This week Fred reviews the latest school recommendations from the Centers for Disease Control and Prevention (CDC) that released a new Operational Strategy for K-12 Schools to incorporate the best available evidence at this time. The evidence suggests that many K-12 schools that have strictly implemented mitigation strategies have been able to safely open for in-person instruction and remain open. Add to this the disproportionately negative effect on low-income communities since schools play such a significant part in promoting equity and getting schools open for in-person classes becomes even more pressing
As Vinay Prasad put it
76 days left to open public schools
Anything less than 90% open in person 5 days a week is failure in my book, and will be when history looks back on this moment
— Vinay Prasad MD MPH (@VPrasadMDMPH) February 14, 2021
What will it take? A layer (aka incremental) strategies. The 5 key mitigation strategies they list for safe delivery of in-person instruction and will help to mitigate COVID-19 transmission in schools:
- Universal and correct use of masks
- Physical distancing
- Handwashing and respiratory etiquette
- Cleaning and maintaining healthy facilities
- Contact tracing in combination with isolation and quarantine, in collaboration with the health department
The priority here is the universal and correct use of face coverings and physical distancing
We also discuss who should vaccinate and specifically the thinking around those who have had COVID19 and this pre-published paper. The highlight here is that for those who had a previous infection with SARS-CoV-2 we have seen a slow decline in antibody titers but for this small group of 10 subjects who received the mRNA vaccine from Pfizer or Moderna) the researchers detected a 1000 fold increase in neutralizing antibodies
So do you need a vaccine if you have had COVID19 (Hint ✅ )
Join Dr Luis Saldana, Fred and myself for our COVID Insights to Action Discussion webinar taking place every Wednesday at 4pm ET. Our training modules are available to help businesses, education facilities and employers get their employees, staff, customers and students back to work and school safely in the context of COVID19
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick, I’m the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with accountable health here helping companies as they operate and reopen keeping their employees healthy through the full continuum of employee health.
Nick van Terheyden
So another week, and here we are. And we’re talking about reopening schools read something, I think there’s probably lots of parents who are asking and wondering when that might happen. I think the whole virtual learning experiences Oh, it’s if it happened, I don’t know how good it was. I’m pretty sure based on the experiences that I’ve heard about, very limited, and certainly very age dependent. Are we going to open schools? What’s going on?
Fred Goldstein
So you brought up the key issue, obviously, we now know how tough it is not to have the kids in the classroom, the impact on them from a mental health perspective and education perspective. And when you really think about this broadly, them interacting with other children with other people is critically important to their development. And it’s also being pointed out that it’s an economic issue now, because we have a long term economic output over the time period where we may see that children haven’t learned as much. And so it’s creating some real deep thinking about what do we need to do. And interestingly, we finally got some new guidance from the CDC. And that guidance, sounds similar in many ways. It says that communities need to look at their communities, infection rates, as well as focus on five key things. And two of them are the most important, obviously, as we know, make sure you’re wearing masks in school, and do physical distancing. The others they talked about were hand washing, cleaning, and then having a contact tracing system in place, those all seem to make sense. But where it gets difficult is when you look at the areas such as six foot distancing in classrooms, that can be really tough to bring kids back, because you may not have the space. And there’s a lot of studies now that are pointing to and we’ve seen it in our work with the universities, that we’re not seeing infections occur necessarily in the classrooms. And the CDC acknowledges that it appears to be safe in the classrooms. In fact, we’ve seen certain situations where campuses have lower infection rates in the general community they exist in. So there’s a lot of arguing going on right now, teachers are saying, we don’t want to come back without a vaccine. But at the same time, you’re looking at lower infection rates, it would be great, I think, to get teachers in line earlier, get them vaccinated, and get them in the classrooms. And then there’s the issue of how do we control spread. And part of the problem is that the focus in this document is on still on cleaning. And we haven’t seen a lot of issues with people getting infected by touching surfaces or contact, it’s aerosol. And there’s much less focus on what’s going on with the air handling systems in the room. So it’s clearly an issue that can take some time. Some some teachers are very upset with this, some districts are upset because maybe their communities don’t hit the standards that the CDC is saying you should use for your four levels of zones. And it’s really going to be interesting to see how many schools are able to open with this type of approach in the fall.
