Latest / The SHEA Podcast / COVID-19: Getting Kids Back To School During A Pandemic & How To Do It Safely, 12/22

Transcript

COVID-19: Getting Kids Back To School During A Pandemic & How To Do It Safely, 12/22 · The SHEA Podcast

• 0:09
  SPEAKER_02: Welcome to the Rapid Response Podcast, brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_02: I am Dr.
• 0:23
  SPEAKER_02: David Bannock from the University of Connecticut, and I will serve as today's podcast moderator.
• 0:27
  SPEAKER_02: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:35
  SPEAKER_02: Shay is excited to launch this episode of the podcast, COVID-19 updates, what we know now.
• 0:40
  SPEAKER_02: Today's discussion will focus on getting kids back to school during a pandemic and how we can do it safely.
• 0:45
  SPEAKER_02: Our speaker today is Dr.
• 0:46
  SPEAKER_02: Weston Branch Alleman, assistant professor of medicine at Harvard Medical School.
• 0:50
  SPEAKER_02: Thank you for joining us today.
• 0:51
  SPEAKER_02: Before we start our discussion, I would like to turn it over to Dr.
• 0:53
  SPEAKER_02: Waleed Javed to get us started with a brief news and guidance update of the week.
• 0:58
  SPEAKER_01: Thank you so much, David, for our news portion.
• 1:00
  SPEAKER_01: Globally, we have over 75 million cases and 16.8 million deaths.
• 1:05
  SPEAKER_01: There are over 17 million cases and over 300,000 deaths in the US.
• 1:10
  SPEAKER_01: Updated guidelines from CDC include guidance on antigen testing.
• 1:15
  SPEAKER_01: There is a wise section on evaluating the results of antigen, including a new testing algorithm reflecting what has been learned about the performance of antigen tests and the need to implement confirmation testing.
• 1:28
  SPEAKER_01: It's based on the pretest probability for a positive result.
• 1:32
  SPEAKER_01: So for symptomatic individuals with a positive antigen test, they will be considered affected.
• 1:38
  SPEAKER_01: Symptomatic individuals with a negative anti-gener test, we will require uh nuclear amplification tests for confirmation.
• 1:45
  SPEAKER_01: Asymptomatic uh individuals with close contact with COVID positive individuals with a negative antigen test would be considered as having no evidence of infection, but quarantine will be necessary.
• 1:57
  SPEAKER_01: Asymptomatic individuals with a negative antigen test should be considered not infected, and asymptomatic individuals with a positive antigen test, either with contact or not, still will require nuclear amplification testing.
• 2:12
  SPEAKER_01: Another guideline that was operated was contact tracing guidelines for COVID-19, which acts uh case investigation and contact tracing priority recommendations.
• 2:22
  SPEAKER_01: And I encourage you to review fees and income infection prevention and control recommendation for healthcare personnel during the coronavirus disease 19 or COVID-19 pandemic was also updated with two important conditions.
• 2:37
  SPEAKER_01: One is double clothing is not recommended when providing care for patients with suspected or confirmed SARS-CoV-2 infection.
• 2:46
  SPEAKER_01: And in general, healthcare personnel caring for patients with suspected or confirmed SARS-CoV-2 infection should not be wearing more than one isolation gown at a time.
• 3:04
  SPEAKER_01: Reviewing various journals across the world, the BMG has COVID-19 vaccine delivering protective community, an article that talks about evidence that supports 43 and detailed responses to the three leading vaccines.
• 3:19
  SPEAKER_01: Another important article was published in Jama, which talks about U.S.
• 3:24
  SPEAKER_01: public attitudes towards COVID-19-1990s, and suggests that it may not be very effective in the front backlash infected by the employer.
• 3:35
  SPEAKER_01: Lancet has interesting correspondence on infectivity of asymptomatic versus symptomatic COVID-19, who is suggesting that asymptomatic COVID-19 patients are infectious but might be less infectious than symptomatic cases.
• 3:49
  SPEAKER_01: And it might be helpful in future contact creating process.
• 3:53
  SPEAKER_01: And that concludes the news update for this week.
• 3:56
  SPEAKER_02: Thank you, Dr.
• 3:57
  SPEAKER_02: Javade.
