2020/07/12

Start School Virtual, Go Physical When Feasible

These are my observations for our local conditions (Santa Clara County, July 10-12, 2020), which to summarize:

Observations


  1. There are still many unknowns and new information is arriving every day.

  2. Local conditions are critical.  This includes both the local prevalence and virus trends, and the school community’s needs and risks.  General statements need to be evaluated to see how they are applicable to local conditions.

  3. Research about both the educational impact of the virus, and distance learning, seems to indicate significant differences between younger children (<~12yo, cutoff) and older (>~12yo).  Specifically:

    1. Younger children appear to transmit the virus significantly less than adults. We don’t know as much about teenagers.  Both young children and teenagers can be infected asymptomatically, and are more likely to be asymptomatic than adults.

    2. Teenagers are “more similar to adults” in their response to the virus, per the SCC guidance.

    3. Younger children can much more easily move to a small-stable-cohort model with a single teacher, without educational loss, than teenagers can.  Teenager learning requirements are different and the varied and differentiated learning model is not very compatible with a single teacher/stable cohort model.

    4. Younger children require childcare, teenagers require much less.  The child care function of the elementary schools, which, let’s be realistic, is driving a lot of the physical re-opening urgency, is not a major issue for high school students.

  4. It’s a surprising apparent result that COVID is transmitted by children much less than the flu. This needs more research, and it seems quite possible new information might bring new guidance or nuances important for school safety.  (Also, I haven’t seen any discussion about how a cold and flu season overlaid with COVID might impact transmissibility, which seems like it could be a concern.)

  5. It is pretty clear that children can acquire the virus without much difficulty, the only real questions are around how much risk they face when they do (to date, not as much in terms of fatality rate, but long term studies don’t exist) and whether they transmit to others (as Dr. Cody said, we don’t know yet).

  6. The risks to teachers are possibly substantial, especially if the transmission hypothesis is wrong.  Many teachers are in high risk categories.  Even the hypothesis is right, think about the multiplied risk of a non-small-cohort based teacher coming in contact with 60-120 students every day, even mediated by masks, inside air conditioned rooms.  (A small risk multiplied by a large number becomes a large risk.)  This is also a risk to students, of course.  And even if a teacher is “just” out for 28 days of isolation, where will a subject-trained, in-person substitute come from?

  7. Schools with in-person socially distanced learning are not going to be educationally equivalent to “regular” school, in my opinion (see also opinion of a 5th grade teacher for that environment).  Teachers won’t be able to walk around and check in on students, students won’t be able to collaborate in hands-on projects or discuss things in small groups in person nearly as well.  So we should be realistic about the options in front of us.

  8. Schools do not currently have the capacity (space or teachers) to have all students come back to school at the same time.  Most likely ½ to ⅓ of the student body at most can be physically on campus at once.  This, obviously, plays havoc with differentiated learning schedules and means that no matter what there is going to be virtual learning going on in the mix -- so, we’d better all get really good at it.

  9. The pandemic isn’t a 6 month thing; we are more likely going to be dealing with this for the entire school year, and, possibly, the next year.  We should plan accordingly.

  10. There’s one month until the planned school start date.  We have very little time to plan and execute on that plan, and this is the point where we should triage and attempt to hit our most important target fully before moving on to second priorities.  If we try to plan for too many contingencies at once, we risk failing at them all.

My Opinion

For at least secondary (middle & high) schools: "Start School Virtual, Go Physical When Feasible"


We should plan on the best possible virtual classroom to start with and make sure we have everything we need before the start of school, 4 weeks away.  This also needs to include in-person safety plans for some groups who absolutely cannot be served by virtual classrooms.


While that plan runs, we start planning for a phased-in physical re-opening.  Whether that’s a different schedule, a partial (1d/week), a different schedule for classes, priority meetings, or something else needs to be worked out.  The metrics and decision trees we need to use for deciding things safe for various stages, and how to move back and forth, must be well defined.


