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Transcript

Back to School in 2022 · The SHEA Podcast

• 0:08
  SPEAKER_00: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, or SHA.
• 0:15
  SPEAKER_00: The society is involved in promoting the prevention of healthcare associated infections and antibiotic resistance and seeks to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:25
  SPEAKER_00: I'm Dr.
• 0:25
  SPEAKER_00: Christopher Cernitch, Chief of Medicine and Hospital Epidemiologist at the Madison VA Hospital and a professor of medicine at the University of Wisconsin School of Medicine and Public Health.
• 0:35
  SPEAKER_00: I will be serving as today's moderator.
• 0:38
  SPEAKER_00: 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.
• 0:47
  SPEAKER_00: Shea is excited to launch this episode that will focus on COVID-19 and heading back to school in 2022 with a focus on elementary and secondary education.
• 0:57
  SPEAKER_00: We are fortunate to have with us today Dr.
• 0:59
  SPEAKER_00: Weston Branch Alleman, who is an associate professor of medicine at Harvard Medical School, and is also an investigator for the VA Boston Center for Healthcare Organization and Implementation Research and the VA Boston Cooperative Studies Program, and is also an infectious disease consultant at the Boston VA Healthcare System and Beth Israel Deaconist Medical Center.
• 1:20
  SPEAKER_00: If that was not enough, she also serves as an unpaid advisor to the Massachusetts Department of Elementary and Secondary Education.
• 1:27
  SPEAKER_00: Thank you for joining us today.
• 1:28
  SPEAKER_01: Thank you so much for having me.
• 1:30
  SPEAKER_00: Well, I think we've got a lot to get to today, so I'm going to just jump right in, if you don't mind.
• 1:36
  SPEAKER_00: First and foremost, it's great to have you back with us again.
• 1:39
  SPEAKER_00: The first time you're with us, you really helped illuminate a number of important topics.
• 1:43
  SPEAKER_00: But for the benefit of our audience, can you refresh our listeners on what your background is, especially as it pertains to working with school systems on COVID-related issues?
• 1:53
  SPEAKER_01: Well, it's been a wild ride the past couple of years.
• 1:55
  SPEAKER_01: And I think before we even get to schools, I'll start with the COVID question.
• 2:00
  SPEAKER_01: So I think a defining moment for me was way back in, I forget whether it was February or late March or early April of 2020.
• 2:09
  SPEAKER_01: I received an email saying, quote, we're activating the four North plan.
• 2:14
  SPEAKER_01: And I wasn't sure what that meant.
• 2:15
  SPEAKER_01: So I pinged the hospital epidemiologist Katie Linzenmeyer, with whom I share an office.
• 2:20
  SPEAKER_01: And she said, she basically said, you have four hours to clean out all your stuff.
• 2:25
  SPEAKER_01: Our office is being converted into an ICU.
• 2:27
  SPEAKER_01: And so I haven't seen my computer or those files since.
• 2:31
  SPEAKER_01: And kind of my entire work life was turned upside down.
• 2:36
  SPEAKER_01: And so very shortly thereafter, one of the hats that I wear is I'm a member of the Institutional Review Board at VA Boston.
• 2:43
  SPEAKER_01: And so I was tasked with running a COVID-19 clinical trial.
• 2:47
  SPEAKER_01: And so shortly thereafter, and during a period of 10 days, we me in collaboration with others at VA Boston designed and then enrolled our first patient in less than 10 days.
• 3:00
  SPEAKER_01: And so my next couple of years were spent really focused on COVID issues and kind of practical COVID questions.
• 3:08
  SPEAKER_01: I do have a background in implementation science.
• 3:11
  SPEAKER_01: And with all of this going on, of course, my kids were at home.
• 3:15
  SPEAKER_01: And so in around June of 2020, I emailed the school principal and basically said, How can I help?
• 3:23
  SPEAKER_01: And she said, we could really use your help on the health subcommittee of the school reopening committee.
• 3:28
  SPEAKER_01: And so I began to volunteer there.
• 3:31
  SPEAKER_01: And through those roles, it really became clear to me that one of the challenges in opening schools back in August of 2020 and some places in July, that there was a gap in testing.
