Archives for category: Health

Benjamin P. Linas, an epidemiologist, writes in VOX that both blue and red states are doing the wrong things about the pandemic. The blue states are too quick to close down schools and the red states are too quick to keep them open without proper safety measures. The Trump administration has provided no guidance at all and left it to states to craft their own responses, which mostly fall along partisan lines.

He describes a plan that he hopes the new Biden administration will adopt that will both contain the pandemic and enable schools to be open for in-person instruction.

Linas offers a plan that he hopes will be the basis for a new approach:

Our current political leaders are failing to provide a clear, national plan for reopening America’s schools. The incoming Biden-Harris administration has announced that it will provide new funds and guidance, but details have not yet emerged. Below are four essential elements for such a plan. 

1) Clear guidance for when and how to open (and close) schools

Such guidance includes two components. One is reasonable, evidence-based thresholds for opening and closing our schools. The CDC has such guidance, but it is not clear how the thresholds were chosen. Further, the guidance has no bite. 

At no time has the CDC said that districts may not open above a given threshold. They simply “advise caution” or “reconsideration” of current policy. We need strong federal action to prevent schools from opening when Covid-19 is not yet controlled in their communities. We also need clear and effective guidance for when schools should be open. 

Second is making new strategy that envisions schools as one part of a larger public health policy. No district should employ school closures as the first intervention when Covid-19 cases rise. In a Covid-19 crisis, it may be necessary to close schools, but if so, then the school closures must be one component of a larger strategy that seeks to generally reduce mobility and social interaction, including restrictions on activities such as indoor dining, bars, gyms, and other places that we know Covid-19 is being transmitted.

2) Clear guidance for distancing in schools 

While 6 feet has become the default stance on appropriate distancing from others in most of the US, 6-foot distance requirements greatly limit the ability of public schools to bring all students back full-time. The reality is, in many public school districts, if we insist on all students being 6 feet apart at all times, many districts simply will not have the space (and thus not really be able to bring all kids back to school full-time until there is an effective, widely distributed vaccine). That means that there is a very realistic scenario in which even in 2021 schools will need to use a hybrid instructional model. 

Globally, the WHO identifies 1 meter (about 3.3 feet) as a minimum for distance from others. We need data-driven guidance for situations in which it is acceptable to distance less than 6 feet in educational settings. 

Fortunately, data does exist to help us gauge the risk of Covid-19 transmission with contact of various distances. Perhaps, with quiet activity and good air flow and all students reliably in masks, a 4-foot distance might be acceptable. Covid-19 is always a question of risk and benefit. The benefit of being back in school full-time is clear. What are the real risks of occasionally being 4 to 5 feet apart during the school day if everyone is wearing masks?

3) Strong mask mandates at the federal, state, district, and school levels 

Every message from every person of authority needs to reiterate the civic duty to wear a mask in public. Currently, many states leave masking mandates up to districts. This needs to change. People do not have a right to walk down the street naked, and almost every school district has a definition of clothing that is not appropriate to wear in school. Likewise, people do not have a right to have a naked face in school during this viral pandemic, and not wearing a mask is at least as inappropriate as wearing short shorts.

4) Robust testing and contact tracing 

It’s critical that whenever any child develops symptoms consistent with Covid-19, it is fast, easy, and free to obtain testing. It is not possible for parents to keep their child out of school for many days every time that child develops a new runny nose, or winter cough. Symptomatic testing is important to make it possible to stay in school. 

The role for asymptomatic screening is more complex. Routinely screening all members of the community holds promise as a strategy to identify and quarantine asymptomatic cases that may otherwise come to school. But we do not currently have the infrastructure or resources to make this happen. And in any case, the real pillars of safe school operation are community control, masks, and distancing. We cannot make asymptomatic screening a prerequisite to opening schools, because if we do, we will not be able to reopen.

This is what a plan to reopen looks like, but implementing it requires courageous leadership at the federal and state levels. With this plan in place, however, America can open its schools, keep students and teachers healthy, and contribute to a larger public health strategy to end the Covid-19 epidemic.

We went to dinner last night at my son’s house, especially to see the grandsons ages 7 and 14. I sat next to the older boy during dinner. The boys are tested regularly at their schools, which both are half in-person and half-remote. As we finished dinner, my son opened his email and found a message from the older boy’s school that he had been in class with a student who tested positive.

Consequently, I will be quarantining for two weeks and hoping to dodge this bullet. My lungs are compromised by a previous very serious hospitalization for pulmonary embolism. I will be careful.

With the upsurge in the coronavirus, the U.S. and Europe are facing new shutdowns to stop the disease. But there is one big difference. European nations are keeping their schools open, as schools in the U.S. close.

London (CNN) Late last month, Ireland entered a strict, six-week lockdown against the spread of Covid-19, under which social gatherings are prohibited, exercise permitted only within five kilometers of the home, and bars and restaurants closed.

But as he announced the new restrictions, Taoiseach (Prime Minister) Micheál Martin emphasized that schools and childcare facilities should stay open. “This is necessary because we cannot and will not allow our children and young people’s futures to be another victim of his disease. They need their education,” Martin said.