• 3:58
  SPEAKER_02: Now I would like to move into the moderated discussion with Dr.
• 4:00
  SPEAKER_02: Brench Ellen.
• 4:01
  SPEAKER_02: So, Dr.
• 4:02
  SPEAKER_02: Brench Ellen, thank you for joining us on the podcast.
• 4:04
  SPEAKER_02: We're really excited to hear your perspectives on this topic.
• 4:07
  SPEAKER_02: So I'd like to first get a sense of how we're thinking about schools in general.
• 4:12
  SPEAKER_02: And I know you've been very much deep into the literature and have shared your thoughts with a lot of individuals, including in social media.
• 4:18
  SPEAKER_02: So I know this is a topic that you're very passionate about.
• 4:20
  SPEAKER_02: But let's go back to the data.
• 4:21
  SPEAKER_02: You know, we're always talking about the science and the data guiding our public policy.
• 4:25
  SPEAKER_02: So can you tell us a little bit about the data regarding kids in COVID-19, maybe specifically how it may shape our thinking about sending kids back to school?
• 4:33
  SPEAKER_00: Absolutely.
• 4:33
  SPEAKER_00: And thank you so much for having me today.
• 4:35
  SPEAKER_00: I'm really excited to be here and to discuss this critically important problem.
• 4:41
  SPEAKER_00: So I think the first thing we need to acknowledge is that COVID-19 has been an unprecedented problem, at least in our generation, as a bit of a personal history.
• 4:51
  SPEAKER_00: My grandmother actually had the 1918 flu back when she was about three years old.
• 4:56
  SPEAKER_00: So while it is unprecedented for our generation, certainly there is a history of getting kids back to school in the setting of pandemics.
• 5:05
  SPEAKER_00: And so historically, they've done that in a variety of creative ways.
• 5:09
  SPEAKER_00: And I think the first thing we need to acknowledge is that the data are constantly emerging and changing.
• 5:15
  SPEAKER_00: And what we know and what we're learning about this novel pathogen changes every day.
• 5:20
  SPEAKER_00: And so we need to think about this as a fluid problem, not a static problem.
• 5:24
  SPEAKER_00: And we need to be willing to adjust as time goes on.
• 5:28
  SPEAKER_00: So back in March, when we still knew very, very little about COVID, schools were closed kind of in the setting of not knowing what the role children play in this pandemic and how much they might be contributing to either symptomatic or asymptomatic spread.
• 5:44
  SPEAKER_00: So back in March, based on models from influenza, it was very, very reasonable to close schools because models from other diseases suggest that kids can be a major driver of pandemics.
• 5:55
  SPEAKER_00: As we've kind of moved from March, what seems like years ago, but in fact is only nine months ago, and to the present time, we've learned a lot more about the role of kids in the pandemic and what happens to kids who are infected.
• 6:08
  SPEAKER_00: So, somewhat unlike influenza, influenza is sort of a story of extremes where very young kids and then elderly tend to get very sick from the disease.
• 6:19
  SPEAKER_00: And early on, we sort of thought that might be the case with SARS-CoV-2.
• 6:23
  SPEAKER_00: However, as data have evolved, we've learned that kids are much, much less likely to suffer from severe disease than adults.
• 6:31
  SPEAKER_00: Children tend to have more mild illnesses or asymptomatic diseases than adults.
• 6:36
  SPEAKER_00: And as we know, as people go through the lifespan, the risk of severe disease from COVID goes way up.
• 6:41
  SPEAKER_00: That still doesn't actually address the issue of how much kids do or do not spread the disease.
• 6:47
  SPEAKER_00: However, it does appear that kids, while they are capable of disease, they are less likely to spread than adults.
• 6:54
  SPEAKER_00: And it seems that question of spread also varies across the age continuum.
• 6:59
  SPEAKER_00: And so one of the challenges with the school discussion, in my opinion, is that we have gotten into the discussion of schools in general, when really we need to be talking about schools in buckets, because the answers for a daycare or a nursery school setting are different than the answers for an elementary school setting and a middle school setting and a high school setting.
• 7:19
  SPEAKER_00: Younger kids seem to spread less than the older kids.
