Thread by @Epi_D_Nique

Make no mistake, this is a policy choice.

And no, it doesn’t matter if hospitalizations & kids in ICU are really there bc of RSV:

A full hospital is a full hospital.

A full hospital can’t care for kids who are sick or injured for *any* reason.

This is crucial…

https://twitter.com/jeremyfaust/status/1427489818645303296

As the linked article even very sick kids have high survival IF they can receive care.

But IF hospitals cannot take more patients, IF they run out if ventilators or staff, kids cannot get that life-saving care.

Sending kids to schools without adequate protections is dangerous.

There's not much excess capacity for children's hospitals in the US.

And remember, kids with cancer, major birth defects, genetic diseases need those ICU beds too. These kids are especially vulnerable to Covid-19 as well so a surge in cases risks their exposure in the hospital.

Very helpful visual on how masks work!

Priorities for kids' masks:

1. If the masks aren't comfortable, kids won't wear them.

2. If masks don't fit well, they won't provide good protection (like having a hole in the mask!)

3. Higher filtration levels (eg KN95, KF94) are more effective than cloth or surgical masks.

David Elfstrom:

Any time there's an outbreak in a congregate setting, like schools, we should be sending in engineers to investigate.

And even before that, get engineers in to check filtration & ventilation in classrooms & other shared spaces!

David Elfstrom:

For pandemic purposes, portable air cleaners are as good as outdoor air.

But - they need to have the highest capacity as possible and *with the least noise*.

If they air cleaners are too noisy, they won't be used and won't be effective.

David Elfstrom:

Forget all the bells and whistles on portable air cleaners (eg ionizers) and just focus getting the highest capacity and least noise.

Jim Rosenthal:

For buildings with central air handling, MERV 13 filters are recommended.

If you need a portable air cleaner on the cheap - you can DIY one!

Get 4-5 MERV 13 filters, a box fan, & tape.

If you can seal a box, you can make one!

The Rosenthal/Corsi box air cleaners are scalable & can even be built by students who then get to be actively involved in ensuring their safety.

These + a CO2 monitor would make a sweet science lesson for students.

Important point, that vaccinations also help reduce the amount of virus in the air since they both prevent infections & cause viral loads to fall faster than the unvaccinated even for breakthrough cases.

Here's the viral load curves for vaccinated vs unvaccinated infections.

@kprather88 has a great point that it's really important that schools (& districts) be transparent about the measures being taken to clean the air.

Say what measures are being done, show data (eg CO2 levels) that show that the systems are working.

@kprather88 Dr Howard Taras on getting community buy-in.

EXPLAIN aerosol transmission. Do it over & over again.

- The analogy of smoking is very helpful for aiding folks in understanding the issues of aerosols & particulates.

Dr Taras on getting masks into schools:

Getting a lot of Doctor's notes saying kids are exempt from masks.

In order to get a mask exemption, students have to work with occupational therapists & other team members to find a mask that works for them. Has been very effective!

Hearing from a parent whose child wasn't doing well with remote learning and a grandparent on immunosuppressants living in the same home.

"Freedom for my daughter is the ability to go to school and not have to worry about killing her Bubbie"

Part 2!

Modeling to try to see what interventions would be effective.

Researchers erred conservative in assumptions - eg., assume only 2-3 students start the year infections, assume some students are protected via previous infection, and using R0=4, 50% reduction from masks.

Models also accounted for varying rates of incoming protection at different school levels based on vaccine availability and previous infections.

Now to see how the policies might work during a semester.

Tested: No intervention, Masking alone, testing alone, then Masking + Testing.

With masking + testing, infections could be limited to as low as 10% of HS students.

Major takeaway: Layered interventions are key.

If you have to choose between masking & testing, masking is more effective alone than testing alone.

With no intervention, as many as 90% of students could be infected.

(nb: increased ventilation and more effective masks were not tested)

TLDR: Mask up or go virtual.

For more info:

Important to note this is under a pretty-close-to best-case scenario.