There has been a similar story in many European countries including Germany, France and England, which made it their mission to keep in-person learning going, even as they imposed strict measures to combat the second wave of the coronavirus pandemic.

 In contrast, major cities in the United States, including Detroit, Boston and Philadelphia, are shutting schools and moving classes online in a bid to stave off rising infection rates.

New York City schools may close as soon as Monday.

“There are rates of infection at which is too dangerous to keep schools open, and that has happened in a number of places in Europe,” Anthony Staines, professor of Health Systems at Dublin City University, told CNN.But he said that the major response should be “effective, highly resourced public health.”

“Schools do spread this virus, but they’re not a major route of spread,” he added.

Staines said it was appropriate for different places to employ different measures “because their economic situation is different, the spread of the virus is different.” Israel, for example, faced major outbreaks linked to schools.

School closures “may be part of a response for a period of time” but “with appropriate knowledge, information and understanding, closing schools is not required,” he added.”European countries have made a choice, I suppose, that trying to keep schools open is very important…”

France and England entered month-long second national lockdowns on October 28 and November 4 respectively. In both countries, non-essential businesses, restaurants and bars have closed, with residents only allowed to leave home for work, medical reasons, exercise or grocery shopping.

One key difference from the spring lockdowns in these two countries is that they have chosen to keep schools open.

Amanda Spielman, chief education inspector at UK education watchdog Ofsted, said in a report published this week that the decision to keep schools open during England’s second lockdown was “very good news indeed.” 

“The impact of school closures in the summer will be felt for some time to come — and not just in terms of education, but in all the ways they impact on the lives of young people,” she said.

The Ofsted report, published on Tuesday, found that some children had seriously regressed because of school closures earlier in the year and restricted movement.

It found that younsters without good support structures had in some cases lost key skills in numeracy, reading and writing. Some had even forgotten how to use a knife and fork, the report said. Some older children had lost physical fitness or were displaying signs of mental distress, with an increase in self-harm and eating disorders, while younger children had lapsed back into using diapers, it found.

Some children in Europe, the US and across the world have been missing schooling during the pandemic because of a lack of access to technology — and it’s hitting low-income students much harder.

Peter Greene thought his small school district could somehow escape the pandemic. He was wrong.

http://curmudgucation.blogspot.com/2020/11/new-update-from-what-is-no-longer.html

He wrote:

It has been just about two months since I told you that if anyone had a shot of starting school up without major Covid consequences, it would be my little corner of the world. I’m here to report that things are not going well.

Back on September 7, the number of cases for the whole county, since March, was 70. People were not panicked, but cautious, with the usual outlying groups of deniers and total freak-outers. Okay, lots of deniers–this is Trump country, and at this point locals know that there are some stores you avoid if you take masking seriously. Our four school districts went ahead and opened, with two choosing a sort of gradual “soft” opening, and the other two just going for it. 

By October 15, the number of cases had doubled. Two of the four high schools had had two cases each. One shut down to clean for 48 hours; the other sent forty students to isolation. Everyone’s sports are still going on, but with limited audiences. 

Yesterday, the state said we had our highest single day total–46 confirmed cases. I’m sure that’s nothing in major cities, but we’ve got fewer than 50K in the whole county. And our totals are probably lagging because there is no place to go get tested in this county. 

That brings our grand total to 359. As you can see, we’re escalating quickly. 

In schools, things are going poorly. At my former district, somehow, they managed to expose the entire administration team, so all administrators and most of the main office staff have been in isolation. This week the district has gone to virtual school. Two weeks back, an entire fifth grade team was sent into isolation. In another district, three teachers have just tested positive. The state has met with several local superintendents, and schools are going to the hybrid model next week; one administrator has already told his people that after a week of hybrid, they’ll be going virtual. 

Please open the link and read the rest of this interesting post.

NYC Schools: A Double Crisis! A Forum on Thursday  Nov. 12 at 6:30 PM

How have pandemic and policy exacerbated the inequity in NYC public schools? What can be done? 

Thursday Nov. 12 at 6:30 PM

Join us at our next virtual event as we discuss these issues with our excellent panelists.

Speakers: (list to date; parent panelist will be announced)
Kevin Bryant — Principal at NYC DOE High Schools and current candidate for a PhD in Education at Harvard
Leonie Haimson — Executive Director of Class Size Matters
Jonathan Halabi –High School Teacher, DOE, & Chapter Leader, UFT
Tracey Willacey –Teacher for the NYC DOE for over 25 years

Co-Moderators: 
Gloria Brandman, Retired Teacher, activist with Move the Money/NYC;
Natasha Santos, Program Coordinator, Brooklyn For Peace

See it on Facebook. Please RSVP and invite your friends!

Register now

Chicago Public Schools are ready to open, according to officials.

CHICAGO — Chicago Public Schools said classrooms are ready for students and teachers to safely return Wednesday after the district installed air purifiers and took other measures to prevent the spread of COVID-19.

Last month, the Chicago Teachers Union said neither teachers nor students should return to class because school buildings are old and not designed to sufficiently ventilate and purify air during a pandemic.

