The latest installment of the #PWChat series centered around the reopening of schools during the COVID-19 pandemic.
Below are the highlights from the chat. You can read the full transcript here, by scrolling down to the corresponding questions and responses.
Welcome to the latest #PWChat, with co-hosts @MVP_Pediatric & @DrLindaMD on opening #school during #COVID19. Our plan is to go until 3pm EST, officially, but let’s keep the convo going well after! pic.twitter.com/fLWpyDwZ7P
— Physician’s Weekly (@physicianswkly) July 30, 2020
Q1: What, in your opinion, do school systems need to do in order to reopen safely in as soon as just a few weeks? Are these steps feasible in most schools in America, considering spacing, HVAC issues, teacher unions, etc?#PWChat #COVID19 pic.twitter.com/g7SQcMTKmi
— Physician’s Weekly (@physicianswkly) July 30, 2020
A1 – Schools need to adopt measures of distancing, smaller class sizes, mask wearing, providing supplies for hand washing and cleaning, and screening for illness in general. It may not be feasible in some areas with a high incidence of #COVID19 and limited resources. #PWChat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
Are there any areas with quick test results if you don’t work in the WH administration or play a professional sport? Most of what we here is upward of 7-9 days#PWChat
— Physician’s Weekly (@physicianswkly) July 30, 2020
um … with an average incubation period of 5 days, a test lagtime of 7-8 seems a bit, um, suboptimal?#pwchat
— Matthew Loxton (@mloxton) July 30, 2020
wow.
So assuming totally average incubation. on day 5 after exposure you show symptoms, get the test next day, wait 7 days. That’s 2+5+1+7= 15 days in which you were infectious and spreading it#pwchat— Matthew Loxton (@mloxton) July 30, 2020
Usually, when I test a patient, I tell them to self isolate until the results are back. However, I think they are more likely to actually do so if I tell them their COVID test is +. #PWchat
— Linda Girgis MD (@DrLindaMD) July 30, 2020
Should be.
— Linda Girgis MD (@DrLindaMD) July 30, 2020
They needed to have been planning for this for several years, and have ready-to-roll tested processes and technologies that they understand fully, have thoroughly tested, and know intimately#pwchat https://t.co/S2PV0cim1C
— Matthew Loxton (@mloxton) July 30, 2020
A1 – “Ideally, local school leaders, public health experts, educators and parents can work together to decide how and when to reopen schools.” #PWchat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
You are correct. In California, only about 9% of children are part of the positive test cohort… #PWchat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
Definitely. Kids spread diseases quite readily when they are around others at school. However, there have been mixed reports of the extent of spread with children at school in other countries…we are still learning about the epidemiology of this virus. #PWchat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
Completely agree. It is contextual for sure!
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
Q2: How can teachers be made to feel more comfortable with opening schools and teaching in-person?#PWChat #COVID19 pic.twitter.com/6kBoIYJxnq
— Physician’s Weekly (@physicianswkly) July 30, 2020
I completely agree. Here is a nice infographic from the American Academy of Pediatrics… #PWchat pic.twitter.com/G34tnyvcCL
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
Not seeing enuf re schools offering meaningful options. Must high-risk teachers choose b/w risky work vs. unpaid leave? Will sick leave apply to quarantine? Are health and life ins. benefits beefed up to compensate for new risk? We need politics-neutral standards. #PWChat
— Tim Bonfield (@TimBonfield) July 30, 2020
Wear a hazmat suit in class?#pwchat https://t.co/itTTMQWojs
— Matthew Loxton (@mloxton) July 30, 2020
A2: Educate them on viral transmission & their individual risk. Maybe some of us (doctors, law enforcement) who have worked this whole time & protected ourselves can reassure them? #flattenthefear https://t.co/5e9GJs4foh
— Molly Rutherford, MD, MPH (@UnbridledMd) July 30, 2020
Yes, and the Israel model didn’t work because they reopened when there were still rising numbers. We should be analyzing and learning from other countries. #pwchat