• 3:43
  SPEAKER_01: So I spent the next several months trying to work out a public-private partnership between the school and a local hospital to improve access to testing for students and staff.
• 3:54
  SPEAKER_01: Ultimately, that project was not successful, but it led to other projects and other investigations, including evaluations of the impact of physical distancing on COVID-19 spread in schools.
• 4:07
  SPEAKER_01: And I became an advisor to the state thinking about how we can get kids back to school during the pandemic.
• 4:14
  SPEAKER_00: Great.
• 4:15
  SPEAKER_00: So with that kind of experience in mind, what do you think are the most important considerations for school districts as it pertains to COVID-19 safety, particularly now?
• 4:25
  SPEAKER_00: Obviously, we're we were dealing with a completely different situation back in 2020, and a lot of things have changed in 2022.
• 4:33
  SPEAKER_00: So how do we kind of look at things through that prism?
• 4:37
  SPEAKER_01: So I think you bring up a critical point, which is that we have really come a long way since we were trying to figure out how to get any tests, and tests were taking 10 to 14 days to turn around back in the summer and fall of 2020.
• 4:52
  SPEAKER_01: So this is not the same context.
• 4:55
  SPEAKER_01: And one of the major focuses of implementation science is thinking about the context.
• 4:59
  SPEAKER_01: And so I think a key point is that the overall context have changed.
• 5:04
  SPEAKER_01: We now have vaccines after the Omicron waves, a large portion of the population was infected.
• 5:11
  SPEAKER_01: And so there is a higher level of natural immunity in the infection in the population.
• 5:16
  SPEAKER_01: We also have EVUSHILD, which is effective for immunocompromised patients, and Pax Clovid for high-risk patients.
• 5:24
  SPEAKER_01: And there is some encouraging data that just came out of Israel showing that among high-risk patients who are vaccinated and got Paxlovid, it did appear that Paxlovid continued to be highly effective for preventing severe disease.
• 5:36
  SPEAKER_01: So we have a lot more tools in our toolbox and we aren't in the same place that we were in July of 2020.
• 5:43
  SPEAKER_01: And so I think that's the kind of an overarching message as we continue to advise school districts on how to consider COVID safety.
• 5:52
  SPEAKER_01: And I think the other key point here is that we are scientific advisors.
• 5:58
  SPEAKER_01: We are not experts in schools, and we certainly are not experts in everything that is happening in the school.
• 6:04
  SPEAKER_01: And so as we provide our scientific expertise in infection prevention, it is important to set very clear goals and expectations and recognize that depending on what the goal that is set by the school and the community, our infection control expectations and recommendations are different.
• 6:24
  SPEAKER_01: And so the other thing to remember is that as contexts change, the goals and recommendations may change too.
• 6:31
  SPEAKER_01: So oftentimes I think we view infection control recommendations in a static framework.
• 6:36
  SPEAKER_01: But one of my favorite implementation science frameworks is the dynamic sustainability framework.
• 6:42
  SPEAKER_01: And I think it's important to remember that we need to be considering our recommendations and our expectations in a dynamic setting, not in the static setting.
• 6:51
  SPEAKER_01: And so it's important to remember that goals may change throughout the year as the context changes.
• 6:56
  SPEAKER_01: And so, number one, we have to be flexible.
• 7:00
  SPEAKER_01: And number two, we need to recognize that we are experts in what we are experts in, and that is not schools specifically.
• 7:06
  SPEAKER_01: And we need to bring our expertise to the key stakeholders, but not assume that we are key stakeholders and experts in schools ourselves.
• 7:16
  SPEAKER_00: So I think what I hear you saying, if I could make perhaps a not perfect analogy, is we should be more open to approaching this like a shared decision-making conversation, where a patient may have different goals and objectives than perhaps we as providers might have.
• 7:34
  SPEAKER_00: And our goal here or our purpose should be to be soliciting those goals and then discussing kind of options that are consistent with those goals, recognizing that there's going to be trade-offs depending on how those goals are articulated and what tools we have in our toolkit.
• 7:50
  SPEAKER_00: Is that a fair analogy or did I go off the rails there?
• 7:53
  SPEAKER_01: No, I think that's a great analogy.
• 7:55
  SPEAKER_01: And I also think taking that a step further, it's important to remember that goals can change, right?
