Given the immense value of in person schooling for America's kids,

Lets talk about how every school can be in person safely today

Not under ideal conditions

But under real-world conditions

First, let's start with "ideal", which LOTS of school districts have done

Thread
What is ideal?

1. Teachers vaxxed/boosted
2. Kids vaxxed
3. Everyone masked w/good masks
4. Ventilation
5. Testing

Billions of $ available for ventilation and testing
Vaccines free, widely available

I get it, some places chose not to do it

But $ is not the barrier

2/n
So lots of school districts chose not to do these things

What if a school doesn't have testing and systemic upgrades in ventilation?

Can schools still be safe?

Absolutely!

If folks vaxxed/boosted
And we have masking (compliance doesn't have to be 100%)

Still very safe
What if no ventilation upgrades
No testing
And kids not vaxxed or masking reliably

Reality in some places

Would I recommend my mom (a former NYC teacher) still go to work?

Yes

Put in portable air cleaners (cheap) in class
Make sure she was boosted
Wear high quality mask

4/5
What would I do as a parent in that situation?

Make sure my kid vaccinated
Get kid a good mask
And ask teacher to put in portable air cleaner

And advocate for systemic fixes like ventilation, testing, better masks for all

But pretty safe

5/
Systemic fixes are always better

But at this point in pandemic, even without systemic fixes,

Individuals can protect themselves

If you are vaccinated (kid) or boosted (adult)

And wear good mask (widely available)

No matter what others are doing

You are very protected

6/7
I get the frustration that some districts haven't done more

As a kid of a mom who taught in PS142 for 20+ years, I get the conditions

But we now have the tools to keep everyone who wants to stay safe be safe

And given the value of school

That's enough to get kids back

End

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More from @ashishkjha

8 Jan
Watching national data

And being in the hospital this week

I see two things that appear contradictory

But both are true

1. Link between cases & hospitalizations is much weaker with Omicron than in the past

2. Our healthcare system is in trouble

Thread: the moment we are in
Let's talk about I'm seeing in the hospital first

In the hospital, seeing lots of COVID patients

Some admitted due to COVID

They are all either:

1. Unvaccinated

2. Very high risk folks not boosted

And some admitted "with" COVID as incidental

Almost all not boosted

2/n
Haven't seen a single boosted person admitted for COVID

And in the national data

Risk of hospitalizations is still those two groups

Unvaccinated
High risk not boosted

And that pool of people is still very, very large

And that is driving the surge of hospitalizations

3/
Read 14 tweets
4 Jan
Day 2 of hospital service

A few observations about the whole "hospitalized for COVID" versus "hospitalized with COVID"

This distinction matters

But may be not in the way people think

First, we have a few patients in the hospital for COVID

But not many, thank goodness

Thread
Not many because RI is highly vaccinated state

More common on our service is folks admitted with COVID

That is, they came to hospital for something else and found to have COVID

Its tempting to say that COVID here incidental and therefore, doesn't matter

Not quite right

2/n
There are two types of "with COVID" patients and they both have an impact on care, utilization, stress to the system

The first type is: had COVID -- was "mild" -- but now have complications

Example (changing details for confidentiality)

The 86 y.o. man with kidney disease

3/n
Read 7 tweets
3 Jan
We know how to keep people safe in schools during COVID

For an airborne virus

Masking and ventilation/filtration substantially slow spread

As does regular testing

And vaccines protect from bad outcomes

So I've been puzzling over why this isn't happening everywhere

Thread
If key strategies include masking, ventilation, testing, vaccines

Masks became widely available late 2020

By early 2021, there was lots of $ from Feds for improving vent/filtration as well as testing

By fall 2021, every adult & school-aged kid was eligible for vaccines

2/n
So barriers are now primarily not money or availability (though testing is currently a challenge)

So what are the main barriers?

First, misinformation

Like schools are always safe (you have to make them safe)

Or masks don't work (they do, some more than others)

3/n
Read 6 tweets
29 Dec 21
.@ezraklein asks a great question

What is the goal at this point?

I think it needs another element

What costs we are willing to pay to achieve that goal?

My goals?

Save lives, prevent hospitals getting overwhelmed, keep essential things (schools) open

In that order

And

🧵
Let's talk about other goals and costs we're willing to bear

Reduce infections? Yes!

Low cost things like encouraging indoor masks will help

But to really suppress infections? We likely need hard lockdowns

Which makes no sense at this point in pandemic

So the other goals...
Saving lives, keeping hospitals functional, schools open?

We know how to do that

1. Vaccines & boosters for all but especially high risk folks

2. Lots of rapid tests in key settings (nursing homes, schools, etc)

3. More ventilation/filtration

This all feels doable

3/4
Read 4 tweets
28 Dec 21
While new CDC isolation guidelines are reasonable, here's what I would have done differently

1. Required a neg antigen test after 5 days

2. Had different guidelines for vaccinated (contagious for shorter time) versus unvaccinated

3. Specified higher quality masks

Short thread
So why are CDC guidelines still reasonable?

Because if you actually follow what CDC says,

They require people be asymptomatic

And wear a mask for 5 more days

And if people actually followed the guidelines

I can't come up with how they aren't quite reasonable

2/4
The critique appears to be that people won't follow CDC guidelines

That they'll stop isolating after 5 days even with symptoms and/or not wear a mask

Yes. That'll happen for some

But shorter isolation means lower barrier to test/isolate

Which will motivate others to test

3/4
Read 5 tweets
26 Dec 21
As Omicron cases explode

We need a strategy for isolating folks who test positive

We need to think about the purpose of isolation clearly

Because if we don't get it right,

It'll both be hugely disruptive and won't keep us safe

So let's discuss what we need to do

Thread
First principles:

Why ask people to isolate at all?

Well, that’s obvious

We don’t want them spreading

So what we care about is CONTAGIOUSNESS

We want folks to isolate when they're contagious

So when are people contagious?

Well, it varies. A lot

OK, so what to do?

2/n
How long folks are contagious depends on two things

1. When they test positive (i.e. early in the phase of infection vs. late)

2. Their immune system's ability to clear the virus

Take the average person who tests PCR+ today

How long will they be contagious?

3/n
Read 15 tweets

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