1/ Listen to the science and reopen schools

Adding months more to this toll will be an educational disaster that some children may never recover from

A thread...
2/ listen to the science, which says that schools can — and should — reopen for in-person learning with appropriate risk reduction strategies, while officials also implement aggressive steps to keep community transmission low.
3/ Listen to the American Academy of Pediatrics, which argued for focusing on science and not politics in supporting a return to in-person schooling with new investments in safety, describing in-person school as “fundamental” to the well-being of the nation’s children.
4/ Prolonged time away from schools has led to months of lost learning and widened gaps in educational achievement, especially for some students of color and those in lower income households.
5/ Adding months more to this toll will be an educational disaster that some children may never recover from. School closures also threaten some children’s safety, due to increased child neglect, hurt children’s mental health, and keep many from getting enough to eat.
6/ The harms of school closure are clear. What about the risks of reopening?

Multiple studies show that children are not only less likely to become seriously ill from COVID-19, they are also only half as likely to get infected in the first place.
7/ Overall, the rate of infection requiring hospitalization among US school-age children (5 to 17) since the beginning of the pandemic though July 4 was roughly 1 in 20,000.
8/ What about the risk to teachers and staff? Again, listen to the science.
9/ A report led by the former head of the CDC under President Obama concluded that children appear less likely than adults to transmit COVID-19 to others — unlike other viruses like influenza — though this evidence is still limited and preliminary.
10/ Studies examining schools with known cases of COVID-19 have shown low transmission rates — for instance, in one case, just two students and no teachers infected out of 863 close contacts.
11/ Others show zero confirmed infections even among teachers and students who sat in the same classroom with a symptomatic child.
12/ Other studies shed light on why childhood infection rates and school-based transmission may be so low.
13/ Compared to adults, children have lower levels of receptors in their airways that allow the coronavirus into our bodies. Children also may not generate as many breath droplets that can transmit COVID.
14/ Finally, what about impacts on the community as a whole? Studies show that social distancing measures have been critical to flattening the curve of COVID-19 infection, but school closures may be among the least effective of those measures.
15/ A study of county rates of COVID across the United States from earlier this year found “no evidence that school closures influenced the growth rate” in COVID infections, and...
16/ ...two international studies similarly found large reductions in COVID spread from social distancing policies in general, but no significant effect from school closures on their own.
17/ No scenario of in-person schooling is risk-free, and there will be infections. Israel has had nearly 2,000 student and teacher cases since reopening in May, though notably it reopened schools largely without classroom size limits or social distancing requirements.
18/ In contrast, 22 European countries have reopened schools without a rise in COVID-19, and there has been little school-based spread in Asia.
19/ Unfortunately, little of this evidence is figuring into the current polarized political conversation. But it should.

We are not advocating a return to schools as usual. Schools must aggressively implement proven risk reduction strategies.
20/ A layered approach should include rapid testing and contact tracing, physical distancing when possible, mask-wearing with breaks built into the day, frequent hand hygiene, and well-ventilated spaces.
21/ Districts should consider adding tents and trailers and converting gyms, cafeteria, and libraries to expand learning spaces.
22/ Staggering arrival and dismissal times and prohibiting parents from entering schools will limit one of the highest risks — having large numbers of adults in indoor spaces.
23/ A final critical step to reopening schools is to keep community rates of COVID-19 low. Opening schools is safer and more feasible if we hold back on higher-risk reopening activities.
24/ State leadership is therefore critical, as school districts can’t control what happens in bars, gyms, large public gatherings (especially of adults), and other high-risk settings.
25/ It reflects poorly on our public priorities that even in Mass, where COVID-19 has been taken quite seriously, it remains unclear if our children will be allowed to return to school, even as adults return, without much debate, to far higher-risk locations like gyms and casinos
26/ Reopening schools should not be an us-versus-them argument. It’s not a Democratic vs. Republican argument. It’s about our children and about the evidence.
27/ We should be following the science that says in-person schooling for our kids is too valuable to give up and that the risks of school-based transmission appear to be low.
28/ We should be investing in adequate testing and tracing resources, making our physical school environments safer, and encouraging a practical balance of social distancing in the classroom with learning and the reality of children’s lives.
29/ This thread is the op-ed we wrote in Boston Globe on July 20th.