• 8:00
  SPEAKER_01: And so your goals before everybody had access to a vaccine are probably different than your goals after vaccines have been widely available for a very long time.
• 8:11
  SPEAKER_01: And so keeping the same goals in a dynamic environment doesn't necessarily make a lot of sense.
• 8:17
  SPEAKER_01: And from an implementation science perspective, it's also important to consider the external environment.
• 8:22
  SPEAKER_01: And schools are not islands, they exist as part of a larger community network.
• 8:27
  SPEAKER_01: And I think sometimes if we have kind of separated schools, like they're this super special environment that's completely different than everything else, but schools absolutely work as part of a community network.
• 8:39
  SPEAKER_01: And it's important to consider what's going on in that community and in the broader context and not kind of treating schools as if they're off locked in their own island and they aren't part of a larger network.
• 8:50
  SPEAKER_00: Excellent point.
• 8:52
  SPEAKER_00: So you have kind of alluded to this already, and in particular, looking at vaccines, particularly now that we have vaccines that are approved for children six months or older.
• 9:04
  SPEAKER_00: And as I'm sure you'll kind of touch on, we've just received kind of new information about approval of biology.
• 9:12
  SPEAKER_00: Putting me on the spot.
• 9:14
  SPEAKER_00: Well, that's what we do here.
• 9:16
  SPEAKER_00: How we should we be advising schools and in particular parents and their children about the role of vaccines in kind of keeping the kids safe and protecting the school environment as much as possible?
• 9:29
  SPEAKER_01: So great question.
• 9:30
  SPEAKER_01: And it's a question that, as you alluded to, it, you know, the answer probably changed this morning.
• 9:35
  SPEAKER_01: And so I think that gets to the dynamic nature of the environment and how quickly things have been changing and how quickly we have to adapt our recommendations and our advice.
• 9:45
  SPEAKER_01: So I think number one overarching point is that we still have a lot to learn.
• 9:50
  SPEAKER_01: And this is going to be a space that is going to be changing and evolving.
• 9:54
  SPEAKER_01: And what we say today may be different based on what we learn tomorrow.
• 9:59
  SPEAKER_01: And so I think keeping that in mind and being flexible is critical.
• 10:03
  SPEAKER_01: I know that's that can be a really hard message to accept, but I think it's the reality.
• 10:08
  SPEAKER_01: And none of us have a crystal ball, and we still have a lot more to learn.
• 10:12
  SPEAKER_01: So, as you alluded to, the FDA this morning approved the bivalent booster, which will, in addition to protection from the original strains, also includes the Omicron variant.
• 10:25
  SPEAKER_01: And these updated boosters are going to be available very soon, likely for everyone aged 12 and up.
• 10:31
  SPEAKER_01: And I think a major place where we need to be careful and think through how we move forward is communications research around vaccination.
• 10:41
  SPEAKER_01: As I discussed briefly in a commentary I wrote this summer in JAMA Open with Malia Jones and Kareem Cater, vaccine uptake communication models are really based on outdated theories of what drive human behavior.
• 10:53
  SPEAKER_01: And one of my favorite studies in this space was a study by Nihon et al.
• 10:58
  SPEAKER_01: that was published in Pediatrics back in 2014.
• 11:00
  SPEAKER_01: And in this study, they randomly assigned parents considering vaccination for their children to different communication strategies.
• 11:07
  SPEAKER_01: And I think the over the high-level takeaway point from this study was that the educational strategies, which by and large were very convincing for providers, were not did nothing to move the needle on parental intent to vaccinate their children.
• 11:25
  SPEAKER_01: And importantly, in this randomized investigation, they also found that strategies that clinicians, I think, often pursue were actually may have had the opposite impacts.
• 11:36
  SPEAKER_01: And in particular, when they showed parents pictures indicating severe disease from the various vaccine-preventable infections, what they found was showing the pictures actually decreased intention to vaccinate.
• 11:49
  SPEAKER_01: And so these strategies where we as clinicians try to express how severe the disease is and why it's so important to prevent were completely unconvincing to parents.
• 11:59
  SPEAKER_01: And so I think really more high-quality studies are needed, like this one, are needed to determine what the most effective communication strategies are.
