Friday, January 1, 2021

Covid Update and Spread in School

Here is the most official and reliable information that I have as of now.  That being said, ALL health experts point out that this is a novel virus that continues to mutate and very little is known about it.  (Which is all the more scarier and worth considering as we weigh in-person learning). 
In any case, here you go:



Return to School Metrics

From Chalkbeat, (Jan 12, 2021)
“The fact that the staff rates are growing at a faster rate than the community rates is something we should be paying attention to,” said Emily Oster, the Brown University researcher who spearheaded the analysis and collection of this data...
In November, Oster pointed to data showing that New York teachers were no more likely to have COVID than others in their community. That is no longer the case in New York, and it hasn’t been the case in Texas for months — two states that have some of the best data on the topic.An analysis Oster did for the Washington Post in November concluding that schools were relatively safe pointed out that teachers in New York had similar infection rates as the broader community...
“What should worry us is if we start to see infection rates among staff or students that are higher than in the surrounding community,” Oster wrote then.
That’s exactly what the data is now showing“Basically no matter how you look at the numbers, the numbers are higher for teachers than for the community,” 

Many school districts are using the ABC Science Collaborative to guide their return to in-person learning.
From the ABC Collaborative (The ABC Science Collaborative is a program that pairs scientists and physicians with school and community leaders to help understand the most current and relevant information about COVID-19. The program helps school leaders make informed decisions about returning to school using data from their own communities. The ultimate goal of the program is to keep teachers, children, and their local communities healthy and safe.),  
The FAQ cites the table below multiple times and suggests that schools have metrics to follow regarding when it is necessary to return to Remote Learning+



The ABC FAQs also mention multiple times that the amount of fresh air coming intop the building and the use of HEPA filters show no scientific data of mitigating the virus, however the recommendation does say that classes outside are encouraged whenever possible: 
To date, interventions around indoor ventilation (i.e. opening windows) have not been shown to be helpful to prevent the transmission of the virus if people are masking. Air exchange, purifiers, or filters may help minimally, but have not been shown to help if people are masked.  The scientific community encourages outdoor classes when circumstances allow. 



American Association of Medical Colleges (AAMC), (November 5, 2020)
This report from AAMC is critical of the ABCScienceCollaborative:
...Nevertheless, many schools have experienced infections that compelled them to quarantine some students and staff at home for a time, and some school districts in Georgia and Utah have shifted to more online learning after experiencing severe outbreaks.
School outbreaks typically come from the community — not vice versa...
Infections in schools reflect infection levels and mitigation practices in their communities....“You can only open your school safely if you have COVID under control in your community,” says Benjamin Linas, MD, MPH, an associate professor of medicine and epidemiology at Boston University School of Medicine....“You can have the best laid plans” in classrooms, but “if kids are not following social distancing and mask usage outside of school, they’re going to bring COVID into the school with them,” says Peggy Thompson, RN, director of infection prevention at Tampa General Hospital (TGH).

The decision to offer virtual, hybrid, or in-person learning is determined by local school districts.
Lake County school districts should utilize CDC indicators and thresholds for risk of introduction and transmission of COVID-19 in schools.
The Lake County Health Department has provided a daily incidence rate; to fit within the context of the CDC indicators, multiply this incidence rate by 14 for comparison to the CDC chart
The Lake County Health Department will work closely with our schools to monitor absenteeism, disease activity, and other indicators to further inform the transition between learning models.


Here is guidance from AAP which sounds almost contradictory and that seems to let schools interpret however:
Since this guidance was first released, there have been several other documents released by the CDC, National Association of School Nurses, and National Academy of Sciences, Engineering, and Medicine. All these documents are consistent regarding the importance of considering the degree to which SARS-CoV-2 is circulating in a community in making school re-opening policies. It is also evident that uniformity across states as to metrics and thresholds used would greatly assist states and school districts. In addition, there should be different thresholds for different age groups and exceptions for certain populations of students, including those with learning and developmental disabilities and of low English proficiency. Although ideally schools could open in communities with low community transmission, there is mounting evidence of the low transmission within schools even in communities with escalating community transmission. Ultimately, the decision to open schools to in-person learning should be based on the joint guidance of local and state public health authorities and school administrators based on current data in the community as well as the evidence of transmission in schools.
...the approaches states and localities have taken to integrating these concerns into school reopening plans are highly variable.
This variability is driven partly by differences in values and priorities. More concerning is that it may reflect inattention to or underweighting of key epidemiological considerations.
Three community considerations are especially important. First, school reopening increases the risk of transmission within schools but also within households, workplaces, and the community at large. Second, community disease prevalence affects in-school transmission risk, and third, other community characteristics drive the potential impact of increased spread. We elaborate on each of these considerations.
a decision-making framework for in-person learning should start with a threshold requirement of strong in-school mitigation measures and then give closer consideration to several factors operating beyond the school gates—namely, looking for flat or declining community incidence over a defined period and demonstrated willingness to implement and enforce community mitigation measures (eg, social distancing, masking).


New England Journal of Medicine (NEJM) (September 3, 2020)

Any region experiencing moderate, high, or increasing levels of community transmission should do everything possible to lower transmission. The path to low transmission in other countries has included adherence to stringent community control measures...

These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.


School Guidance Illinois Department of Public Health
The school may open with in-person learning but should have a plan to change to all or partial remote learning in the event of COVID-19 cases or outbreaks occurring in the school.






Lake County Detailed Metrics Illinois Department of Public Health
Screen Shot 2021-01-04 at 10.05.50 AM.png

(UPDATE - the map just changed (Jan 6, 2021) to blue which is a positive indicator of stable metrics.  If it stays that way, I have no problem with the return to hybrid model with mitigation strategies.

Adaptive Pause Metrics Guidance for Schools from ISBE (August 17, 2020)
Decisions about implementing school-based strategies (e.g., pivot to remote learning, event or extracurricular cancellations, other social distancing measures) should be made locally, in collaboration with local health officials, who can help determine the level of transmission in the community


Operating schools during Covid-19 from the CDC (December 30, 2020)
...risk being the lowest if community transmission is low...

Indicators for Dynamic School Decision-Making from the CDC (September 15, 2020)
(NOTE: This verbiage was created by the Trump administration during the time when he was saying that the virus is going away and everything should open back up.  Despite that, the verbiage still implies that SHS should be considering the local cases.)
...when making decisions on when to open schools for in-person learning it is important to understand SARS-CoV-2 transmission within the surrounding community to determine the possible risk of introduction and transmission of SARS-CoV-2 within the school...
Core indicators include one or both measures of community burden AND one self-assessed measure of school implementation of key mitigation strategies. Additional information including how to calculate these indicators is found in the table below.
...The number of new cases per 100,000 persons within the last 14 days, AND/OR
The percentage of RT-PCR tests that are positive during the last 14 days, AND
The school’s ability to adhere to the following key mitigation strategies:
Consistent and correct use of masks
Social distancing to the extent possible
Hand hygiene and respiratory etiquette
Cleaning and disinfection
Contact tracing in collaboration with local health department

Each indicator or combination of indicators should neither be used in isolation nor should they be viewed as hard cut-offs by STLT officials and school district decision-makers. Rather, they serve as broad guideposts of inherent risk to inform decision-making.

If, after applying the core indicators described in the table below, a school is at “medium,” “higher,” or “highest” risk of transmission, it does not mean that the school cannot re-open for in-person learning, but that the risk of introduction and subsequent transmission of SARS-CoV-2 is higher and the school could consider alternative learning models (e.g., mix of in-person and virtual learning, also known as hybrid learning, or virtual-only).