With delta having an R0 ~ 6-8 we can see why schools are having to shut down shortly after opening due to lots of infections.

There's also likely to be many more introductions to schools bcof community rates.

@DataDrivenMD: looking at the data coming out of schools right now, one of the biggest challenges is not having a vaccine for kids <12.

Cases in this group are also the most hospital admissions. We've never hospitalized so many children so quickly during the pandemic.

@DataDrivenMD: Important to not just focus on the immediate hospitalizations.

MIS-C shows up weeks later & often requires hospitalization and sometimes ICU admission.

(If there are ongoing acute covid outbreaks these kids will be competing for hospital beds with the new cases)

@DataDrivenMD: We should also not forget the risks of Long Covid for kids.

Importantly, these are policy choices and we can speak to policy makers to prioritize the safety of children in schools.

@JuliaRaifman: on Alabama child hospitalization rates "I've never seen a curve like this".

Protecting children from covid until they can be vaccinated is critical.

(That is basically a vertical line! 😨🤯 And note the scale is larger than for the national numbers too.)

Indoor universal mask mandates work and the benefits increase over time since every avoided infection stops multiple future infections!

Mask mandates help reduce transmission so that more severe & harmful measures are not needed.

(Note: School closures are already happening!)

@JuliaRaifman:
"We have to control the pandemic so it doesn't control us"

Having clear guidelines for when masks are needed or not is helpful for public understanding.

Masks need to be used at all times indoors - that means that we need safe eating spaces.

@JuliaRaifman:
Child hospitalizations are *preventable*!

To prevent children's hospitals from being overwhelmed we need to keep childhood infections down.

We need to be planning for equitable & rapid vaccination of children <12 now.

@Theresa_Chapple on Racial Equity in Schools!

Remote schooling has not necessarily been a negative for all children.

Many Black parents found that their children were doing better because kids were more protected from racism & allowed parents to protect kids better.

@Theresa_Chapple: People say schools are the safest place for kids to be & schools are where learning happens best, remember that this is not true for all kids- that Black kids are often *not* safe for them.

Black students more likely to be suspended & arrested than white kids

@Theresa_Chapple: Black & brown children have also made up the majority of child covid hospitalizations and deaths.

More Black & brown children have had family hospitalized or die due to Covid.

Their schools are worse environments than schools that most white kids go to.

@Theresa_Chapple: When we think about "learning loss" during the pandemic and the fact that students from Black-majority schools were further behind white peers, is this because of virtual school?

Or is this a result of substantial trauma burdens of the pandemic for Black kids?

@Theresa_Chapple: Since Black & brown communities have been more affected by the pandemic & also experience systemic racism in schools which were in worse shape before the pandemic.

So are these kids safest in schools?

What do we need to do to make that true?

Two added slides from @kprather88

Particulate & Co2 monitors to provide transparency and continued monitoring of air quality.

Plexiglass panels can trap viral particles so may be more harmful than helpful.

@CarolynCannu on Lunches:

- Outdoor is always better than indoor

- High filtration/ventilation

- Large spaces & with few people for the shortest amount of time possible.

Adjusting schedules so that students are in school for a half day so they don't need to eat there.

@CarolynCannu on School Outbreaks:

**Outbreaks will happen!**

In every school. In every district. No matter how many mitigation measures are put in place. Delta is just that contagious.

Key points: catch cases as quickly as possible, contact trace them, support quarentine!

David Hoffman*:

Eating lunch in unmasked after having masks on every day is like kids holding their bladder all day while in the pool, but at lunch, going to a hot tub and letting it all out! 😳

It's a lot of interaction with the virus in a very short time.

David Hoffman*:

One thing that can improve safety for indoor lunch in addition to big room, few people, spread out, no talking, is to ventilate the room for a while before the next group comes in.

In models this is one of the most effective measures.

*I hope I got that right

Here's the link to the recording:

This is really fantastic!

I encourage folks to share with their school boards & other decision makers so that they have a good understanding of the science behind the recommendations!