w/ my @HarvardChanSPH colleagues Ben Sommers, Sara Bleich, Jessica Cohen


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More from @j_g_allen

21 Sep
1/ If your school is closed and trying to reopen (or if you're open and want to keep it that way), some resources:

✅risk reduction strategies
✅'How to' for assessing ventilation
✅Tool to help pick portable air cleaner
✅20Q every parent should ask

2/ Knowing when to open is hard, too. We recommend basing it on metrics of community spread.

Report here w/ @dsallentess @ashishkjha @meiralevinson @jenkinshelen

globalepidemics.org/wp-content/upl… Image
3/ Not sure what to look for at your school?

Here are 20Q every parent should ask (w/ @CorsIAQ @etgall @KimberlyClev +)

Read 13 tweets
19 Sep
1/ Stay in your seat and remain calm.

This report is making the rounds.

I read it. (including appendix, which I'm guessing few read, b/c if you did....)

2/ For background, flight was from early March, 10-hour flight, thorough attempt to contact all passengers. A massive lift, so nice work by the authors on that front.
3/ Index patient had active symptoms, actively coughing, no masks

First takeaways:

-airplanes are vectors of disease, moving people around countries and globe and spreading
-this person was irresponsible

*stay home when sick*
Read 22 tweets
18 Sep
1/ Want to buy schools time? Open the windows

In late August, FAUCI answered a question on whether he supported healthy building strategies:

"You’re telling me we have this big crisis, and you’re telling me to open up a window? Yes, I’m telling you to open up the window.”
2/ Can it really be as easy as Fauci suggests? Just open the windows? Yes.
3/ When someone coughs, sneezes or just breathes, he or she releases viral particles suspended in respiratory droplets into the air, ranging in size from infinitesimally small to large droplets that will settle out of the air due to gravity.
Read 25 tweets
16 Sep

Why are some more likely to get Covid19?

Why are some asymptomatic while others suffer?

Why are kids so different than adults?

Short thread of new paper by @HarvardChanSPH colleagues, led by Kris Sarosiek (@CellDeathLab), first author @zintisinde
2/ For background, ACE2 is the receptor that SARS-CoV-2 uses to get into our cells

Questions they sought to answer: are there differences in ACE2 expression by age and does this correlates with disease severity?
3/ Here’s what they did:

They measured ACE2 expression in human lung tissue specimens from over 100 donors from ~4months to 75 years of age.

The full preprint is here, but come back to it. Keep reading thread to end.

Read 9 tweets
15 Sep
1/ The Lancet COVID19 Commission recognizes the role of aerosol transmission

In addition to role as a Commissioner, I am Chair of Task Force on Safe Work, Safe School, and Safe Travel

I added this section to our first statement, released today, and approved by all Commissioners
2/ Full text of section 15:

Identifying the dominant modes of COVID-19 transmission is an urgent public health priority. There is growing consensus from the aerosol science and infectious disease communities that aerosol inhalation is a key contributor to COVID-19 transmission.
3/ The US Centers for Disease Control and Prevention (CDC) and WHO have widely communicated a narrowed scope of possible transmission routes, limited to large droplets expelled by coughs and sneezes, and contact with contaminated surfaces.
Read 7 tweets
13 Sep

✅grocery stores
✅Broadway theater
✅jury trials

Thread pulling together our guidance since March

All avail at Harvard #HealthyBuildings: forhealth.org
2/ what to do in SCHOOLS

(w/ Harvard #HealthyBuildings team)

3/ what to do in HOMES

(w/ @mlipsitch)

Read 15 tweets

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