• 7:22
  SPEAKER_00: And so children in elementary schools seem to have less potential to spread SARS-CoV-2 than children in high school.
• 7:29
  SPEAKER_00: And that's due to a variety of factors.
• 7:32
  SPEAKER_00: Teenagers probably behave more like adults.
• 7:34
  SPEAKER_00: Their bodies are different.
• 7:35
  SPEAKER_00: There are also some school-specific factors that may play into differential spread in different school environments.
• 7:42
  SPEAKER_00: Elementary school students tend to stay in one room.
• 7:45
  SPEAKER_00: There isn't as much mixing.
• 7:46
  SPEAKER_00: They have one teacher, maybe they have a couple of specialist teachers, but they're primarily in one room and they're not moving about the building and interacting with other kids.
• 7:55
  SPEAKER_00: High school, on the other hand, high schools are arranged so that kids have different teachers for different subjects and there may be different students and different classes.
• 8:02
  SPEAKER_00: And so there's a lot more mixing of people in addition to the changes that occur from the time children are in elementary school and they're small and to the time when they are in adolescence and post-adolescence.
• 8:14
  SPEAKER_00: So I think one of your questions was how can we begin to think about this problem?
• 8:19
  SPEAKER_00: I think a couple key take-home messages are that we need to think about this problem as one that is dynamic and not static, and we need to be willing to adjust based on new data that are coming out.
• 8:29
  SPEAKER_00: And we also need to think about this as separate problems for daycare settings, elementary school settings, middle school settings, and high school settings, because there are differences between the students in each of those settings, and there are also differences in how the education is provided in each of those settings.
• 8:45
  SPEAKER_00: As epidemiologists and infection control experts think about it, it's also really important that we elicit feedback from other stakeholders across the continuum of the school settings and recognize that we are experts in infection control and transmission, but we aren't experts in education and we don't necessarily know what is developmentally appropriate at different ages.
• 9:06
  SPEAKER_00: And so we need feedback from partners across the stakeholder spectrum, including educators, school staff, parents, local health departments, all of these people in order to develop a safe reopening plan.
• 9:20
  SPEAKER_02: Thanks.
• 9:20
  SPEAKER_02: I like how you really pointed out how nuanced this decision really needs to be.
• 9:25
  SPEAKER_02: There isn't really a one size fits all when it comes to different ages, and there's different levels of transmission risk associated with different activities with different ages.
• 9:33
  SPEAKER_02: I think that's really important.
• 9:34
  SPEAKER_02: And, you know, you mentioned that as a healthcare epidemiologist yourself, this is an area that you became involved with.
• 9:41
  SPEAKER_02: You know, I've been involved with this to some degree, both from my own professional perspective, but also as a parent of a school-aged child.
• 9:47
  SPEAKER_02: And, you know, I'm interested to see on what your advice is to folks who work in our field of healthcare epidemiology and our role in lending expertise and our potential seat at the table with all the other relevant stakeholders.
• 9:59
  SPEAKER_02: Like, how has that been going from your perspective?
• 10:01
  SPEAKER_02: I know you've gotten involved quite a bit with your school systems.
• 10:03
  SPEAKER_00: So I think it's important to recognize where we can be helpful and where we can't be helpful.
• 10:09
  SPEAKER_00: That's number one.
• 10:10
  SPEAKER_00: We're experts in disease transmission and in infection control.
• 10:14
  SPEAKER_00: And we also have a lot of expertise, although we often as a field don't express it this way.
• 10:19
  SPEAKER_00: We have a lot of expertise in implementation.
• 10:22
  SPEAKER_00: So I think we can help a lot in some of the implementation questions.
• 10:26
  SPEAKER_00: If we think about different pillars of infection control, I really like the original CDC model for flu control, which emphasizes four broad categories that we can use to prevent transmission of infection.
• 10:38
  SPEAKER_00: And those are engineering controls, such as ventilation systems and outdoor airflow, outdoor spaces.
• 10:45
  SPEAKER_00: We know that outdoor spaces are much, much safer when it comes to preventing transmission.
• 10:51
  SPEAKER_00: So engineering controls are kind of the first bucket that we have in our arsenal.