— Linda Girgis MD (@DrLindaMD) July 30, 2020
Right, and then test them in our own environment. Run simulations and look for gaps
We seem to be going more for a grit-teeth-and-hope-for-the-best at the national level#pwchat
— Matthew Loxton (@mloxton) July 30, 2020
I get that, but shouldn’t we be trying to replicate their approach with our parameters in simulations before just letting stuff happen?#pwchat
— Matthew Loxton (@mloxton) July 30, 2020
A2: I would think this question should not be how to make them more comfortable, but rather what can we do to make them more safe? Thinking about risk-based strategies, assessing air handling/filtration, cohorting, etc. PPE as last line of defense… #PWchat #Covid19 pic.twitter.com/XnnS7zcQoI
— Melissa Johnson (@IDPharmacist) July 30, 2020
A2: protect teachers like other essential workers. PPE to level of risk, modify job if needed for high risk workers, liberalize absentee policies, educate on actual risk and methods of virus transmission #PWChat
— Mary D Tipton (@MDTiptonMD) July 31, 2020
Q3: The case & mortality rates of #COVID-19 in March called for closing of schools in many parts of the country. Why, with these rates higher than ever in most areas, is there a call for universal reopening of schools?#PWChat pic.twitter.com/IjS4JXVwDM
— Physician’s Weekly (@physicianswkly) July 30, 2020
A3. I think no one expected for schools to be closed for so long. Much of it’s politics. Everyone wants
kids to be back in school when it is safe and no one can really predict what will happen. #PWchat https://t.co/pGp8y77HFn— Linda Girgis MD (@DrLindaMD) July 30, 2020
Is there anyone at CDC or HHS level actually testing that belief? Like running simulations with a dummy pathogen to see if this is even in the realm of feasibility?
I mean this is a wager with some serious consequences.#pwchat
— Matthew Loxton (@mloxton) July 30, 2020
Q4: There is disagreement among government officials with some calling for opening schools for the fall 2020 semester no matter what and some who are more hesitant. Why do you think there is such disagreement at the governmental level?#PWChat pic.twitter.com/9Ej8e7D1lf
— Physician’s Weekly (@physicianswkly) July 30, 2020
A4 – We don’t want the treatment to be worse than the disease, but also don’t want to sacrifice lives for economic stability. #PWChat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
A4 There’s such disagreement because their are different value props for every group of stakeholders i.e economic impact vs. containment and safety #PWChat
— shereesepubhlth 😷 (@ShereesePubHlth) July 30, 2020
A4 – We don’t want the treatment to be worse than the disease, but also don’t want to sacrifice lives for economic stability. #PWChat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
That is true. If you are dead, you can’t contribute the the economy… 🙁
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
Q5: In Israel, schools reopened, resulting in an all-time high spike in cases among students and teachers resulting in schools shutting down. But, in Germany, they opened with an increase in student spread, but not staff, and stayed open. What can we learn from this?#PWChat pic.twitter.com/lT7jFE0iBP
— Physician’s Weekly (@physicianswkly) July 30, 2020
A5. It teaches us that we can’t just reopen schools without precautions. #PWchat https://t.co/ELcpTsPw4g
— Linda Girgis MD (@DrLindaMD) July 30, 2020
A5 – The factors that affect transmission of #COVID19 are multifactorial. But, it appears that standard safety measures (i.e., wearing masks, distancing, etc.) do make a difference in transmission in any scenario. #PWChat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
A5 – Multifactorial. Full circle for me: Without a plan (masks, distancing, pod structure, contingencies etc.) and $$/resources to execute a safe return opening will result in quick closure
The goal, as some have hurriedly pushed for, is not to open
The goal is to STAY OPEN— Sajjad A. Yacoob M.D. (@sayfuturemed) July 30, 2020
Q6: What are those pushing to reopen schools during #COVID19 not considering?#PWChat pic.twitter.com/ahvOIZQ4t7
— Physician’s Weekly (@physicianswkly) July 30, 2020
A6. The impact it will have on adults working in the school and the spread to the community. Also,