• 12:08
  SPEAKER_01: But we also need to be humble that just because it is convincing to us doesn't mean it's convincing to the parents.
• 12:15
  SPEAKER_01: And so as we think about vaccines and vaccine promotion, it's really important to remember that what we find convincing may not be convincing to the parents.
• 12:25
  SPEAKER_01: And that I think is an important takeaway for all providers as we think about counseling not only school districts, but also counseling parents.
• 12:34
  SPEAKER_01: So I think communications research around vaccination and thinking about how we communicate is critically important and something that anyone advising school districts should think about.
• 12:43
  SPEAKER_01: And then as we think about vaccines in pediatric populations in particular, a couple bits of advice.
• 12:51
  SPEAKER_01: And as I say, this is not a place where we have a lot of data on what actually works, is that we should be honest about what is known and what is not known.
• 13:00
  SPEAKER_01: The beauty of mRNA technology is that it can be adapted quickly.
• 13:04
  SPEAKER_01: And so part of the reason we were able to get vaccines into arms and ultimately prevent many, many deaths are because the mRNA technology is very adaptable.
• 13:15
  SPEAKER_01: The downside of that is that it's a relatively new technology, and the boosters today were approved based on data from mice.
• 13:24
  SPEAKER_01: We don't even have immunologic data from humans, let alone efficacy data from humans.
• 13:29
  SPEAKER_01: And I think that is going to be a major challenge as we think about counseling patients and school districts and how we think about this vaccine.
• 13:38
  SPEAKER_01: And so I think it's a challenge.
• 13:40
  SPEAKER_01: And then I will say that it is my intention to get the updated booster.
• 13:44
  SPEAKER_01: So I don't mean to suggest that I am not convinced that this is a good strategy, but I do think being honest about what is known and not known is critically important.
• 13:54
  SPEAKER_01: And being honest about where the data are and where they may be in a little while.
• 13:58
  SPEAKER_01: Over the course of the pandemic, many parents have educated themselves, and it's important to acknowledge limitations of current data and not to dismiss their concerns.
• 14:08
  SPEAKER_01: Because ultimately, not acknowledging limitations and not acknowledging the extensive research that many parents have done erodes trust.
• 14:17
  SPEAKER_01: And I think, as we have all seen, trust is in pretty short supply these days.
• 14:22
  SPEAKER_01: Finally, I hear a lot about how kids are low risk and therefore should not be vaccinated.
• 14:28
  SPEAKER_01: But I think a key point, and I think a key point that is missed in this message is that we often vaccinate kids, even when kids are at relatively low risk of a particular disease.
• 14:38
  SPEAKER_01: And a great example of this is polio, right?
• 14:41
  SPEAKER_01: Polio is actually a disease of sanitation.
• 14:44
  SPEAKER_01: Prior to sanitation, almost all kids got it when they were very young and it caused a relatively mild disease and they developed immunity and then subsequently did not suffer the severe consequences of polio.
• 14:55
  SPEAKER_01: After sanitation, we moved up the age at which kids were exposed to the disease, and that's when we began to see paralytic polio and the really severe consequences of the disease.
• 15:05
  SPEAKER_01: But we're vaccinating kids when they're young when they're not at high risk, and then that protects them over the course of their lifetime from high-risk disease.
• 15:13
  SPEAKER_01: And a challenge here is that COVID is still relatively new.
• 15:16
  SPEAKER_01: We don't have 30 years worth of data on COVID, but it's important to remember that kids are kids now, but they're going to become teenagers and then they're going to become adults.
• 15:25
  SPEAKER_01: And if we get them immunity when they're young, that may translate to long-term improvements in health for when they're older and when they really are at higher risk of severe outcomes.
• 15:34
  SPEAKER_01: And so I think it is true that kids are certainly at lower risk than adults.
• 15:40
  SPEAKER_01: It is also true that vaccinating them when they're young may protect them when they're older.
• 15:44
  SPEAKER_01: We have to recognize that we don't have a lot of longitudinal data, but certainly data from other pathogens suggests a benefit to vaccinating during childhood to provide lifelong protection against some of these vaccine preventable diseases.
• 15:58
  SPEAKER_00: That's a really interesting way of looking at it.
• 16:00
  SPEAKER_00: And I really actually had never kind of considered that kind of approach or talking point.
