@Epi_D_Nique and I collaborated to provide a user-friendly review of the CDC’s study on #Covid_19 spread in elementary #schools in one Georgia district. This study is important because of its focus on young children and community spread. Happy🧵reading! cdc.gov/mmwr/volumes/7…
Data were collected over 24 school days (Dec 1-Jan 22, 2021) on Covid-19 spread in and outside of elementary schools, from Cobb County, GA. What’s interesting about this study? It focuses solely on elementary schools. Why is that important?
These schools serve the youngest group of school age kids, and some believe their contribution to Covid spread is negligible. We know that young kids have less extreme symptoms and lower risk of death compared to older children and adults.
Because of all those factors plus predicted impact of educational loss & lack of socialization, many push to allow the youngest age groups to fully #ReopenSchools. CDC guidance never suggests that elementary kids ever attend fully virtual school, even in the red zone.
This study shows elementary students can spread in schools & be the index case (first case starting the cluster). Data were obtained from 8 schools in one district. Pretty cool things they did- observed school mitigation techniques & collected self-reported data on it too.
Let’s review mitigation approaches- promotion of COVID-19 precautions outside of school, minimizing in-person adult interactions at school, ensured universal & correct mask use, physical distancing (3ft), & plastic barriers.
80% of the kids returned to school, space was an issue so schools did 3ft of distancing instead of 6. Teachers were close to students during small group work, mainly reading. Kids ate in their classrooms.
When a person tested positive for Covid (PCR or antigen), they either self-reported to the school or the school was notified by the health department. The school contact traced and contacts were advised to quarantine and test between day 5-10.
This is huge! This is one of the first studies that tested elementary age children that were quarantined. About 60% of those recommended for free testing, actually tested. Therefore, the data here could be underestimated, but we’re excited to see this much data presented.
Huge thing #2 this study looked at (limited) secondary contacts. For school spread cases, (index case infected another person at school), the investigators tested the household contacts. This provides insight into the question, does school spread contribute to community spread?
Huge thing #3, they actually tell us how they defined “close contacts” and the criteria for being a school-associated case! This is important because these details can be really important to what is found. More on that later.
What did they find- during the study 9 clusters (≥3 linked school-associated cases) were identified involving 13 educators and 32 students in 6 of the 8 elementary schools, all within 24 in-person school days (Dec 1 - Jan 22).
Teachers were the 1st identified case in 4 clusters, a student in 1, & in the remaining 4 a teacher & student were suspected. Teacher-Teacher spread followed by teacher-student spread occurred in 2 clusters which resulted in apx half of the spread in schools (15/31 cases).
Who infected whom? 8 of the 9 school clusters involved at least one educator & educator-student transmission. Also: 4 student-student, 3 student-educator, 2 educator-educator-student. So a whole lotta spreadn’ going on!
I thought there was mitigation? How did this happen? Breakdowns in mitigation. Breakdown #1- Because 80% of students were in person, < 3ft separation was possible. Plastic barriers between students may have helped but didn’t stop spread.
Researchers also suspect transmission between students & educators (7 clusters) occurred during small group instruction, where teachers were close to students. We guess that this happens in classrooms a lot, especially with the younger kids.
Although masks were mandated by the district, compliance wasn’t perfect. Reported & observed compliance was high, but in interviews it came out that students sometimes didn’t wear masks or didn’t wear them correctly (5 clusters).
Then there’s lunch. Lunch was suspected to contribute to transmission among both educators & students. Because, no masks. This has been found in other settings too (NFL study!). It’s a real problem for bringing anyone into buildings.
Speaking of the NFL study, that showed that transmission can happen in way less than 15 mins exposure. But the study used >15 mins per day (plus in 6ft) as the criteria for “close contact” which may have led to missed transmissions.
Did anyone bring covid home? YES. Free testing was offered to all home contacts who could be reached. 60% of all contacts were tested; 26% (n=18) were positive. This shows that schools can contribute to community spread.
Because the devil is always in the details, a few things to keep in mind when we interpret the results. Although this study makes some big advances in our knowledge, the lack of routine testing means not all cases were captured - especially for the students.
There were only 2 clusters where all of the spread was among children. It’s possible that teachers really are more likely to spread. It’s equally possible that spread among children wasn’t always identified since asymptomatic or very mild cases might not have been tested.
Speaking of testing! Routine testing could have prevented these clusters or at least limited their size. Clusters I & F, which show multiple transmission events, might have been stopped before they started if testing captured the index cases very early.
Kudos for reading this far. You get BIG TAKEAWAYS: 1. Transmission happens in schools even with mitigation 2. The more layers of mitigation, the more protection against spread when one layer fails 3. Ventilation/filtration is important for mask/distancing mistakes & meals
Takeaways cont: 4. Plastic barriers don’t replace distancing & ventilation 5. The more people in a building, the more virus in the air, both because there are more people in a room & more people = higher chance *someone* (or more than one someone!) has covid.
Final note: (at least) 14 cases came into the school which resulted in (at least) 63 more cases. Did schools contribute to community spread? Yes. Do family members of students & educators have reason to worry about infection? Yes.