testing needs to be in place and schools need to have a backup plan, ie a return to virtual teaching, in
case cases spike. #PWchat https://t.co/dAyF1j1Kyp— Linda Girgis MD (@DrLindaMD) July 30, 2020
A6 – They are not considering that there will likely be an increased transmission of #COVID19 amongst students, despite reports of lower transmission among younger kids. Also, teachers’ concerns have been not appropriately addressed. #PWChat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
They aren’t considering the social, personal, and economic impacts of large number of people getting sick, having long-term chronic illness, or dying#pwchat https://t.co/t56FdQzQgl
— Matthew Loxton (@mloxton) July 30, 2020
A6 – While spread of #COVID19 may not be as bad as we think, the testing resources will be depleted because every child w/ any concerning symptom will be tested for #COVID19 because of its variable presentation in children. #PWChat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
And we need to have access to quick results. #PWchat
— Linda Girgis MD (@DrLindaMD) July 30, 2020
What a Hobson’s Choice!#pwchat
— Matthew Loxton (@mloxton) July 30, 2020
Thanks for sharing! South Korea did an excellent job in controlling its outbreak from the onset. The US is in a very different place. #PWchat
— Linda Girgis MD (@DrLindaMD) July 30, 2020
yes, but even when Korea had it contained they had issues with outbreaks once they opened up schools. They were only able to trace symptomatic children vs asymptomatic.
— Mary Schook (@Beauty212) July 30, 2020
But, they were able to contain things a lot quicker and more effectively. There was more of a coordinated effort and more aggressive testing. #PWchat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
Q7: What are those pushing to keep schools closed during #COVID19 not considering?#PWChat pic.twitter.com/COujrMiU6L
— Physician’s Weekly (@physicianswkly) July 30, 2020
They may not be thinking about the families who lack resources and would have to stop earning in order to have kids at home
Not everyone is able to homeschool#pwchat https://t.co/aOCjgRHKmD
— Matthew Loxton (@mloxton) July 30, 2020
A7 The psycho-social impact on students with learning disabilities as well as their parents who are essential workers. #pwchat
— shereesepubhlth 😷 (@ShereesePubHlth) July 30, 2020
A7. The socialization that children need, both in the classroom and in extracurricular activities. #PWchat https://t.co/Y7EKplmI3Q
— Linda Girgis MD (@DrLindaMD) July 30, 2020
A7 – Also, families who depend upon kids being in school while they work or schools providing lunches and other services will be severely disadvantaged and suffer the most. #PWChat
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
A7 – In California, those children with significant disabilities also depend on the school to provide some of their therapies #pwchat
— Sajjad A. Yacoob M.D. (@sayfuturemed) July 30, 2020
I agree but my concern is this:
I do not have a good way to measure when the harm from being at home is more permanent or nonrecoverable than the harm from getting/passing on COVID. Is it 4 months, 6 months? And what age? All kids are different so back to no one size fits all— Sajjad A. Yacoob M.D. (@sayfuturemed) July 30, 2020
True. We need good epidemiologic data. Hopefully, this will provide us with some answers to help us make more informed decisions:https://t.co/xwnjR0cCyy
— David Epstein, MD, MS, FAAP (@MVP_Pediatric) July 30, 2020
We allowed staff to split their workhours so they could better balance work vs homeschooling, but I’m not sure many offer that, or what the long-term effect is#pwchat
— Matthew Loxton (@mloxton) July 30, 2020
Since we’re running short on time, still have some questions we wanted to get through, & things are changing daily in regard to #SchoolReopening, @MVP_Pediatric & @DrLindaMD have agreed to co-host a part 2 of this #PWChat at a TBD day & time. Stay tuned!
— Physician’s Weekly (@physicianswkly) July 30, 2020
We’re officially out of time, but PLEASE, let’s keep this very important discussion going! Stay tuned for part 2!
In the meantime, we give special thanks to @MVP_Pediatric & @DrLindaMD for co-hosting & thank you all for joining and providing great insights and thoughts!#PWChat pic.twitter.com/QEQDS8NOAn
— Physician’s Weekly (@physicianswkly) July 30, 2020