• 10:55
  SPEAKER_00: The second bucket are administrative controls, and these include things like symptom screens, stay home when sick policies, potentially thinking creatively about the school calendar and building in mandatory quarantine breaks if there are times when we think a school may be a particularly high risk for either introduction of infections or if there are challenges with spacing.
• 11:18
  SPEAKER_00: I'm a big advocate for thinking creatively about the schedule and how we want to actually structure the school year.
• 11:25
  SPEAKER_00: Other administrative controls are things like physical distancing and limiting contacts.
• 11:30
  SPEAKER_00: A popular administrative control that has been implemented is the hybrid model.
• 11:34
  SPEAKER_00: And I think we can come back and talk about the hybrid model and how we think about that in the context of emerging data.
• 11:41
  SPEAKER_00: Other categories are epidemiologic controls, and this includes strategies to keep cases from entering into the school buildings, things like contact tracing, testing, surveillance programs, and keeping community prevalence low.
• 11:54
  SPEAKER_00: And then finally, the individual bucket of things, and that includes things like PPE and hand hygiene that are sort of individual level interventions.
• 12:03
  SPEAKER_00: Where we can be helpful is in taking some of these things and providing expertise into the what and the how of these broad controls and also helping with the kind of detailed implementation of some of them.
• 12:18
  SPEAKER_00: So we are not experts in education and we don't necessarily know what is developmentally appropriate when it comes to making recommendations for how to arrange a kindergarten lunch.
• 12:28
  SPEAKER_00: You know, I think sometimes it seems like we can make a simple recommendation like just tell the kid to eat at their desk if you want to keep them apart.
• 12:36
  SPEAKER_00: Well, you can't necessarily ask a five-year-old to sit at their desk and not squiggle around and not do anything for hours at a time.
• 12:42
  SPEAKER_00: And so we can make recommendations that you need distancing, but we do need feedback from others about what the kids can and cannot do and what is reasonable in a classroom setting.
• 12:53
  SPEAKER_00: But there are places where we have a lot of expertise that we can lend to this question.
• 12:57
  SPEAKER_00: For example, school settings generally don't have any mechanism for creating a dashboard.
• 13:05
  SPEAKER_00: Whereas we in healthcare epidemiology have a lot of experience with contact tracing and line lists and following up on cases.
• 13:13
  SPEAKER_00: So how can we help them set up a dashboard that is relatively streamlined, easy to use, easy to follow, and make sure we are tracking down all of those positive cases?
• 13:24
  SPEAKER_00: We can also help a lot when it comes to developing testing and surveillance programs.
• 13:29
  SPEAKER_00: How can we operationalize that?
• 13:31
  SPEAKER_00: How can we make sure that positive cases are tracked down?
• 13:34
  SPEAKER_00: How can we make sure that the appropriate reporting occurs?
• 13:37
  SPEAKER_00: How can we actually implement the testing plan?
• 13:40
  SPEAKER_00: How are we going to set up tents and actually collect swabs and make sure that the swabs get to the right place?
• 13:46
  SPEAKER_00: We're really good at all of those pieces of it.
• 13:48
  SPEAKER_00: And so we can help school systems that don't have a lot of experience and things like dashboards and contact tracing and surveillance programs.
• 13:56
  SPEAKER_00: We also really need to make sure we're careful about eliciting feedback and working with the other stakeholders in these questions.
• 14:03
  SPEAKER_02: Thanks for sharing all those ideas.
• 14:05
  SPEAKER_02: I like how you broke it down into basically the fundamentals of infection control and how we can adapt things that we've been doing in the hospital to other settings like schools.
• 14:14
  SPEAKER_02: And we've had prior podcast discussions where we've talked about all different types of settings where healthcare epidemiology and infection control expertise can be useful.
• 14:21
  SPEAKER_02: Again, just honing in on those fundamentals and they can really be quite valuable.
• 14:24
  SPEAKER_02: I think one other area that I'm interested in your thoughts are regarding communication.
• 14:28
  SPEAKER_02: I think if COVID's taught us something about communication, is that there's a real need for communication and that we in our field, healthcare epic and infection control, can play a role in communicating with the public.
• 14:38
  SPEAKER_02: And when it comes to schools, communication can become complex because all the different stakeholders.