• 16:05
  SPEAKER_00: And so something that I'll need to consider when I'm talking to parents.
• 16:10
  SPEAKER_00: So as we kind of look at kind of the logistics of reopening, what kind of work are you doing now or have done to help schools open as safe as possible?
• 16:22
  SPEAKER_00: And what advice would you have for others who are kind of in that same role?
• 16:27
  SPEAKER_01: Sticking on the vaccines for a second, because I think this actually relates to the vaccine question, is a big question is when and how to deploy a booster vaccine campaign.
• 16:38
  SPEAKER_01: So broadly speaking, we know that boosters reduce risk of severe disease, but we also know that the benefit of boosting, at least with current vaccines, for reducing transmission and preventing any infection, wanes relatively quickly over time.
• 16:52
  SPEAKER_01: So after a booster dose, the major benefit in terms of preventing any infection lasts for maybe 10 weeks.
• 16:59
  SPEAKER_01: There are also some encouraging studies that, including a very well-done recent preprint conducted in prison populations, suggesting that there is also long-term reduction in transmission.
• 17:10
  SPEAKER_01: But I would say the biggest bang for your buck, you really feel over a two to three month period.
• 17:15
  SPEAKER_01: And so I think a major place where we can bring our expertise is in advising schools on how and when to conduct a booster vaccination campaign and also partnering with schools to bring boosters and vaccine vans and vaccine campaigns to the schools in order to deploy this.
• 17:34
  SPEAKER_01: And so thinking through when is the period where you're going to get the most benefit from boosters preventing transmission.
• 17:43
  SPEAKER_01: And so, for example, in the Northeast, that's probably around the same time we're thinking about flu vaccination to get us over that hump that is very likely to occur in December and January.
• 17:53
  SPEAKER_01: So I think thinking through optimal timing and then also the logistics and helping schools actually administer the boosting campaigns.
• 18:02
  SPEAKER_01: As I as I mentioned, schools are schools.
• 18:04
  SPEAKER_01: This is not something that they usually do.
• 18:06
  SPEAKER_01: They're not used to testing, they aren't used to HIPAA, they aren't used to all of these things.
• 18:11
  SPEAKER_01: And so, how can we help bring our expertise and our ability to provide vaccines and bring it to their door to make it as easy for them as possible?
• 18:20
  SPEAKER_01: I think another thing where we can really bring a lot of value is for the past two years, we have been almost singularly focused on preventing COVID-19.
• 18:31
  SPEAKER_01: But we can see from what is going around the country that there are many other problems that are occurring simultaneously.
• 18:37
  SPEAKER_01: And in particular, I think a major place where we need to direct our attention is on just simple routine childhood vaccinations.
• 18:45
  SPEAKER_01: There's a polio outbreak ongoing in New York.
• 18:49
  SPEAKER_01: And obviously there were measles outbreaks before we had the current polio outbreak.
• 18:53
  SPEAKER_01: And there really needs to be a strong focus on the tried and true childhood vaccinations and making sure that children who are eligible for those vaccinations, MMR, polio, all of them are receiving those vaccinations.
• 19:09
  SPEAKER_01: And I think that means recognizing that the mRNA technology is new and that other countries don't necessarily recommend COVID vaccination for kids.
• 19:18
  SPEAKER_01: And so my kids are vaccinated.
• 19:21
  SPEAKER_01: I think that the long-term impacts of vaccination outweigh the long-term risks.
• 19:27
  SPEAKER_01: But parents are not wrong when they tell you that there may be an increased risk of myocarditis, and they're not wrong when they tell you that Denmark doesn't recommend vaccinating kids.
• 19:36
  SPEAKER_01: On the other hand, I'm sure all countries are recommending polio and MMR vaccines.
• 19:41
  SPEAKER_01: And we really need to make sure that we don't spend so much time focused on COVID that we lose the forest for the trees and focusing on and making sure that kids are up to date in other vaccinations, especially given the recent changes and re-emergence of polio, especially polio vaccine.
• 20:00
  SPEAKER_00: Great.
• 20:01
  SPEAKER_00: So looking at other kind of non-pharmacologic, uh non-vaccine related indications, I know that as you already alluded to, the quality of evidence underlying things like testing and enhancing indoor air quality just are not there to kind of make black or white recommendations.