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More from @Theresa_Chapple

20 Feb
my concern about the CDC operational report on reopening schools
new classification of low, moderate, substantial, and high.
Low is 0-9 cases per 100,000 with a test positivity rate of less than 5%.
moderate combined 2 previous levels and includes up to 8% + rates
I get that the thought is younger children are less likely to contract the virus, but at the same time we believe that pregnant ppl are at increased risk of contracting the virus. It is not a leap to believe elementary age children may live with a pregnant parent.
This is actually highly common for the 40% of families with 3 or more children. Yet, in moderate/low areas, there's no recommendation for virtual school for elementary age kids.
This is a concern for anyone that has any health condition making in-person school particularly risky
Read 20 tweets
17 Feb
3rd grade homework assignment was to discuss with the family why we live where we live. I tried to broadly answer, but my daughter kept probing. Qualitative researcher in the making?
The conversation I didn't want to have, that I ended up having, was about the racism we endured.
I tried to focus on us moving from ATL to MD because of my job. But she's old enough to remember that this is not our 1st home in MD.
Why did we move from our 1st MD home, she askes?
Crap, truth or lie? Think quick. Truth won out.
Our neighbors kept calling the police on us.
She wanted details, why? which ones? how often? was she happy or scared to see the police? She had all the probes.
I explained, everytime we'd enter the home through the front door instead of the garage, the neighbors would report a burglary in progress.
Read 6 tweets
7 Feb
#BlackHistoryMonth Yesterday's letter was E for excellence.
I was tired last night & just wanted the children to go to sleep, but they came to me asking, "who's our example of Black Excellence mom?"
So, I mustered all the energy I could to enthusiasticly discuss @MichelleObama
Mrs. Obama, are 44th First Lady is the epitome of Black Excellence, and became this was as a result of hard work, parents love, community support, quest for knowledge.

My children were impressed to learn that her mother, Mrs. Robinson stayed home with the children and taught
them so much during their early years, that both Mrs. Obama and her brother skipped 2nd grade. We talked about Mrs. O early academic achievements that led her to one of the top high schools in Chicago. How she traveled by bus 1 hour each way to obtain a good education.
Read 13 tweets
6 Feb
Great article on the 8 different ways to sign up for the vaccine in MoCo, MD. "Montgomery County vaccine registration, confusing, time consuming |

wusa9.com" wusa9.com/amp/article/ne…
Philly people can call this number for the vaccine
"Eligible Philadelphians who lack internet access can call a hotline at 215-685-5488 for help making appointments."
"Philadelphia to open mass COVID-19 vaccination clinics, pharmacies to get doses" inquirer.com/news/coronavir…..
New Jersey
"People who are currently eligible for vaccination in New Jersey will be allowed to book appointments as early as Feb. 9. Patients must register in advance at CVS.com. People without online access can contact CVS customer service at 800-746-7287."
Read 5 tweets
6 Feb
#BlackHistoryMonth Today's letter is D- for drive.
I had an entire plan, but my children wanted to learn about Ruby Bridges.
They said that someone had to DRIVE her to school😆, so, I went with their selection.
Ruby Bridges, born in 1954, the same year as my mother. My children were shocked to hear that when their gma was a child, integrated schools were resisted.

My children learned about how even with laws in place, people made up creative ways to ensure segregated schools.
In New Orleans, Black children had to take an extremely hard placement test in order to get into the White school. 6 kids passed the test at Ruby's school, 2 of the children remained at the Black school, 3 Black girls went to McDonogh school and Ruby went to Frantz on her own.
Read 8 tweets
5 Feb
#BlackHistoryMonth Today's value- "C" is for creative. This was hard to narrow down, so I selected two people to discuss with my family.
1- Issachah James Savage @SavageTenorJI. I read a quote about him once that said "His name is Savage. His sound is sophisticated."
Philly born opera singer, Issachah possesses an expansive, take-notice tenor that has propelled him to the front of orchestras such the Los Angeles Philharmonic and on stages such as Houston Grand Opera and the Metropolitan Opera.
It's a voice both refined and deep in its range, in that rare category known as a heldentenor, and he is using it to crush Verdi and Wagner roles here and abroad.

He's won: The Seattle International Wagner Competition in 2014
The 2012 Marcello Giordani International Competition
Read 8 tweets

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