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

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More from @DrJinRussell

5 Oct
Kia Ora everyone. This is a thread for people overseas, to put context around what is happening in Aotearoa New Zealand with our Covid-19 strategy. The first point to make is that though we are now shifting away from hard elimination, we couldn’t have picked a better strategy /1
Some headlines will say we have “failed” in our attempt to eliminate delta. This misses a key point. Our Go Hard, Go Early lockdown nationally, led to such a hard suppression of the virus, that our daily case counts are still low overall. Our outbreak seeded from NSW, compare: /2
NZ’s Alert Level 4 was effective even against delta, and while it was in place, we prevented uncontrolled exponential spread. We have prevented 1381 chains of transmission so far. Daily case counts are <50. /3
Read 22 tweets
2 Oct
I’m not sure who needs to hear this but it is possible to have a deeply Christian faith and believe this compels you to put the needs of others ahead of your own, to not grasp for power or “freedom”, to not put others in danger during a global plague, to love the vulnerable

1/ “Do nothing out of selfish ambition or vain conceit, but in humility consider others better than yourselves. Each of you should look not only to your own interests, but also to the interests of others” — Phil 2:3-4
2/ “You must have the same attitude that Christ Jesus had. Though he was God, he did not think of equality with God as something to cling to. Instead, he gave up his divine privileges” — Phil 2:5-7
Read 6 tweets
25 Sep
A few weeks ago I started drawing attention to Singapore's Covid-19 response as one NZ can learn from. S'pore has pop 5.7 million, 73 Covid-19 deaths, 83K cases. After reopening commenced on 19 Aug, cases rose exponentially. What should we be learning? /1…
Vaccination currently stands at 84% of the *population* has received 1 dose, 82% population has been fully vaccinated. Now, 5 weeks after reopening commenced, the Singapore government announced the need for increased restrictions. It *did not* lie down and scream "Freeeedom" /2
No, the Singapore government has (rightly) taken steps to protect it's population from Covid-19. The large majority of new cases (98%) have been mild or asymptomatic. This is thought due to the high vaccination rates. /3
Read 22 tweets
14 Sep
Look I appreciate the need to get overseas experts commenting on the NZ response on telly but (a) none are experts on NZ hospital capacity or population health inequities, (b) continuing elimination while we achieve high vax rates does NOT mean we aren’t thinking about the future
I mean, here’s an actual verified Johns Hopkins expert @AmeshAA whom I do respect but who comes across as ridiculous at points simply because he doesn’t understand our extremely limited hospital capacity, need for equity, or long term planning.…
If I were starting off a TV interview and speaking to a country that has done remarkably well with few resources and stretched healthcare, I would do the decent thing and say “Bravo NZ! Great you’re moving on vaccines now! Here’s some extra things to consider…”. Y’know. Tone.
Read 7 tweets
13 Sep
Kia Ora to the overseas folk. For those curious, NZ’s alert level 4 has managed to successfully reduce the R value of the delta outbreak from 6 to consistently <1. In 28 days we have stopped 955 chains of transmission. The lockdown has already lifted everywhere, except Auckland/1
Auckland remains in Level 4, where a handful of “mystery” cases mean we will stay the course. We have prevented hospital overwhelm, which modelling predicted would have occurred by now, had we not effected such a successful lockdown. So far we have had zero deaths from delta /2
We are vaccinating very fast. Some days this outbreak we have vaccinated 1.5% of the population in a single day. Thanks to new shipments of vaccines from overseas, we can keep up the pace. 68% of 12y+ population have had at least 1 dose, 35% fully vaccinated and forecasts high /3
Read 10 tweets
12 Sep
Delta is airborne, schools have been impacted in this current cluster. This morning I spoke with ⁦@SusieFergusonNZ on⁩ ⁦@radionz⁩ about the need to lift our game on ventilation in schools to make an end to damp, poorly ventilated classrooms /1…
2013 NZ study (Wang et al) has shown that often, levels of carbon dioxide in 3 of 6 NZ classrooms exceeded recommended levels (1000 ppm) for 50% of the school day. C02 levels here are a proxy for ventilation. As C02 levels rise, students may also feel headaches, sleepy /2
Not every child can mask, and emerging evidence suggests that improving ventilation maybe as effective as masking. So in looking to the future, and wanting to prevent covid closing schools, this needs to be a priority for investment. Our piece:…
Read 4 tweets

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