covid-update

KAUFMAN COUNTY, Texas — Kaufman County Health Officer Dr. Benjamin Brashear answered the question "Can we open schools with in-person instruction safely?

Dr. Brashear's response, below:

As with many things in Medicine, it depends.

1. The answer is YES, if the community transmission is low at the time schools open, and IF it remains reasonably low after that.

For this discussion, “Community Transmission” is the combination of several factors: Number of new cases, positivity rate, and hospitalization rate. This way we can talk about prevalence and also severity at the same time.

This YES answer assumes good protocols and measures are in place at our schools and will be reasonably well implemented. Because of the evidence available, masks should be expected at all times for appropriate ages, and in all situations while indoors. There will be inevitable failures to adhere to this, of course, but setting the bar high should result in much better compliance. No plan is ever perfect, and with so many variables we can expect lots of chinks in the armor, both with masking and with hygiene practices.

Even with low community transmission, and even if we have perfect adherence to hygiene protocols, there are of course risks associated with this plan. As with many areas of life, we have to consider the risks we encounter, even the risks we see by choosing what initially appears to be the “safest” option. For example, we can fly instead of drive on vacation, but we can’t control all those variables either. There are already other diseases and infections that can attack our kids at weird moments. We simply can’t say we want the risk to be “zero” of contracting Covid – that doesn’t exist, and it’s not how we treat risk for anything else.

It should be noted also that closing schools due to COVID does not suddenly drop the chance of any bad outcome to zero. It doesn’t even drop the chance of spreading COVID to zero. We also have to consider the loss of jobs and income from those families who are unable to work from home, or the neglect and loss of support for those kids who depend on schools to provide basic needs. So while shutting down would at first glance seem to be the safest option, it must be considered that there are dangers inherent with having kids at home also.

HOWEVER…

2. The answer is NO, if the current (July 16) community transmission rate in Kaufman County remains at this level.

Although I think much more remains to be learned about kids and their response to COVID19, I am not necessarily saying this only out of fear of our kids getting this disease. Don’t get me wrong, I don’t want any child to get this virus, not a single one. But if the rate of spread and rate of severe complications of SARS-CoV-2 infection in children under 14 were the norm for the rest of us, I don’t think we would be here.

What I am even more concerned about is the prospect of dozens or even hundreds of our kids contracting this, and then taking it home with them, as well as the idea that so many teachers and staff would increase their daily exposure to virus. Not only would we possibly see a number of kids sick and even seriously ill, but the community spread (once the kids/teachers/staff take the new exposures and infections home) would inevitably get worse than where it is now.

3. So how do we improve things between now and when school starts?

There are ways that we can drive that transmission rate DOWN before school starts, and to keep it down. That way we can open to in person education AND do a reasonable job of protecting our students and teachers and staff.

My basic take on it is this: If we can get high compliance for the next 3-4 weeks with the simpler measures (masking, distancing, and hygiene) AND we can all agree to reduce our normal activities to ONLY the bare necessities, then we can safely expect the community transmission rate to go back down. No guarantee on how low, but hopefully we will see the number of new cases go down, the hospitalization rate go down, and the positivity rate go down.

How do I know this would even help?

Unfortunately, there are no other countries who have mangled the COVID response quite as badly as the USA has, and then successfully opened schools. So, we don’t have the hard data we would like. No other country has reopened schools with transmission rates like we are currently seeing in the US. In fact, all the countries who have kids back in school have flattened the curve WELL beyond what the US has ever reached. Most of these countries also had adequate testing and contact tracing strategies, which we do not. So, where do we look?

Per Emily Smith at Baylor, one excellent report we can use is from Washington State. She says, “In this model, they compared 6 strategies for school re-openings which included screening, testing, and contact tracing of students, usage of face masks and other non-pharmaceutical interventions (NPIs) such as distancing, and classroom cohorting. They also looked at community transmission rates - a KEY indicator to look at for decision making regarding schools.”

Her takeaway was that in places where the community transmission started out high (like Kaufman County is now), there was no model of school reopening that allowed for community transmission of COVID to get below exponential levels. Not even with perfect student compliance and rapidly available testing and contact tracing and all that. BUT - with lower transmission to start - and even so-so implementation of the interventions listed above, the community transmission level stayed manageable all the way through the Christmas break in December.

So the real question we should all be asking is not “what can the schools do to keep our students and teachers safe?”

The real question is what can WE do to reduce community transmission for our kids and our teachers and for US to have the best chance?