• 14:43
  SPEAKER_02: Can you maybe think back to the experiences that you've had with how you've been communicating with other stakeholders, you know, certainly teachers, school administration, parents, students.
• 14:52
  SPEAKER_02: Have you found that to be a useful role where someone within a background in infection control and epidemiology can be helpful?
• 14:59
  SPEAKER_00: So I think the communication piece is one of the hardest.
• 15:03
  SPEAKER_00: And you're right, it's been a challenge throughout the COVID-19 pandemic.
• 15:07
  SPEAKER_00: You know, I guess what I would say is I think one of the hardest issues to communicate is that this is really a nuanced question.
• 15:15
  SPEAKER_00: And it can be very, very difficult to create nuanced messages.
• 15:20
  SPEAKER_00: And so we need to be really careful of what we say and really careful with how we say it.
• 15:26
  SPEAKER_00: And I think it's been challenging because the reality is we weren't right about everything up front.
• 15:31
  SPEAKER_00: You know, we weren't necessarily right about mask recommendations and all of that.
• 15:37
  SPEAKER_00: And we need to sort of recognize that some of the communication around masking and the kind of more global communication has been challenging.
• 15:45
  SPEAKER_00: And that's created challenges in other areas.
• 15:48
  SPEAKER_00: So I don't have a great answer to this question.
• 15:51
  SPEAKER_00: I think it's critical that we listen.
• 15:53
  SPEAKER_00: I think listening can be an underrecognized aspect of communication and recognizing that sometimes when we're communicating, we can communicate a sort of broad message of safety, but our experience and what we know about may not extend the classroom setting.
• 16:10
  SPEAKER_00: So as healthcare epidemiologists, we have a lot of experience teaching people how to use PPE and how PPE works.
• 16:17
  SPEAKER_00: And I think in the hospitals, by and large, people have become pretty comfortable that if they're wearing appropriate PPE, they can be safe and they're protected in a hospital setting.
• 16:26
  SPEAKER_00: But we need to recognize that not everybody has the same background and experience that we do.
• 16:32
  SPEAKER_00: And we're comfortable with PPE, but not everybody is.
• 16:35
  SPEAKER_00: And I think a challenge for healthcare epidemiologists when we're communicating with schools and other stakeholders is that their point of view and their view of how all of this works is very different.
• 16:45
  SPEAKER_00: And it's fairly easy in the hospital to be telling healthcare workers, well, I shouldn't say it's fairly easy, but it's fairly routine for us to be advocating for hand hygiene and mask wearing.
• 16:56
  SPEAKER_00: But the way we advocate for that in the hospital is very different when you're talking about trying to get a five-year-old to wear a mask all day.
• 17:03
  SPEAKER_00: And so I think we can provide a lot of education about the science and the background, but we do need to be careful that our experience is different.
• 17:12
  SPEAKER_00: And when we're communicating, we need to make sure that we think about how our experience may be different from the experience of others.
• 17:19
  unknown: Great.
• 17:19
  SPEAKER_02: I think that's a really good point.
• 17:20
  SPEAKER_02: I mean, as we think about how we're communicating with all these other groups and that we have a history and a perspective that's focused on primarily healthcare settings, but especially hospital settings, and broadening that has its own unique challenges and adaptation.
• 17:32
  SPEAKER_02: So I'm thinking about someone who is in a position where they have infection control expertise and they want to become involved in advocating for schools and ensuring that schools are safe and safely reopened.
• 17:44
  SPEAKER_02: Can you give any advice to anyone listening to this who wants to begin to get involved with that?
• 17:49
  SPEAKER_02: Are there any good resources out there or any other suggestions you have for someone who's looking to make that step?
• 17:54
  SPEAKER_00: Absolutely.
• 17:55
  SPEAKER_00: And I think it's been really challenging because this has been such a decentralized process.
• 18:00
  SPEAKER_00: And one thing that I would love to see, and I may be jumping to the end, is a more centralized data collection and analysis process and also some more openness to testing and evidence generation so that we can make really strong evidence-based recommendations.
• 18:18
  SPEAKER_00: But the way I got involved was I simply reached out to our local school principal and I asked if there was anything I could help with.
• 18:24
  SPEAKER_00: And I got assigned to the local school health committee.
