, combined with being less than three weeks away from the end of the school year, means the prudent thing to do is maintain the safeguard provided by face masks for a short while longer. That is consistent with the advice Polk County Health gave in their note below as well as the CDC’s guidance that unvaccinated people should continue to wear masks. Our school nurses and administrators will be looking at some of our mitigation efforts for our summer programs and hope to begin a “normal” school year in August, but now is not the time to back away from a proven measure while so many of the people in our buildings remain unvaccinated.

I’ve enclosed below the email from the Polk County Health Department’s disease prevention supervisor Kari Lebeda Townsend. She accurately paraphrased the CDC’s advice.

The CDC’s guidance update for fully vaccinated persons doesn’t really impact schools. If you are NOT vaccinated or if you are NOT fully vaccinated, the CDC continues to recommend the use of masks both indoors and outdoors. Children under the age of 12 are not eligible for COVID-19 vaccine at this time. And, just this week, CDC’s ACIP endorsed the safety, effectiveness and use of the Pfizer-BioNTech COVID-19 vaccine for 12-15 years old youth. We have much to do to encourage vaccinations with the goal of reaching herd immunity for children, youth and adults. The use of masks and physical distancing is safest and provides the best risk reduction for unvaccinated people.

Additionally, quarantine will be required by public health if an unvaccinated person and/or the COVID-19-positive person are NOT properly wearing masks at the time of the exposure. The continued use of masks will allow an unvaccinated, asymptomatic person to self-monitor and remain in school and activities in lieu of quarantine.

Communications staff for the Iowa Department of Public Health did not respond to Bleeding Heartland’s inquiry asking whether the governor or her staff were involved in developing the state’s latest guidance for schools and child cares.

Regardless, Reynolds will surely be thrilled with Garcia’s march toward normalcy. It’s a safe bet the public health director will continue to receive large annual bonuses for the foreseeable future.

UPDATE: On May 15, the CDC posted an “important update for schools,” recommending that they “continue to use the current COVID-19 prevention strategies for the 2020-2021 school year.”

However, several Iowa school boards voted over the weekend to drop their mask mandates.


Appendix 1: Iowa Department of Public Health news release, May 14

Today Director Garcia sent the following letter to school superintendents, child care providers and local public health departments regarding updated COVID-19 guidance:

Dear Education and Child Care Professionals,

I write to you today to underscore the continued importance of supporting children as we navigate this recovery phase of our COVID-19 response. From the beginning, this response effort has been grounded in mitigating risk and protecting our vulnerable populations, realizing that completely eliminating risk was never an option. We appreciate the difficult position school administrators and child care providers, who are not necessarily health professionals, have had to navigate. Your efforts over the last year have required patience, grace, and flexibility. For that, we are tremendously grateful.

For the 2020-2021 school year—knowing that spread of disease in schools is minimal and can be mitigated with strong infection control measures—Iowa shifted to support safe, in-person learning. And for child care settings, Iowa’s child care providers remained open, supported by DHS. To successfully implement that strategy, Iowa issued guidance that allowed children exposed to COVID-19 while wearing a cloth face covering to avoid quarantine. This allowed kids to remain in school, with all of the benefits that in-person learning provides. Cloth face coverings have been one of the tools in mitigating the spread of COVID-19 and, along the way, additional tools to treat and mitigate the spread of COVID-19 have also come along, such as therapeutics and vaccines.

Our response today does not, and should not, look the same as it did a year ago. In fact, yesterday the CDC announced updated guidance rolling back mask usage for adults. Our guidance is also evolving as we learn more information. This evolution allows people to hone in on what is risky and what is not—which ultimately keeps our collective public health response strong.

With that in mind, and with acknowledgement that the goal of every educational institution and child care provider is to safeguard children from harm and foster inclusion, today, the Iowa Department of Public Health has adjusted its guidance to recommend that schools and childcare settings approach COVID-19 like other child illnesses. For ease of reference, please see this link for a detailed list of common child illnesses and exclusion criteria, which now includes COVID-19. This guidance comes in consultation with the Department of Education, and underscores that the overall health and well-being of children must be our primary focus. 

We are concurrently revising our COVID-19 guidance for school and child care settings, including quarantine guidance, to recommend that while COVID-19 positive and symptomatic children should be excluded, exposed children should no longer be required to stay home, regardless of mask usage. Moreover, when there is a positive case, parents should be given information around exposure to COVID-19 in order to make their own informed decisions regarding risk. To that end, while we acknowledge that some parents may want their child to continue to wear a cloth face covering for reasons that make sense for their family or that child’s individual health condition, we urge schools and child care settings to provide parents and students with the option to make their own decision about mask usage.

As this school year winds down and summer school and camps begin, we must work together to continue to support a flexible approach. We stand ready to provide the support necessary to ensure our children’s success.

Sincerely,

Kelly Garcia

Appendix 2: May 14 email to school nurses from Kari Lebeda Townsend, disease prevention supervisor for the Polk County Health Department. The subject line read, “Updated CDC Guidance for Fully Vaccinated Persons”

Yesterday, the CDC eased the mask-wearing guidance for fully vaccinated persons.  The release of this update was sudden and without prior notice to state and local public health.  IDPH is evaluating the new guidance for Iowa. We expect to see updated guidance from IDPH in a few days.  We will keep you informed as we have more information.

The CDC’s guidance update for fully vaccinated persons doesn’t really impact schools.  If you are NOT vaccinated or if you are NOT fully vaccinated, the CDC continues to recommend the use of masks both indoors and outdoors.  Children under the age of 12 are not eligible for COVID-19 vaccine at this time.  And, just this week, CDC’s ACIP endorsed the safety, effectiveness and use of the Pfizer-BioNTech COVID-19 vaccine for 12-15 years old youth.  We have much to do to encourage vaccinations with the goal of reaching herd immunity for children, youth and adults.  The use of masks and physical distancing is safest and provides the best risk reduction for unvaccinated people.

Additionally, quarantine will be required by public health if an unvaccinated person and/or the COVID-19-positive person are NOT properly wearing masks at the time of the exposure.  The continued use of masks will allow an unvaccinated, asymptomatic person to self-monitor and remain in school and activities in lieu of quarantine.

Science shows vaccines are VERY effective, however, we have not reached herd immunity.  The COVID-19 vaccines are remarkably effective at preventing severe illness and death.  However, no vaccine provides 100% protection against infection—and again, we have not reached herd immunity.  We also have more to learn about the role of COVID-19 vaccines in curbing the spread of COVID-19 and the impact of variants.  Even if you are fully vaccinated, it is safer to avoid crowds and/or to wear a mask in public and crowded spaces and, most importantly, when around people over 65-years of age and those with health conditions and weakened immune systems.  

We expect mask use to continue to be required for all people in certain venues particularly public transportation and certain public and/or congregate sites.  IDPH will provide an update for Iowa regarding these venues and public spaces.  

We encourage schools to refrain from changing mask policies through the end of this school year.  The School Nurse Work Group will be planning over the summer and addressing guidance updates for summer activities and the upcoming school year.

Thank you,

Kari Lebeda Townsend

Top image: Kelly Garcia, interim director of the Iowa Department of Public Health, speaks at a televised news conference on April 15, 2020, as Governor Kim Reynolds looks on. Photo by Brian Powers/Des Moines Register (pool).

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