• 20:21
  SPEAKER_00: Can you kind of speak in general about how schools should be thinking about testing or kind of how you approach this when you're talking to the schools that you're involved with?
• 20:32
  SPEAKER_01: Absolutely.
• 20:33
  SPEAKER_01: That is a fabulous question.
• 20:35
  SPEAKER_01: A couple things, and I have a couple points to make.
• 20:38
  SPEAKER_01: First, the data continue to emerge.
• 20:40
  SPEAKER_01: And one of the things that I'm really excited to see is there's actually a cluster randomized controlled trial being conducted by the University of Leeds on the addition of HIPAA filters into classrooms.
• 20:51
  SPEAKER_01: That study was initially planned to be conducted last spring, but it did get delayed, but is ongoing.
• 20:58
  SPEAKER_01: And it will close, I believe, the study protocol says we should the last day of data collection is September 30th.
• 21:04
  SPEAKER_01: And we should expect to see some results from that study very shortly.
• 21:08
  SPEAKER_01: And I hope that that will provide us with some better data to really say if HIPAA filters are effective, how effective are they?
• 21:16
  SPEAKER_01: And how much bang for your buck are you going to get from that intervention?
• 21:20
  SPEAKER_01: The other places where we can think about these recommendations are how are we going to deploy other non-pharmaceutical interventions like ventilation upgrades, masks, and tests.
• 21:33
  SPEAKER_01: Without getting too much in the weeds, according to Education Week, state education departments and local school systems got approximately$190 billion from three legislative packages for elementary and secondary education.
• 21:48
  SPEAKER_01: And I don't want to get too much into the weeds with this, but some of those funds were allocated for learning loss.
• 21:54
  SPEAKER_01: About 20% of one of the programs was allocated for learning loss, but that leaves a lot of money.
• 22:00
  SPEAKER_01: That can be spent in other ways.
• 22:02
  SPEAKER_01: And just to give you a rough estimate of where schools currently stand, I checked Buck Boston Public Schools and they had received around$40 million in federal support.
• 22:12
  SPEAKER_01: But as of June of this year, only about 20% of those funds have been allocated.
• 22:17
  SPEAKER_01: And so a major place where infection control experts and hospital epidemiologists can help is to provide assistance to schools about how to allocate these funds and where these funds would be most appropriately spent and where they might have the best bang for their buck.
• 22:33
  SPEAKER_01: And so we've sort of moved away from mandatory masking as a universal policy, but masks are certainly still recommended by the CDC in some settings where there's high transmission.
• 22:47
  SPEAKER_01: And any person who wants to wear a mask should be supported in that decision.
• 22:51
  SPEAKER_01: I would also say that any person who wants a mask should be provided with a high-quality mask.
• 22:57
  SPEAKER_01: And that is a good use of these federal dollars and a place where the federal dollars can be spent to support education.
• 23:03
  SPEAKER_01: But schools don't have a lot of expertise in which types of masks they should purchase, or how many they should purchase, or what sizes they should purchase.
• 23:11
  SPEAKER_01: And that is a place where our expertise can come in to help them think through what types of masks they want to distribute, how many masks, all of those sorts of questions.
• 23:21
  SPEAKER_01: Testing is another place where we've seen a lot of evolution.
• 23:24
  SPEAKER_01: And in prior years, a lot of funds have been spent on surveillance testing, which is a, at least in the state of Massachusetts, surveillance testing was converted by pooled PCR testing among asymptomatic students to identify cases.
• 23:38
  SPEAKER_01: We also had a test to stay program last year.
• 23:41
  SPEAKER_01: And the idea of the test to stay program was if you were exposed in a classroom setting, you could then take an antigen test that morning.
• 23:49
  SPEAKER_01: And as long as you were negative, continue to stay in school.
• 23:51
  SPEAKER_01: And also symptomatic testing for students who became symptomatic at school.
• 23:57
  SPEAKER_01: And I think data are still emerging and evolving about the effectiveness of the surveillance testing program.
• 24:04
  SPEAKER_01: The test to stay program was actually decommissioned in, I believe, the end of February of last year, of last school year here in Massachusetts due to the Omicron surge and the massive amount of work we added to school nurses' workload.
