Listening to this phenomenal seminar by @kprather88 and others on what's at stake on the return of kids back to school this month.

@denise_dewald explains that the ICU system for kids if fragile and not designed for big shocks

Letting children get infected (and 1% of them will need hospitalization) will overwhelm this system quickly, and opens the prospect of triaging which child gets life-saving care.
@kprather88 explains that aerosol spread is the primary mode of spread of SARS2, and can float and linger in a room. Indoor spaces need to be filtered, masks need to be worn.
Vaccinated can still transmit and infect others, but for a shorter duration, so masks are going to be essential to prevent spread in schools
Next, @linseymarr shows that masks are proven to reduced risk in classrooms over multiple studies
Marr: Our kids will require better masks. Surgical masks have leaks on the sides which allow virus in. N95 masks are not made for children, but Chinese (KN95) and Korean (KF94) kid size are alternatives. Tight cloth masks with reusable filters are also effective if they fit well
Can we get classrooms ready by fall, yes! says @CorsIAQ. Classrooms right now are extremely unhealthy ventilation wise and have needed improvement for decades
Dose of infected particles depends on a number of factors, and can be mitigated by masks, ventilation and filtration. Do as much outdoors as possible, upgrade systems (though too late now), increase natural ventilation.
Filtration is a great tool, to improve the CADR, the Clean Air Delivery Rate. HEPA filters are a quick and cheap solution that can be readied in time for $10 per student per year
They can be built quickly and cheaply in the time we have left with box fans and furnace filters
texairfilters.com/iaq-research-p…
Some important factors mentioned by @DavidElfstrom and @Poppendieck:
Focus on moving air, getting a high clean air delivery rate, while also reducing noise.
ASHRAE standards encourage 2-3 air changes/hr, but this should be doubled to 6 air changes/hr
As @JimRosenthal4 explains, easy to make a simple HEPA filter with 4-5 MERV 13 filters, a box fan and some duct tape. 2-3 of these will service a classroom for <$100. Its a neat project for students, can be scaled to large spaces.
Have to stop here, but the recording I'm sure will be up soon. Each speaker is an expert in their field and all of these recommendations are pure gold to keeping schools safe this fall.
Some other great live tweets of the event:

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More from @KashPrime

14 Sep
Really strong case for 3rd doses, especially for those over age 60:
This should be the biggest priority for decision makers in the coming weeks.
I'll go over why in this thread ->
Waning immunity is being observed in multiple studies, in elderly populations, and needs to be addressed. It's too bad our federal authorities are paralyzed by the election, a decision needs to be made soon.
Vaccine equity is an issue, but:
- the world is swiftly catching up
- Median age in Africa is 19.7 years, its 45+ in most Western countries, and death/ICU risk increases exponentially with age
Read 8 tweets
5 Sep
How is it that 18m after the first mRNA vaccine was developed we still don’t have an approved vaccine for kids?
This will be one of the greatest preventable public health failures in history, and it is happening in real time right before our eyes
What can we do? Some ideas: Image
The stakes are massive; cases in children in the US are rising exponentially. Given how infectious Delta is, and the lack of mitigations in most schools, we can expect many, perhaps most, children to be infected in the next few months. aap.org/en/pages/2019-… Image
And it must be emphasized, as seen above, children can get seriously ill from this virus; 1/100 will need hospital admission, 1/10000 will die. 24 died in the US last week out of 200k new infections
1/50 will get Long Covid:
covid.joinzoe.com/post/long-covi…
Read 21 tweets
18 Aug
Going through US data on children and Covid from @AmerAcadPeds is pretty alarming reading. Cases and hospitalizations are accelerating quickly.
aap.org/en/pages/2019-…
It looks like a pediatric hospitalization rate of 0.9% is consistent across 23 US states (Texas, Florida, Arkansas and many others are refusing to report this data)
If you extrapolate roughly from the rate of new pediatric cases every week, which is at 120K children last week (and accelerating), that's >1000 kids needing admission this week alone.
Read 5 tweets
17 Aug
Happy to see that teachers will be required to vaccinate (or get rapid tests). Ontario's plan is probably the best in the country now, but there's still some big gaps:
- Require masks from JK up
- Eliminate unmasked indoor activities
- Come up with a safe plan for lunch-time
Some great ideas on making lunch-time safer, especially when the weather gets colder:
Overall our children need a circle of protection around them. Vaccinated parents, teachers, rapid tests, ventilation upgrades. We have the resources and time to get this right.
Read 7 tweets
3 Aug
Here is a checklist you can show your local school administrators on protecting kids <12 before school starts. Will post supporting documents and explainers later this week, but we have no time to waste... we have a month to get this right.
The stakes are high. As @DanielGriffinMD likes to say, kids are at low risk, but they are not at no risk. Perhaps 1/25 will get long-term symptoms, 1/140 may need to be hospitalized, 1/3000 may develop MIS-C.
Read 5 tweets
13 Jul
If I had to summarize what I think are the most basic things to keep everyone safe and the economy humming, it boils down to these elements:

1) Keep public masking
2) Push vaccination rates higher
3) Vaccine requirements in sensitive areas like borders, hospitals, schools
Basic measures have kept us safe so far, and the results are dramatic; we are performing much better than many of our closest, and less careful, neighbours and allies. More can be done, but we should be proud of what we've accomplished.
And it builds on another idea, that we are very close to herd immunity, that we can eliminate circulation of this virus when enough are vaccinated. We have to hold the line until younger kids can get the vaccine this fall
Read 7 tweets

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