At this point, I would feel far more comfortable if the SCC guidance for surveillance testing of teachers once per month were extended to testing the entire school community at least once or twice per week.  Because any cases among students are likely to be asymptomatic, symptom based surveillance is unlikely to catch problems until after the virus has spread substantially.  Experts recommend this measure and it’s what several other countries are doing -- and the others have much lower community transmission than we do.  The costs at the moment are substantial, but there are several ways to reduce the costs per person.  We should explore them, and having time to do that is another reason to push this back.

References

SCC County Guidance (Jul 2), Announcement, Q&A .  At https://youtu.be/P36GN01dovY?t=1486 Dr. Cody says “In this country, we don’t know yet” about how much children are contributing to the pandemic and how much re-opening will affect it, and that guidelines may change as the science changes.


Leaked CDC July 8, 2020 briefing document outlining guidance and risks for schools: https://int.nyt.com/data/documenthelper/7072-school-reopening-packet/b70172f2cc13c9cf0e6a/optimized/full.pdf#page=1 (note: no discussions about transmission via normal aerosols from breathing, which is an area of active research; nor of HVAC systems that might play a role in indoor transmission.)

Metrics

https://covidactnow.org/us/ca/county/santa_clara_county?s=647107 -- Tracks Rt and other metrics over time, recommended by Harvard Global Health institute to help guide decision making by local authorities.

International & College School Re-Openings

How schools across the globe are reopening amid the coronavirus pandemic

Harvard will allow some students on campus this fall so long as they take coronavirus tests every 3 days  

Harvard, Princeton roll out plans for fall amid Trump pressure to reopen 

'Not Safe': Georgia Tech Faculty Fight Back Against In-Person Classes This Fall 

Here is the new return plan for South African schools 


Studies

Preliminary / In progress

Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents -- Shows no laboratory evidence of lower infectiousness in children (no difference in viral load / shedding) vs. adults.  To be published in October.


An analysis of SARS-CoV-2 viral load by patient age -- in-progress work tentatively indicating ~37% of under-18 COVID patients appear potentially infectious per lab tests vs. 51% of adults (not a huge difference).


Published


Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review: Annals of Internal Medicine: Vol 0, No 0 


Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study (teenagers & 30yo similar in seroprevalence, young children lower). 


Guidance

Coronavirus and Schools - Novel Coronavirus (COVID-19) - County of Santa Clara (Guidance)

 

Key Metrics for COVID Suppression (Harvard) Summary: A  6 page document from Harvard Global Health Institute.  Relevant to translating public health data (e.g., case counts, deaths) into risk levels and action items for public health agencies and other authorities.  While no local agency has adopted this to my knowledge, they haven’t adopted anything comparable, and this seems like a good framework for decision making.

Anthony Fauci: ‘We are living in the perfect storm’

Public Health On Call: 110 - What Do Colleges and Universities Need to Consider to Safely Reopen in the Fall During COVID-19? 

Individual Experts

Perspective | The case against reopening schools during the pandemic — by a fifth-grade teacher (7/10/2020) 


An evidence summary of Paediatric COVID-19 literature -- Jul 10, 2020 rapid review of current evidence and recent updates. 


Top Pediatrician Says States Shouldn't Force Schools To Reopen If Virus Is Surging 


Aerosol transmission: https://twitter.com/quicktake/status/1281467223245295616?s=12 

400 questions from educators: Reopening Schools in NJ- Educator Concerns 

Jul 8, 2020: GA Educators say local data should drive reopening decisions for our schools


Denmark's Rt has gone from 0.6 to 0.9 after school re openings, below 1, but need vigilance (https://www.thelocal.dk/20200430/reopening-denmark-has-increased-rate-of-infection-spread-ssu)  

239 Experts With One Big Claim: The Coronavirus Is Airborne 


Jul 2 new-updates thread on children in schools by UK pediatric infectious disease researcher (survey) includes:

  • The Australia study of 18 confirmed cases (heavily referenced elsewhere as well)

  • The French high school w/660 kids with >14y having high antibodies (exposure)

