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Kids should be in school right now. (long thread)
How is that for diving back into COVID post election?
Ok, that’s a bold statement, but I thought I would put a flag in the ground at the furthest end of the field and then work back from there.
How is that for diving back into COVID post election?
Ok, that’s a bold statement, but I thought I would put a flag in the ground at the furthest end of the field and then work back from there.
Of course, there are exceptions, considerations, and nuance to that statement; but I do believe that should be the starting point of the conversation. After looking at all the available data, that is the conclusion I believe is supported.
I encourage every parent to look into the science that I am attempting to provide, build upon it, consider your own individual family situation, and make an informed decision for yourself.
…There is so much going on with COVID right now; between a real task force in charge, the newly released vaccine findings, and the emergency use authorization from Lilly for their antibody therapy.
Additionally, that is a statement I will make in the face of surging cases around the country.
When we started this journey 8 months ago, there was so much uncertainty around children, schools, and impact.
When we started this journey 8 months ago, there was so much uncertainty around children, schools, and impact.
We now are beginning to have a handle on the data, but it is up to us to listen to it and react appropriately. In fact, there is so much data on this subject, I feel the need to organize it into four buckets.
1. Illness and infectivity among children.
2.
1. Illness and infectivity among children.
2.
School outbreaks among students.
3. School outbreaks impacting teachers and staff.
4. Schools as drivers of community spread, or vice versa.
Within each category I will attempt to keep things further sub-divided into elementary school age, high schools, and colleges.
3. School outbreaks impacting teachers and staff.
4. Schools as drivers of community spread, or vice versa.
Within each category I will attempt to keep things further sub-divided into elementary school age, high schools, and colleges.
As always, please realize that I am doing this as an exercise in therapy for myself as a parent so I can better address my own concerns. Also, I am a pediatric intensive care physician, not a public health expert. I’m open to education if I interpret something incorrectly.
1. Thankfully, we continue to see that children are less impacted by SARS-CoV-2 infection. Hospitalizations and mortality continue to remain very low. This is holding true even in this current wave.
Additionally, we are learning more about the differences in responses due to age. For example, this group from NY was able to discover distinct antibody responses between adults and children and between children who develop MIS-C and those that don’t.
( https://www.nature.com/articles/s41590-020-00826-9) This is fantastic information towards our understanding how and why there are such differences in age-driven responses. We also are beginning to understand the risk factors that are unique to age.
For example, children with cancer may also be slightly spared when compared to adult matches. ( https://ashpublications.org/.../Outcomes-of-patients-with...) I’m certain we will see more of this type of data for other disease states such as transplants, lung/heart diseases, etc.
2.
2.
Schools are not super-spreader events. No evidence suggests that they are the cause of the current surge/wave. There are so many references for my statements. Here are a few to read.
( https://www.theatlantic.com/.../schools-arent.../616669/)
( https://www.nytimes.com/.../opinion/schools-coronavirus.html)
( https://www.nytimes.com/.../coronavirus-schools-children...)
( https://www.npr.org/.../were-the-risks-of-reopening...)
To summarize all of these references:
Multiple municipalities are reporting ongoing infection rates in schools (just like here in Houston https://www.houstonisd.org/covid19dashboard).
( https://www.nytimes.com/.../opinion/schools-coronavirus.html)
( https://www.nytimes.com/.../coronavirus-schools-children...)
( https://www.npr.org/.../were-the-risks-of-reopening...)
To summarize all of these references:
Multiple municipalities are reporting ongoing infection rates in schools (just like here in Houston https://www.houstonisd.org/covid19dashboard).
Repeatedly and consistently, the infection rates have hovered around 0.07 % in students and 0.14 % in staff. That has been remarkably consistent across the world. What does that mean?
In a school of 1350 students you would expect 1 case every 2 weeks in the students and if you have 100 teachers and staff, you would expect 1 case every 14 weeks. Look at those numbers. First, that is cases, not deaths.