Nick van Terheyden
Wow, lots to unpack there. But you know, once again, advisement advice remains the same. Yeah, make sure you wear a face covering and that obviously applies for the students. And I know that creates some challenges. I’ve seen some interesting concepts around, see through masks with filtration. Obviously, there’s double masking. Gosh, I can only imagine with younger students, that might be an additional challenge. But you know, these are not insurmountable problems. We teach our kids to do other things. Why can’t we teach them to do this? I agree with you on this surface thing that continues to sort of trouble me I wish we could get past this. Because it just doesn’t seem to be and I can tell you my own personal life. You know, initially I was very rigorous about it. Now I don’t even worry about it. I just make sure that I wash my hands I can thank my cats for that. Because my eyes explode when I get any cat near me, we have a house, I was forced to have a cat. And what that did was anytime I touch the cat, I go wash my hands. So I wash my hands all the time, which is, you know, proven to be a very good thing. And I think that’s a better sort of strategy. But the one that I think would really benefit is the air handling and the improvement because that seems to be the bigger issue. And you know, even when you don’t have the capacity to improve air, outdoor and air handling systems, or in old buildings, we’ve seen some clever innovation where you just put some habit filter systems into the rooms, position them in a smart way so that you drawer all the airflow away, filter out, some of this stuff just makes sense. And the damage that I think we’ve done, we’re going to see this for years to come. And I think it’s going to hit specific age groups, we have to reconcile and repair that as quickly as possible, because you just some of these things. I mean, just think about language. If you want to learn a foreign language, there’s an age at which, you know, you stopped really becoming totally fluent, because your brain is like this sponge at a young age. And if you lose that opportunity, it’s very hard to return and recover, not saying impossible, but very hard. So the sooner we get back to the classrooms, the better.
Fred Goldstein
And I just want to point out one thing I’ve been involved with the National COVID-19 outdoor Learning Initiative, it’s a great group. If you go to WWW dot Greene school yards.org. You can find COVID learn outside, they’ve now got a full library up there. And it’s actually now mentioned in the CDC guidelines that perhaps we move activities outdoors, there are ways to overcome the weather. There are ways to maybe you do some indoor, some outdoor, it doesn’t have to be 100%. But it can certainly help based on what we know. And that raises some interesting questions now around the vaccine. Nick, I know you’ve been looking into this, and vaccine for people who have already been infected. Yeah.
Nick van Terheyden
I don’t need the vaccine. So much. And here’s what’s really interesting, it was a small study, let’s be clear, it was only 10 people. And they looked at these 10 individuals and their antibody titers. So what did they have in their bloodstream? So this is the blood test, and we look at the antibody titers. And to be clear, we’re still working out what all of that means. So what we’ve seen, typically, especially with people that have either asymptomatic or very mild symptoms of the COVID disease, is we see a relatively lower incidence of the antibodies and it seems to decline. Now what does that mean? As you know, the virologists, immunologist, and others would point out just because your antibody titer declines, doesn’t mean to say that you’re no longer immune, for sure, we just don’t know. But here was what was interesting, and I think important in that group of 10, who received the messenger RNA, so that’s Pfizer on the derner vaccine, they managed to bump up the neutralizing antibody, and we use that term for testing against viral titers and take their antibody titer and see if it will kill the virus, neutralizing antibodies went up by a factor of 1000. That’s pretty significant. Very important. Yes, it’s a small study, I think the you know, what that tells us is, if you’ve had COVID-19, you should still get vaccinating. And you know, expect to have that as a boost. But here’s one point to remember. You should be lower down on the priority for, you know, after people that haven’t had it and still need to get the vaccination.
Fred Goldstein
So in that case, is it one shot they’re considering versus the two?
Nick van Terheyden
Yeah, I don’t think we know that. And, you know, again, still lots to be discovered, which, you know, keeps this video programming. Alright, keep talking about going on for a longer time than I ever expected. You know, we still did it.
Fred Goldstein
And as we fit before we finish up I just like to point out a couple things. One, you’ve had an excellent guest on your show from Baylor Peter Granick, and they can find that at
Nick van Terheyden
so that’s it healthcare now radio.com and it’s also an incremental doc shelf.
Fred Goldstein
Yep. And I also had someone from Baylor Ben Ryan, the associate clinical or clinical associate professor at the University talking about some of his ideas around the pandemic. And you can find that again at healthcare now radio or go to accountable health llc.com and you can listen to that show. Both of them are really fascinating on how the university has adjusted and done things to keep themselves open. And it can it can certainly inform other universities K through 12 as well as companies as they consider how they continue to operate during this pandemic. So with that, once again, another fantastic week. Nick, thanks so much. This is Fred Goldstein with accountable health.
Nick van Terheyden
And this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