• 18:27
  SPEAKER_00: And so I worked on the health committee advising on various questions related to infection control.
• 18:33
  SPEAKER_00: So I guess the first way I would say if you're interested in getting involved is to reach out locally and see what is needed and where you can be helpful.
• 18:40
  SPEAKER_00: I did volunteer to offer teaching on PPE, but it was decided that they would rather have their own independent contractor rather than a local parent.
• 18:49
  SPEAKER_00: And so I think keeping an open mind about what people are comfortable with and what they want is important as you do that and recognize that there are a lot of different stakeholders who have different experiences and may have really very different opinions than you.
• 19:02
  SPEAKER_00: And you're going to be working in a much more heterogeneous environment than we may be used to.
• 19:07
  SPEAKER_00: Most schools have kind of a school superintendent, and often that person is in charge at the district level.
• 19:13
  SPEAKER_00: So that can be another place to reach out.
• 19:15
  SPEAKER_00: And the other thing is to listen carefully to the local school boards and the school committee and think about attending the school committee meetings.
• 19:23
  SPEAKER_00: In our town, for example, they have the school committee meeting is every other week, and there's always an option for citizens to speak and to think about listening in on both what other people have to speak and then also providing some guidance during some of these public forums can be helpful in a way to get involved.
• 19:39
  SPEAKER_00: I also strongly recommend the school committee members are local representatives, and it makes sense to kind of get involved at the local politics level and reach out to them and offer your help on the school committee level as well.
• 19:52
  SPEAKER_02: That's very helpful to our listeners to know how they can get started and start to assist with any help that might be requested or needed.
• 19:58
  SPEAKER_02: Before we wrap up, I'm interested to hear your thoughts of sort of where we are at this moment.
• 20:03
  SPEAKER_02: You know, you're nearing the end of December.
• 20:04
  SPEAKER_02: There's a lot going on.
• 20:05
  SPEAKER_02: We see rising and very high rates of community-level transmission of COVID throughout many parts of the country.
• 20:11
  SPEAKER_02: Concurrently, we're also seeing vaccine deployment begin now in phase 1A, but just yesterday ACIP met and discussed what phase 1B is going to look like, and teachers and other school personnel will be included.
• 20:23
  SPEAKER_02: So I'm interested to hear what your main focus is regarding schools at this point and if you could try to predict what the future may look like.
• 20:31
  SPEAKER_02: And of course, we'll never hold you to any predictions you make, but I'm just very interested in hearing on what you're thinking and you know any thoughts, especially as we look at turning after the holiday break, kids are gonna be getting back in school.
• 20:41
  SPEAKER_00: So that's a fantastic question, and I'm glad you addressed it.
• 20:44
  SPEAKER_00: And I think one of the things that I have learned over the past six months or so is that different people have a different metric for what they mean by safe.
• 20:53
  SPEAKER_00: And so I think, and I hope as a society, we can come up with some benchmarks for when we regard school as being safe enough in terms of COVID-19.
• 21:04
  SPEAKER_00: So I've heard various benchmarks.
• 21:07
  SPEAKER_00: So the Department of Elementary and Secondary Education in Massachusetts had determined earlier in the fall that it was safe for schools to go back.
• 21:15
  SPEAKER_00: However, other stakeholders, in particular teachers and many parents, did not feel school was safe enough.
• 21:21
  SPEAKER_00: So I think the safety benchmark is a hard one to put down, but it's important that we not keep on moving our goalposts.
• 21:29
  SPEAKER_00: And so, kind of getting back to your other question, we're really lucky to have the first vaccine.
• 21:35
  SPEAKER_00: It's amazing that in the course of about a year, we went from knowing very little about this virus, having no effective treatments to where we are now.
• 21:43
  SPEAKER_00: We've gotten better at treating people in the hospital.
• 21:46
  SPEAKER_00: The first vaccine was deployed.
• 21:47
  SPEAKER_00: That is a major success over a relatively short period of time, even though it's been a rough year for all of us.
• 21:53
  SPEAKER_00: That being said, we need to think about the vaccine in terms of timeline and who needs to be.
• 22:00
  SPEAKER_00: Vaccinated and who can be vaccinated.