• 24:20
  SPEAKER_01: Many school nurses are relatively understaffed and overworked, and they have a lot of responsibilities.
• 24:26
  SPEAKER_01: And so I think it's important that when we talk about what should be done in schools, we remember what school nurses are already doing and that they already often had a completely full plate.
• 24:36
  SPEAKER_01: And while we are focused on preventing COVID-19, they're focused on a whole lot of other things: allergies, making sure children who are diabetic get their insulin, lots of really, really important topics.
• 24:49
  SPEAKER_01: And so when we ask schools to do something, we need to think about what we are adding to school nurses.
• 24:55
  SPEAKER_01: And I think engaging school nurses and listening to what they have to say and their feedback is critically, critically important.
• 25:02
  SPEAKER_00: Well, that's a whirlwind tour of some really difficult and challenging topics.
• 25:07
  SPEAKER_00: And I really appreciate your perspective on those.
• 25:11
  SPEAKER_00: Do you have any final thoughts for our listeners as we kind of wind up this podcast today?
• 25:16
  SPEAKER_01: Sure.
• 25:17
  SPEAKER_01: So I think the biggest thing is that I hear a lot that, quote, the science has changed.
• 25:21
  SPEAKER_01: And, you know, that's I think some often mocking, especially on social media.
• 25:25
  SPEAKER_01: And it's not really true that the science has changed, but it is true that our understanding and the tools that we have in our toolbox have changed.
• 25:33
  SPEAKER_01: The other thing that has been constantly changing is the context of the pandemic.
• 25:37
  SPEAKER_01: We are not where we were in March of 2020 or even July of 2020.
• 25:42
  SPEAKER_01: And our recommendations and how we approach schools need to adapt to the current environment.
• 25:48
  SPEAKER_01: We have to be nimble and constantly adapting.
• 25:51
  SPEAKER_01: That is one of our biggest challenges.
• 25:53
  SPEAKER_01: And if there's one thing that I would like everybody to take away from this, is that we need to listen to the stakeholders on the ground.
• 25:59
  SPEAKER_01: We are experts in infection control, but we are not experts in schools.
• 26:04
  SPEAKER_01: What works in hospitals does not necessarily translate well to other settings.
• 26:08
  SPEAKER_01: And it's important to listen to the concerns and learn about the current workload and processes within the schools before making any recommendations.
• 26:16
  SPEAKER_01: We don't hear from the end users.
• 26:18
  SPEAKER_01: Ultimately, we're going to make recommendations that are not feasible or acceptable, and our impact will be reduced.
• 26:23
  SPEAKER_01: And so thinking about who the end users are, what they can do feasibly, and what their goals are is critically important for actually translating our expertise into impact.
• 26:34
  SPEAKER_01: And finally, like, don't forget the basics.
• 26:37
  SPEAKER_01: For the past two years, essentially our entire focus has been on COVID-19.
• 26:41
  SPEAKER_01: But health is much more than just one outcome and other infections and basic infection control is important too.
• 26:48
  SPEAKER_01: There's a polio outbreak because uptake of other childhood vaccinations have fallen off.
• 26:53
  SPEAKER_01: And we've also heard over the past two years a lot about airborne aerosol transmission, but not to sound too much like a hospital epidemiologist, but hand hygiene is still important.
• 27:03
  SPEAKER_01: Thinking about the basics and remembering that when we're providing advice, we can provide advice about COVID, but also about other things too, is very important.
• 27:11
  SPEAKER_00: Wonderful.
• 27:12
  SPEAKER_00: Thank you, Dr.
• 27:13
  SPEAKER_00: Branch Element.
• 27:14
  SPEAKER_00: And thank you for a wonderful conversation today.
• 27:17
  SPEAKER_01: Thank you so much for having me.
• 27:18
  SPEAKER_01: I'm always happy to come back.
• 27:20
  SPEAKER_00: Thank you again to Dr.
• 27:21
  SPEAKER_00: Branch Element for sharing her perspective on this topic.
• 27:24
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program, where you will also find resources such as the SHA COVID-19 town halls.
• 27:35
  SPEAKER_00: This concludes today's episode of the Rapid Response Podcast.
• 27:39
  SPEAKER_00: Thank you for tuning in.