Thread by @DrJinRussell

ECEs are opening bubbles of 10 in Level 3 for Auckland, and schools are tentatively set to open on October 18th. I'm mum to a school boy and an ECE boy, and have my community paediatrician and child epi hats on. How can this be safe? Okay, let's walk through it. /1

When children are infected with Covid-19, they fortunately typically experience a mild or asymptomatic illness. Hospitalisation of children can occur but, from Australian experience, this is thankfully uncommon. /2 abc.net.au/news/health/20…

But we still need to do ALL we can to not expose children to this virus, while we wait for vaccinations for children <12, as children with pre-existing medical conditions are at higher risk of severe illness, and longer lasting symptoms are still being researched. /3

Now, with elimination off the table in Auckland, we need to recognise that the harms to children from prolonged school closures are *significant*. Schools provide so much more than formal education. They are "essential services" for kids, as it were. /4

Children don't tend to infect others. The direction of transmission is from adult to child. Within schools, an Australian NCIR report of delta transmission in schools is helpful here. See ncirs.org.au/covid-19-delta… /5

In this study of delta transmission within schools, the proportion of infected children who transmitted the virus to another person (secondary attack rate) was only 2% or less, in ECEs and in schools. The attack rate for adults infecting children...was much greater. /6

What this means is that protecting children and keeping schools open IS within our reach, we need to aim for 100% of adults in schools, and 100% of eligible students (12-18y) to be vaccinated. /7

Overseas, some schools have been able to re-open safely, with very few outbreaks. Or in the case of San Francisco, no outbreaks in schools /7 npr.org/2021/09/10/103…

Overseas guidance from the CDC and European CDC are aligned - by implementing a SUITE of measures, schools can really drive down the risk of transmission to very low levels. ecdc.europa.eu/en/publication… /8

Alongside vaccination, these measures include IMPROVING VENTILATION - bring as much outdoor air in as possible. We need to lift our game. Delta is airborne. thespinoff.co.nz/science/21-09-… /9

Some children are not able to wear masks for whatever reason, and there should be no stigma. We need to encourage school students to adopt a masking culture. The way the measures work is that if you can't ventilate well, other measures, like masking, becomes more important. /10

When schools eventually reopen, I would love to see vaccine delivery on site, for BOTH students and parents. These are two under-vaccinated age groups. It is an equitable approach, that makes it easy for families to do the right thing. /11

Finally, it may feel for some that it is all falling apart. To you, I want to say Kia Kaha. Unlike other countries, we will re-open with vaccines, safe and effective vaccines, in our arsenal! Elimination has bought us this position, thank you to the PM, Gov and it's advisors /12

So, what's the way to open schools and ECEs safely? We need to aim for as close to 100% of education staff, and 100% eligible students to be vaccinated. This protects the children who can't be and those at higher risk. As Portugal and other countries show, this is do-able. /end

Not sure what happened, here, but here is the rest of the thread!

https://twitter.com/DrJinRussell/status/1444890573928681477

Addendum: I am seeing so much grief. I am grieving too, I have been so proud of what we have achieved with elimination. Facing the possibility of prolonged school closures, I am trying to lay out evidence for how we can protect children and keep schools open. It’s not easy.

Addendum 2: Does delta cause more severe illness in kids? No firm evidence that it does yet, it is more transmissible so when surging even rare outcomes are seen more commonly: aappublications.org/news/2021/09/0…

Addendum 3: Some are wondering how much infected children transmit. This is a good review article (2021, 2020) which covers this issue: adc.bmj.com/content/106/2/…