• 22:02
  SPEAKER_00: Right now, we're lucky to have an effective vaccine for adults, but not for children.
• 22:07
  SPEAKER_00: But there's still a lot we don't know about the vaccine.
• 22:10
  SPEAKER_00: So we know that the vaccine appears to be quite effective on the order of 95% for preventing severe disease.
• 22:18
  SPEAKER_00: We still don't know whether or not the vaccine can prevent transmissions, although we're hopeful that it can.
• 22:24
  SPEAKER_00: We don't know if it's going to prevent asymptomatic infections.
• 22:27
  SPEAKER_00: And so that has some implications for community spread.
• 22:31
  SPEAKER_00: It is possible that the vaccine is preventing people from getting very sick, which is great and an important outcome in and of itself, but we don't know what the impact will be on community-level transmission.
• 22:41
  SPEAKER_00: The other key thing about the vaccine is that it hasn't been tested in kids.
• 22:45
  SPEAKER_00: And so when we're talking about a vaccination program, we're talking about a vaccination program for adults.
• 22:51
  SPEAKER_00: We're not talking about a vaccination program for kids.
• 22:54
  SPEAKER_00: And so when we're talking about safe enough, a big question is safe enough for who?
• 22:59
  SPEAKER_00: Are we talking about we can open up schools when the hospitals are protected?
• 23:04
  SPEAKER_00: In which case we're talking about relatively short order.
• 23:07
  SPEAKER_00: Best guess for that kind of timeline due to distribution and manufacturing problems is February to April.
• 23:13
  SPEAKER_00: Are we talking about when school staff is vaccinated?
• 23:17
  SPEAKER_00: In which case we're maybe talking about late spring or the summer, or are we talking about when children are vaccinated, in which case we're probably looking at a year from now?
• 23:26
  SPEAKER_00: And so I think it's really important when we think about the vaccine, we think about these issues of distribution and timeline because just because we have an effective vaccine doesn't mean that people are getting vaccinated right away.
• 23:39
  SPEAKER_00: And it also doesn't mean that children are getting vaccinated.
• 23:42
  SPEAKER_00: And so when we think about safety, are we talking about issues of transmissions from staff to students and between school staff?
• 23:52
  SPEAKER_00: Or are we talking about the concern of a child getting infected in the classroom and then potentially bringing that classroom home?
• 24:00
  SPEAKER_00: I know locally that's been a major concern, particularly among communities of color that might be more likely to have multi-generational homes.
• 24:07
  SPEAKER_00: A major concern about returning to school has been the concern that a child would get infected in school and then bring the virus home to vulnerable adults in that home.
• 24:16
  SPEAKER_00: And so we need to think about how we are defining safety and who we need to vaccinate as we think about the role of vaccination in school reopening.
• 24:26
  SPEAKER_00: That being said, again, the vaccine being available is something to celebrate and we need to be excited about it.
• 24:31
  SPEAKER_00: But it kind of doesn't change the fact that we still need a long-term plan about school reopening.
• 24:36
  SPEAKER_00: And we're probably still looking at implementing mitigation measures in school settings for at least the duration of the school year.
• 24:42
  SPEAKER_00: And when we think about how we want to move forward, we need to recognize that there are going to be risks at school, and those risks can be mitigated, hopefully, with vaccination of staff soon.
• 24:54
  SPEAKER_00: Emily Oster has done an amazing job with her dashboard.
• 24:58
  SPEAKER_00: And one of the things that she's found is that masking is a critically important intervention in schools and something that we really need to think about.
• 25:05
  SPEAKER_00: And we also need to recognize that there are downsides to not being in school and that being out of school is also not perfectly safe.
• 25:13
  SPEAKER_00: I think that's been a major challenge as we've thought about this, is there tends to be this view that we can see the cases that may or may not happen inside of school, but we don't see the cases that don't happen outside of school.
• 25:25
  SPEAKER_00: We kind of have a laser focus on in-school transmission with very little focus on what happens outside of the school.
• 25:32
  SPEAKER_00: And I think it's really important as we think through these problems that we think through some of the unintended consequences of not having the kids in the classroom.
• 25:40
  SPEAKER_00: So if a child is in a hybrid model, they may be going to school one day and then at home the other day.
