COVID-19: School Guidelines / Severely Immunocompromised

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Here are some of the recent COVID-19 guidance from the CDC:

School guidelines: The CDC released guidance on safely reopening and operating K–12 schools during the pandemic. For areas with substantial or high transmission, it recommends that elementary schools operate in a hybrid mode and requires physical distancing of at least 6 feet. When there is substantial community transmission, middle and high schools should operate in hybrid mode or reduced attendance, and sports and extracurricular activities can be held outdoors. When there is high transmission, these age groups should operate in virtual-only instruction unless they can "strictly implement all mitigation strategies, and have few cases." Extracurricular activities should also be virtual only. For all levels of community transmission, the agency recommends universal and correct use of masks, as well as other strategies, like handwashing, contact-tracing, and quarantine.

Severely immunocompromised patient guidance: Severely immunocompromised adults with COVID-19 require additional testing and consultation with infectious disease specialists before ending their isolation period, the CDC says in updated guidance. Studies have found that they can produce replication-competent virus beyond 20 days after symptom onset. For these purposes, severely immunocompromised patients include those who have cancer and are being treated with chemotherapy, untreated HIV infection with CD4 T lymphocyte count of less than 200, combined primary immunodeficiency disorder, and receipt of prednisone of more than 20 mg per day for more than 14 days. A test-based strategy could be considered for determining when severely immunocompromised patients can end their isolation period.