Pennsylvania has largely left school reopening decisions up to individual districts, recommending that they follow CDC guidance but declining to impose a statewide school mask mandate.

But a back-and-forth this week between health officials in Harrisburg and Bucks County highlights what has become one of the most intense debates in the Philadelphia region over how to reopen schools safely after a year of disrupted learning.

On Monday evening, Pennsylvania’s acting health secretary rebuked Bucks County over its reopening advice, calling it “alarming” and warning the county commissioners in a letter that it could diminish the county’s ability to respond to coronavirus outbreaks and derail in-school instruction for students.

By early Tuesday, schools across the county had gotten revised direction from Bucks officials. Their new statement insisted that much of the county’s previous guidance had been “in sync” with the Centers for Disease Control and Prevention but that the revision “will serve to strengthen that connection.”

That came less than a week after the county had already made one change — reversing its opinion that schools institute optional mask policies — after fielding concerns from hospitals about their capacity to treat pediatric COVID-19 cases. Now the county is recommending masks in schools countywide.

With districts across the region on the cusp of a new school year, a slate of Bucks school boards are meeting this week to consider revised health and safety policies. Officials are bracing to face a divided public; parents opposed to masking have voiced outrage, while others say schools aren’t planning to do nearly enough to protect against the spreading virus.

“Nobody wants to have this morph into something where it’s going to be having a more severe impact on all the kids in the county,” said Larissa Hopwood, a parent who favors more mitigation measures in the Central Bucks School District, where 30 parents will be allowed to speak at its board meeting Wednesday night — half who support universal masking and half who oppose it.

The Council Rock School District is expected to tackle the issue Thursday night, after surveying elementary parents on whether they would place their children in cyber school if the board does or doesn’t approve a masking requirement.

The state’s intervention is likely to add fuel to the debate. In her letter to the county commissioners, acting Health Secretary Alison Beam said aspects of the county’s Aug. 15 guidance “disregard evidence-based public health practices,” are not supported by scientific understanding of the virus, and are inconsistent with CDC and state recommendations for schools.

Department of Health spokesperson Maggi Barton said no other counties have been sent letters like the one to Bucks, but said that state officials want to ensure local leaders across Pennsylvania understand public health guidance as the school year approaches.

It also underscores how Pennsylvania’s approach heading into the fall has paved the way for a patchwork of rules that can differ from town to town and has left school boards, rather than scientists or government officials, making health decisions that have stirred bitter community division. In the handful of counties with health departments, which are tasked with preventing disease, that’s put an onus on them to provide direction to schools.

The debate in Bucks has been particularly contentious, in part because the COVID-19 prevention measures recommended for schools by the county’s health director, David Damsker, have been less strict than what’s come from federal and state officials. Earlier this summer, Damsker advocated that schools treat the virus as they would a typical seasonal flu.

Damsker also endorsed a three-foot social distancing minimum last year before the CDC had shifted its guidance to that standard. He has recommended that some children exposed to COVID shouldn’t have to quarantine, a policy adopted by some Bucks County schools. And in June, he supported ending school mask requirements before the expiration of the state mandate.

His approach has made him a lightning rod — drawing support from parents who have wanted schools to reopen more quickly and criticism from those who say his philosophy is too lax.

In a July email to an administrator of a Bucks County day care that was widely circulated online and sparked outcry among some parents, Damsker suggested that “one easy way” of handling the requirement to notify the county of cases “is not to have your parents report COVID-19 to you.”

» READ MORE: From COVID-19 data to in-person school, Bucks County’s Health Department goes its own way

His department’s Aug. 15 guidance cited “science, years of public health policy, 18 months of accumulated local experience with the pandemic, and common sense.”

Beam said some of the recommendations lacked adequate scientific support.

“Without … clear messaging — or worse, with the inconsistent and alarming messaging included in the [Bucks County Health Department] guidance document — I fear our school leaders will not be equipped with the tools to keep our children safely in school,” she wrote to the commissioners.

Damsker did not respond to a request for comment Tuesday.

The updated guidance the county released this week says anyone who has coronavirus symptoms should be referred for testing, and anyone who tests positive for COVID-19 must isolate from school for 10 days. It also indicates that schools and the county are expected to contact-trace people who have been infected, which Bucks had previously said it was not planning to do.

The county Health Department “wants our schools to be safe, healthy, open, and able to provide a quality in-person education,” its officials wrote.

Taken together, their new guidance represents a sharp reversal from the county’s earlier directive that students who test positive for COVID could return to school after being fever-free for 24 hours or if they have not developed symptoms within three days.

Beam called that policy “completely inconsistent” with federal and state recommendations and said there was “no definitive evidence” for it “published in the scientific record.” She said the county’s Aug. 15 guidance would “allow for infectious people to be in schools,” putting all children under 12 and anyone else unvaccinated at increased risk.

Beam’s letter also took aim at the county’s policy on reporting coronavirus cases. Schools are required to report coronavirus cases, but Beam contended the county impeded that effort by only “strongly recommending” that parents report cases to schools.

On Monday — before Beam’s letter arrived — county spokesperson James O’Malley told The Inquirer that the July email from Damsker regarding the day care was written “six weeks ago, when cases were extremely low. The situation is much different now.”

The county’s guidance now includes the requirement for schools to notify the county Health Department of cases and says parents should report them to schools.

» READ MORE: Despite CDC guidance, some Philly-area schools aren’t planning to require masks — for now

Disruption and debate

As in other parts of the region, the renewed spread of the virus has plunged Bucks school districts into flux.

Backed by Damsker’s recommendation earlier this summer, some planned to start the year with optional masking. On Aug. 15, the county recommended “time-limited” mask requirements for younger children based on local case rates or in the event of classroom outbreaks.

But two days later, after hearing from hospitals, the county announced that it was recommending all students wear masks in schools.

» READ MORE: School mask requirements are coming under fire as parents ramp up pressure on districts

“[That] the hospitals came in and said we’re not going to be able to accommodate these children if they get sick seems like an absolute failure for a public health official, to have to be told that,” said John Bochanski, a Council Rock parent among those anxiously awaiting a school board vote Thursday before sending his 6-year-old daughter to school Monday.

In Central Bucks, Frances Gonzalez-Griffin said a vote to require masks would be the “bare minimum.” But without other measures, she isn’t sure that will be enough to persuade her to send her 13-year-old daughter to school.

“They don’t want to do any mitigation,” said Gonzalez-Griffin, who is immunocompromised and has two younger children she opted to enroll in virtual learning.

Some districts haven’t changed plans. During a meeting that ran past four hours Monday night, the Pennridge School Board didn’t revisit its plan for optional masking, drawing praise from parents who waited until the end of the meeting to speak.

“Any loss of life is a tragedy, but what we are doing to children is also a tragedy,” said a woman who said she was an ICU nurse, thanking the board. A father told the board his family was “so excited” when the district announced the mask-optional policy: “I hope you keep it.”

Other parents voiced concern — in particular for children under 12, given that they haven’t been vaccinated.

“We’re saying to them, ‘You’re not worth the protection that everyone else is entitled to,’” one man told the board, asking it to reconsider a decision he said was made “without any medical basis.”

Board president William Krause responded that parents had a choice. “Our health and safety plan does not prohibit children from wearing masks,” he said, to applause.