  • French Primary school with 3 kids in school, no evidence of transmission

  • Ireland: 3 kids/3 teachers, no asymptomatic testing, no in-school transmission detected

  • Singapore: 3 cases w/asymptomatic close contacts tested, all negative (12yo, 5yo, 16 staff)

  • “almost no controversy that children’s safety is not the concern from being in school” (though this is looking only at death rates)

  • Data from Sweden doesn’t show increased risk for high school teachers (of course, Sweden is a bit of a mess generally: https://t.co/mB3HyVp2SF?amp=1)

  • Israel had trouble with outbreaks from secondary schools (high schools)

  • With low community transmission, many countries have schools up and running with few if any issues so far (Spain, Netherlands, SA)

  • Recommends prioritizing school openings over bars and restaurants (because everything contributes to risk->community transmission->need to lock down again)


Why AAP Guidelines Are Pushing for Schools to Reopen This Fall 


CT Bergstrom: "My view is that we should be using school / workplace testing for as many people as possible, ideally at least twice a week." 


(Economist) Paul Romer: Reopening Schools , FAQs on Virus Tests In Schools 


Covid-19, children, and schools: 6 reopening questions, answered by a doctor (health screening and testing as a prerequisites). 

News

Coronavirus: Missouri Summer Camp Closes After 82 COVID-19 Cases 


Texas day care coronavirus risks unclear as state limits information 


37 out of 429 student-athletes/coaches/staff test positive for COVID at UNC Chapel Hill 


Santa Clara County meeting that exposed 40 principals to coronavirus raises red flags 


Explainer: Do children spread COVID-19?  Risks as schools consider reopening. 


Israel school epidemic after school re-opening, Over 20 more schools closed as Israel sees largest daily virus rise in a month 


Duration of exposure to COVID-19 increases risk of infection  


Coronavirus: 45% of asymptomatic patients may have lung damage (A new study from Scripps Research in La Jolla, California, found that among 76 asymptomatic coronavirus patients on the Diamond Princess, 54% had lung damage indicated on CT scan)  


The medical case for reopening schools. (Jul 1)


Research Shows Students Falling Months Behind During Virus Disruptions [NB: The data set at https://tracktherecovery.org/, reference for the math losses in this article, appears to be using ZLearn math lessons as a proxy, which (a) is very noisy (b) applies only to elementary age students (c ) also shows _gains_ of up to 20% during lockdown in some places, such as NY and (d) shows gains for high income ZIP codes in CA, holding roughly steady for middle and low income ZIP codes.  Ignore the big “drop” in June, which is the start of summer vacation.]


Reopening Bars Is Easy. Schools Are Difficult. (Atlantic) 


Reopening Is a Psychological Morass (Atlantic) 


https://www.elcaminohealth.org/newsroom/information-from-el-camino-health-regarding-novel-coronavirus-covid-19#districttesting 

 

Why the U.S. still hasn't solved its testing crisis 


A COVID-19 outbreak on UW’s Greek Row hints at how hard it may be to open colleges this fall


How Covid-19 can damage the brain


Guest opinion: The risk of returning to the classroom in the fall


Opinion | Coronavirus Testing the Cheap, Simple Way (Future paper strip tests)   


https://www.mv-voice.com/news/2020/07/02/what-californias-budget-deal-means-for-k-12-schools?utm_source=express-2020-07-02&utm_medium=email&utm_campaign=express  


Scientists doubt Floyd protests led to COVID-19 spikes | McClatchy Washington Bureau -- Some evidence that outdoor gatherings are safer than indoor.


Fraternity parties lead to 47 new coronavirus cases at UC Berkeley




1 comment:

  1. Thanks for the writeup, John. It seems we should have an abundance of caution and err on the side of safety even as we don't yet have all the answers. We really shouldn't be taking chances with our kids as guinea pigs for the sake of convenience, politics or the economy.

    ReplyDelete

Start School Virtual, Go Physical When Feasible

These are my observations for our local conditions (Santa Clara County, July 10-12, 2020), which to summarize: Observations There are still ...