The U.S. Centers for Disease Control and Prevention unveiled a long-awaited set of guidelines intended to instruct communities about how to safely reopen businesses, schools and other entities amid the coronavirus pandemic.
The 60-page document was released after the White House had blocked the CDC from publishing an earlier draft obtained by the Associated Press.
The two documents are significantly different, with instructions specific to religious institutions stripped from the guidelines that were made public.
White House Coronavirus Response Coordinator Deborah Birx had repeatedly clashed with CDC Director Robert Redfield and agency officials over the guidelines, according to a number of news reports.
Birx told CNN May 7 the White House was not delaying the guidelines but was in the process of editing them.
After being criticized for not providing the guidelines, the administration on May 14 posted six one-page "decision tree" charts of basic tips on the CDC's website — documents consisting of checklists.
Since January, about 1.54 million Americans have been infected with COVID-19 — the disease caused by the novel coronavirus — and nearly 93,000 have died, according to Johns Hopkins University Center for Systems Science and Engineering.
The CDC in mid-March urged businesses, schools, restaurants, child care centers and other entities to shut down all onsite operations — unless deemed essential by the government — and have employees work from home.
While President Donald Trump has been pressing states to reopen, a new poll from the Associated Press and NORC Center for Public Affairs Research found that 83% of Americans said they were at least somewhat concerned that lifting social distancing restrictions would lead to additional COVID-19 infections, with 54% of those responders saying they were very or extremely concerned.
The CDC's new guidelines also come after the agency issued two recent Morbidity and Mortality Weekly Reports showing how easily one or two people with COVID-19 were able to infect large numbers of individuals at events like church gatherings or choir practices.
In a May 19 MMWR report, the CDC said two symptomatic people with COVID-19 at a church gathering in Arkansas infected at least 35 other people, with three of those individuals dying of the disease. Those people went on to spread COVID-19 to 26 others in their community, with at least one other person dying.
Overall, the two people sick with COVID-19 who attended the church event led to at least 61 infections and four deaths, the CDC reported.
'Menu of safety measures'
The CDC said its new guidelines set forth a "menu of safety measures, from which establishments may choose those that make sense for them in the context of their operations and local community."
The agency's plan for reopening the U.S. takes a three-phase approach for reducing social distancing measures and are intended to be implemented statewide or community-by-community at governors' discretion. It suggests six gating indicators for assessing when to move through from one mitigation phase to another.
The CDC outlined a number of measures for employers to consider and urged that for the first step in reopening to "scale up only if business can ensure strict social distancing, proper cleaning and disinfecting requirements and protection of their workers and customers."
Workers at higher risk for severe illness are recommended to shelter in place, the CDC said.
Workplaces should enforce handwashing, covering coughs and sneezes and using cloth face coverings when around others where feasible, though it said certain industries may require face shields.
Companies should ensure that adequate supplies to support healthy hygiene behaviors, including soap, hand sanitizer with at least 60% alcohol, tissues, paper towels and no-touch trash cans, are available.
The CDC urged employers to consider conducting routine, daily health checks, such as temperature and symptom screening, of all employees. Those health checks, however, should be done "safely and respectfully, and in accordance with any applicable privacy laws and regulations."
"Confidentiality should be respected," the agency said.
Employees with symptoms, such as fever, cough or shortness of breath, should immediately be separated and sent home, the agency said.
Daycare centers should initially restrict spaces to children of essential workers and then expand to all children with enhanced social distancing measures, the CDC said.
Like child care centers, schools should be sanitized and disinfected, the agency said. School desks and seating should be spaced out to permit social distancing and meals should be served in classrooms rather than large cafeterias.
Other plans to reopen the nation also emerged this week, with at least two of those coming from former U.S. government officials.
Former CDC Director Tom Frieden, now president and CEO of Resolve to Save Lives, a nonprofit global public health initiative, unveiled a color-coded alert-level systems framework, which includes accountability measures — something the CDC's plan lacks.
A plan outlined from former Centers for Medicaid and Medicaid Services Administrators Andy Slavitt, who served in the Obama administration, and Mark McClellan, who led the agency under former President George W. Bush, laid out a number of recommendations. Their guidelines, however, followed many of the CDC's and the Trump administration's earlier suggestions and did not include the metrics and accountability measures found in Frieden's proposal.