As @BillHanage has written, hybrid schooling may be the worst of all worlds. I'd like to walk you through a week in the life of my first grader to illustrate why.…
For context, my city has very low community spread: test positivity is 0.16%. Public high schools are fully remote, middle schools will be remote until at least November, and elementary schools are using a hybrid approach. (Many private schools are opening full-time in person.)
On Mondays and Tuesdays, my 6-year-old will be learning remotely while cohort A attends school in person. He can't handle remote learning on his own and both parents work, so he'll probably be with a paid sitter, likely one that's shared with at least one other family.
On Thursday and Friday mornings, he'll be learning in person at school as part of cohort B, in a reduced class size of about 10 kids. Those afternoons, he'll be in paid childcare at the school in a group of 26 kids, including kids from other cohort B classrooms.
On Wednesdays, he'll be in paid childcare at the school, again with a group of 26 kids, but this time mixing with kids from *both cohort A and cohort B.* (He'll be doing "remote" learning during this time, but the staff can't assist beyond helping the kids turn on their devices.)
Hybrid allows distancing in the classroom. But here's the result: in one week, my kid will have interacted with 1) the teacher and kids in his class, 2) childcare staff, 3) kids in other cohort B classes, 4) kids in cohort A, and 5) a sitter and other families on remote days.
What about research on the hybrid approach? One model found that hybrid could reduce the risk of outbreaks in elementary schools compared with full-time in-person learning, but the study didn't account for social contacts on remote days.…
There are obvious educational, health, and equity costs to kids doing most of their learning remotely. But setting those aside for the moment, it's hard to see how the hybrid model makes sense even from an infection prevention standpoint.

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More from @JuliaLMarcus

18 Sep
In contrast to #COVID19, there are powerful pharmaceutical interventions that can prevent HIV transmission: #PrEP is ~99% effective and #UequalsU is 100% effective.

So why has HIV incidence essentially flatlined in the U.S., and what does this mean for COVID19?

Structural inequities ensure that HIV prevention strategies are used least by those most in need. That's why incidence is *increasing* in young Black gay and bi men while stable or declining in other groups.

The result: highly effective interventions, limited population impact.
We can't just put interventions out in the world and hope for the best — we have to address people's barriers to using them.

Unstable housing is a key barrier for HIV. So what happens when we provide housing assistance? HIV outcomes improve.…
Read 5 tweets
15 Aug
🚨NEW: I wrote this piece for @TheAtlantic about the latest weapon being unleashed in the war against #COVID19: the cops. Crowded indoor parties need to be avoided during a pandemic, but policing people’s behavior will be toxic to public health efforts. 1/…
Enforcement may be ramping up now, but let's be real: we’ve already spent months policing each other. People have been widely shamed for enjoying themselves—even when their fun is low-risk. The message is clear: pleasure is not essential in a pandemic. 2/…
The instinct to yell at people for being careless and selfish is perfectly understandable. But public health is a service industry, and it can't serve customers without first trying to understand them. Let’s start by asking *why* people are partying. 3/…
Read 7 tweets
24 Jul
Many people have seen this new @CDCgov statement on the importance of opening schools, which is watered down and likely politically driven. But there was also some useful guidance that was posted today.

I'll try to link each item in this thread.…
Here's the guidance for K-12 administrators on preparing to open schools, including considerations related to community spread and best practices for prevention.…
Here's the guidance on the use of cloth face coverings for schools, including scenarios where they're recommended and strategies to support students of various ages in wearing masks.…
Read 8 tweets
17 Jul
Since writing this piece for @TheAtlantic, I've been contacted by a whole lot of dudes who won't wear masks. I've had some good conversations with them.

Here are a few things I've learned. 1/…
These men were universally grateful to read something about anti-maskers that didn't shame or demonize them. It made them want to hear what else I had to say about why it might be worth wearing a mask. Compassionate public health messaging builds trust. 2/
They felt like mask mandates were an infringement on their liberties. Instead of dismissing that concern, it helped to acknowledge it and talk about other people's freedoms too, especially people who don't have the choice to move away from them. 3/
Read 6 tweets
29 Jun
I've been writing about the need for empathetic public health messaging, which is more effective than trying to shame people into changing their behavior. Some have asked what exactly that looks like.

Here are a few simple examples.
It's easy to call people selfish for going to brunch in a pandemic. But messages about the risk of gathering indoors will be heard much more clearly when they come from a place of compassion.
Acknowledging what people dislike about masks, instead of telling them to stop whining, will help them trust you when you try to convince them it's worth the discomfort.
Read 4 tweets
17 Jun
People want to socialize – and not just outdoors, masked, and 6 feet apart.

We're craving a sense of normalcy. We desperately want to forget we're living in a pandemic.

So why aren't we talking more about social bubbles?

The idea with bubbles is that people have just a handful of social contacts, maybe a few friends or one other household.

Everyone keeps up the masks and distancing outside of the bubble, but there's normalcy within it: dinner parties, playdates.

Social bubbles aren't risk-free. But modeling suggests they could be a viable strategy for keeping the curve flat. And if bubbles can give people enough of a sense of normalcy to forgo crowded bars and house parties, that's a public health win.

Read 5 tweets

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