Any illness is terrible and any death is horrific; but let us try to regain a sense of equilibrium. These numbers are not zero, which for many will be looked as a failure; but zero was NEVER a realistic expectation. It is about managing risk with appropriate measures.
If you argue that any risk is too great and that schools should be completely and totally safe; what is your stand on gun control and school shootings?
The younger the student, the more these numbers are reassuring.
The younger the student, the more these numbers are reassuring.
If you divide the age groups, all young children should be in school without question. High school students could be drivers. College students are unique.
This study out of India ( https://science.sciencemag.org/content/370/6517/691) demonstrated two very important findings.
This study out of India ( https://science.sciencemag.org/content/370/6517/691) demonstrated two very important findings.
First, children seem to infect similar aged children; not others. Second, the virus’ continued spread is driven by only a small percentage of those that become infected.
In fact, 70% of infected individuals did not infect any of their contacts, while only 8% of infected individuals accounted for >60% of new infections. There are super spreaders among us; but they are NOT our kids!
High school students are most definitely more infectious than smaller children. However, the risk among older children may need to be evaluated differently. In Israel, they closed down the country because of HS outbreaks.
However, both there and in the US, a significant proportion of cases seem to come from activities outside school such as carpools, travel sporting events, locker rooms, parties, and weekend events. It speaks to priorities (more later).
Colleges, when managed well, are a microcosm of what we are supposed to do as a society. The universities with few cases represent those entities with excellent testing and (most importantly) meticulous contact tracing.
Where the rest of the country has on average had only 26% of tests received within 1 day and 35% waited more than 4 days; colleges have turnaround times on tests measured in hours.
( https://www.nejm.org/doi/full/10.1056/NEJMp2028209) There are multiple examples of universities that have basically no cases. ( https://www.nationalgeographic.com/.../the-colleges-with.../) ( https://www.nytimes.com/.../covid-college-cases-tracker.html) However, this has required an enormous amount of commitment on both the administration and the students.
This has been a priority (there that word is again); even more so than televised football games. Of course, Thanksgiving will have a set of issues; but we have to honest that we simply do not know what the effect will be. ( https://www.nytimes.com/.../colleges-coronavirus...)
3.
3.
There are terrible stories of teachers contracting COVID and dying. Be cautious in the interpretation of these incidents. It is actually not clear if these teachers were infected at schools.
In fact, the overwhelming evidence suggests that the teachers were infected in the community and not in the schools.
Rather, a Yale study tracked childcare workers and found no difference in the rate of infections between workers who continued to care for children and those that stayed home. ( https://news.yale.edu/.../child-care-not-associated....)
But what about the rest of the world?
4.
But what about the rest of the world?
4.
There are no data to support the idea that schools have been the source of world-wide surges. In fact, students and schools are the victims/recipients of the laxities of the rest of society rather than the driver of societal ills.
Spain’s second wave predated the open of schools. In Vietnam and Thailand, cases in the country dropped overall when schools went back in session. It’s not that schools had zero effect, but they are not the driver.
So, it comes down to priorities.
So, it comes down to priorities.
In places around the world that truly have placed schools in higher priority than bars and restaurants; children have received in person, uninterrupted education.
In societies that committed the intellectual and financial resources to schools; plans were put in place weeks ago. Unfortunately, the US has failed to do these necessary measures to ensure common sense and effective policies to keep kids safely in schools.
That has resulted, yet again, with the poorest children bearing the brunt of the negative effects. In fact, schools serving a high percentage of students in poverty are more likely to be fully remote. ( https://www.crpe.org/current.../covid-19-school-closures)
Is our priority young children?
Is our priority young children?
Do we want our HS students in class, or do we want them to have sporting events? Do I want to not pay full tuition for remote college classes, or do I want massive testing versus PAC 12 football?
I write this today to give myself information as a parent.
I write this today to give myself information as a parent.
I hope this helps others decide that their children will be safe in school.
More importantly, I hope the data gives all of us the motivation and the armamentarium to hold our local school districts accountable to make the informed decisions regarding the start of the calendar year after the holiday break.
