Thread by @amychomd

As teachers go back to school, I think it's important that they learn from what we have learned in hospitals. I will share some things and hope others chime in with their best tips.

#MedTwitter #NurseTwitter #teachertwitter

First of all, if folks have any potential symptoms, they need to get tested and STAY HOME.

Common symptoms:
*Fevers/chills
*Shortness of breath
*Cough
*Fatigue
*Sore throat
*Headache
*Muscle aches
*Loss of taste/smell
*Nausea, vomiting, diarrhea

cdc.gov/coronavirus/20…

Unfortunately, though, we cannot effectively screen out all of those with active infections because some don't get severe symptoms.

Some folks who are infected are:
*Minimally symptomatic
*Pre-symptomatic
*Asymptomatic

However, we believe they can still spread infection.

For this reason, we must take "universal precautions." That means that we observe the same precautions around everyone, even though they don't seem sick.

In the ER, we have a new saying..."Everyone has COVID"

"Everyone has COVID" reminds us that we must observe universal precautions around all patients...and around one another.

One thing we have learned in hospitals is that outbreaks occur among employees and colleagues, too, because it is easy to let your guard down.

In fact, the Minnesota Department of Health has been monitoring healthcare worker cases of COVID-19 and approximately 25% of cases have been acquired from a fellow co-worker.

It is important to realize that the same precautions need to be followed colleagues, not just students.

Just to reiterate...MDH found that healthcare workers exposed to co-workers with COVID-19 are almost four times more likely to go on to develop COVID-19 (4.2%) compared to healthcare workers exposed to a COVID-19 positive patient (1.5%).

I know it stinks, but you should consider shutting down the breakroom along with the cafeteria. You may want to continue planning meetings from your own room via virtual conferencing. If you meet in person, social distance and wear masks.

Hospitals have learned and we now understand better how to prevent transmission. The most important interventions can be easily adapted in schools and include:
*Physical distancing as much as possible
*Universal masking
*Eye protection
*Hand hygiene
*Disinfection

Fomite transmission (from touching surfaces) is a possible mode of transmission. This study showed that the virus lives longer on surfaces like plastic and for a shorter period on surfaces like cardboard.

nejm.org/doi/suppl/10.1…

This is why, in the hospital, we store our masks in paper bags and not tupperware.

Some hospitals have developed disinfection protocols (e.g. UVC). Others use a rotation where a set of masks are used, stored in paper bag and reused after 5 days to be sure the virus is "dead."

Eye protection seems provide additional protection because droplets and infection can enter through the mucosal surfaces of the eyes as well as the nose and mouth. cnbc.com/2020/07/31/dr-…

Most physicians who work with COVID patients follow some sort of personal "protocol" when they get home from work...wash hands, disinfect cell phone, change out of work clothes, leave shoes at door, shower.

Hospitals also worked very hard to improve protections for aerosol-generating procedures. This includes the use of more effective masks (N95s) and improved air exchange in rooms by converting them to "negative pressure."

This would be harder to replicate in schools. But there are ways schools can accomplish this including:
*Hold classes outdoors, opening windows
*Avoid high risk activities e.g. singing
*Increase air exchanges in the building
*Offering maximum PPE to teachers
*Air disinfection

This is an exceptional, evidence-based, actionable guide to ways schools can mitigate risk of infection and transmission to teachers and families.

schools.forhealth.org/wp-content/upl…

It is NOT all-or-nothing. For a virus that spreads exponentially, even small decreases in spread makes a difference. There is some evidence suggesting severity of infection might be decreased by decreasing the viral load (amount of virus) in the exposure.

In March, I was concerned our hospitals would become hotspots and engines for spread since they are not places where physical distancing works. But we have learned a lot since then and I feel a lot more confident now that we can stop the spread of COVID in hospitals.

My emergency medicine group worked with a process improvement team donated by Medtronic to help us. Five different hospital systems participated. It was successful. We aren’t seeing outbreaks among staff. NONE of our docs seem to have been infected at work.

The team worked tirelessly and helped us immensely. The excellent work is freely available here: medtronic.com/us-en/healthca…

I am scared now as schools re-open. But I also have hope that we can have similar success as hospitals.

Decreasing community spread so that fewer people aren't coming into schools infected is incredibly important. Schools do not operate in a vacuum.

Pretending that the risk doesn't exist is not helpful. Kids are largely spared but some do die. But kids live with at-risk family members and teachers and staff are at higher risk.

Funding schools so they can make the needed changes to mitigate risk is incredibly important.

Sharing what we know from hospitals can help.

It will take significant investment. It won't be easy. But #MedTwitter can help. We won't give up. #teachersareessential #kidsdeserveit