• 25:46
  SPEAKER_00: And at home, what's happening?
• 25:47
  SPEAKER_00: Are they mixing in a pod with other kids?
• 25:50
  SPEAKER_00: Are they in an uncontrolled setting where they're not wearing masks?
• 25:53
  SPEAKER_00: What are they doing in that setting?
• 25:54
  SPEAKER_00: And so we need a better, kind of more balanced view of what happens both inside of school and outside of school.
• 26:01
  SPEAKER_00: And I think that when we think through some of these problems, the hybrid model is one that, in the fullness of time, seems like a less good idea than it did over the summer because of this issue of perhaps more mixing and children spending more time in riskier environments and getting sicker.
• 26:17
  SPEAKER_00: The other thing, kind of beyond unintended consequences and not knowing what is happening outside of the school, another important thing to recognize is that more and more data are emerging on the dangers of not sending kids to school.
• 26:31
  SPEAKER_00: We see widening achievement gaps, we see children losing literacy gains, and the mental health and safety consequences of not having kids in school are another public health crisis.
• 26:42
  SPEAKER_00: And so it's also important to recognize when we think about schools and school reopening that COVID-19 is an important outcome, but it's not the only outcome.
• 26:52
  SPEAKER_00: And children's mental health and their long-term well-being are critically important.
• 26:56
  SPEAKER_00: We're seeing rises in depression.
• 26:59
  SPEAKER_00: We're seeing fewer abuse reports being filed.
• 27:02
  SPEAKER_00: We're seeing rising rates of childhood obesity.
• 27:04
  SPEAKER_00: All of those are going to have long-term effects on our children too.
• 27:07
  SPEAKER_00: And so we need to think about COVID and we need to think about how to mitigate COVID and a long-term plan for COVID control.
• 27:14
  SPEAKER_00: We also need to think of the other side and the other impacts of school closing.
• 27:18
  SPEAKER_02: So thanks for that very comprehensive overview.
• 27:20
  SPEAKER_02: I think you know you hit on so many aspects that demonstrate the complexity of the topic and how we really need to look at the total picture with regard to schools.
• 27:29
  SPEAKER_02: You highlighted a few of the key safety mitigations measures like masking.
• 27:33
  SPEAKER_02: I think the vaccination will be helpful, but I think there's so many factors to consider, including the challenges associated with remote learning and not having kids in school or in-person learning.
• 27:43
  SPEAKER_02: So complicated, but I think you've really laid out the critical things of consideration and some ideas for moving forward.
• 27:48
  SPEAKER_00: One last thing.
• 28:05
  SPEAKER_00: We've also seen some really promising data that they're actually very good at masking.
• 28:10
  SPEAKER_00: I had heard early on there were concerns that the little kids wouldn't keep their masks on, but they really want to go to school and they've done a very good job of it.
• 28:17
  SPEAKER_00: And so at the same time, elementary school kids have a much harder time with remote learning.
• 28:23
  SPEAKER_00: It's much harder if they don't have adult supervision.
• 28:26
  SPEAKER_00: And so thinking about those kids and what's developmentally appropriate for them is really different than thinking about middle school and high school.
• 28:33
  SPEAKER_00: And those kids are at higher risk of complications, they're more likely to spread, and they're also more able to engage in remote learning.
• 28:41
  SPEAKER_00: And so we really need to split up this discussion into different pieces.
• 28:45
  SPEAKER_02: So thank you very much to our speaker for sharing your perspective and experiences.
• 28:50
  SPEAKER_00: Thank you for having me.
• 28:51
  SPEAKER_02: This podcast can be accessed on Shay's online education center or learning CE under the Rapid Response Program.
• 28:57
  SPEAKER_02: You'll also find resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHAE COVID-19 town halls.
• 29:04
  SPEAKER_02: You can now receive 50% off 2021 SHAY membership using the coupon code WELCOME2021 during checkout.
• 29:10
  SPEAKER_02: That concludes this episode of the Rapid Response Podcast.
• 29:13
  SPEAKER_02: Thank you, Dr.
• 29:14
  SPEAKER_02: Branch Ellen, for joining us, and thank you, listeners, for tuning in.