CPS said it addressed those concerns by spending $8.5 million to put a HEPA air purifier in every classroom. District officials said the 20,000 purifiers are capable of removing “99.9% of ultrafine particles,” including airborne mold, bacteria and viruses like COVID-19. 

Additionally, CPS officials said the district implemented the top five COVID-19 mitigation efforts recommended by the Centers for Disease Control to keep schools safe, and hired independent industrial hygienists to produce a school-by-school analysis of air quality and ventilation systems.

Now the district says classrooms are ready for students and staff so long as they have either a HEPA filter or an operating mechanical ventilation system which includes both an air supply and an exhaust. By those standards, CPS says 99% of its classrooms are ready and the ones that are not will be prioritized for repairs. 

Economist Emily Oster of Brown University has become the go-to expert on the risks that children might get COVID. She has written widely in the popular press and been quoted extensively by others about the low risk of reopening schools. Oster is an economist, not a public health expert.

Writing in The American Prospect, journalist Rachel Cohen quotes many public health experts who disagree with Oster. She writes that Oster’s datasets are incomplete and flawed. There is more uncertainty about the risks to children than Oster reports, she writes.


But she concludes by giving Oster credit:

Oster, unlike others and to her credit, does acknowledge that some people will get sick and even die if schools reopen. In addition to emphasizing the social, emotional, and academic harms students face by missing in-person school, Oster says we accept mortality risks in normal times, like allowing people to drive cars, have swimming pools, and avoid the flu shot. “There will be some in-school transmission, no matter how careful we are,” she wrote in July. “This is the unfortunate reality. Some of these people may get very sick. If we are not willing to accept this, we cannot open schools.”

States like Montana have a strong tradition of rugged individualism. That tradition is now in conflict with the need for public health measures. This story in the Los Angeles Times is a fascinating read. A doctor in small-town Montana is a leader of the anti-masking rebellion. So far, she’s winning.

WHITEFISH, MONT. — When Steve Qunell won a seat on the City Council last year in this town of 8,000, he figured he’d be dealing with potholes and affordable housing.

Instead, he finds himself at the center of a raging debate over how to fight the coronavirus, which is surging in Montana like never before.

The state’s governor, Steve Bullock, a Democrat who is in the final stretch of a tight U.S. Senate race and has been reluctant to impose restrictions that could hurt his campaign, called on the hardest-hit counties to consider shutting bars and enforcing a statewide mask mandate.

There was little appetite for that in conservative Flathead County, where the health board has been dominated by an outspoken doctor who argues that the pandemic is a hoax.

That left the Whitefish City Council.

“We are the last line of defense,” Qunell, a 49-year-old high school social studies teacher, told his fellow council members during an online public meeting this week. “Are we going to lead? Or are we just going to follow the nonbelievers in the county?”

Places like Whitefish once could afford to view the pandemic as a distant big-city problem. Through mid-September, sparsely populated Montana had a death toll of 140.

But that figure has doubled over the last five weeks as a new wave of infections sweeps the country. More than 85,000 cases were reported nationwide Friday, the most in a single day since the pandemic began. 

The worst outbreaks are in the rural Midwest and Rocky Mountains. With 4,693 new cases over the last week, Montana had the country’s third-highest infection rate, trailing only the Dakotas.

The rise in Montana has overwhelmed efforts to conduct contact tracing and strained health systems across the state.

And as events in Whitefish show, efforts to stem exponential increases are pushing up against a culture that prides itself on rugged independence and freedom from government rules.

Early in the pandemic, Whitefish, a gateway to ski areas and Glacier National Park, moved more decisively than many other communities to contain the virus. 

Last spring, the City Council ordered hotels and short-term rental properties to take in only essential workers — a requirement that remained in place until the end of May.

Whitefish was also one of the first cities in Montana to make people wear masks — though the governor soon issued a mandate statewide.

Still, from the beginning, there was strong local opposition to such restrictions. 

Leading the resistance was Dr. Annie Bukacek, a 62-year-old internist known for her far-right views and opposition to vaccination.

Flathead County commissioners appointed her to the county health board last December after dismissing two other doctors with more public health experience — changes the commissioners said were meant to increase the diversity of views.

Bukacek became a hero of anti-lockdown activists across the country last spring after she delivered a speech to a local church congregation alleging that the federal government was exaggerating the coronavirus death toll.

“People are being terrorized by fearmongers into relinquishing cherished freedoms,” she told members of the Liberty Fellowship. 

She wore a lab coat and stethoscope for her presentation, which has been viewed more than 860,000 times on YouTube.

The congregation is led by Chuck Baldwin, who is described by the Montana Human Rights Network as “the unofficial reverend of the militia movement.” He has defied state orders by continuing to hold in-person services. 

Bukacek and a small group of allies protest outside schools and government buildings a few times each week to demand an end to mask requirements and other state restrictions they equate to martial law.

Their message struck some as plausible last summer as cases and deaths remained low, even as more tourists than expected visited Whitefish and the national park.

Eventually though it became clear that Flathead County, population 100,000, would not avoid the kind of suffering that so many other parts of the country had experienced. 

The first major outbreak in Whitefish struck a nursing home in August, infecting 43 of the 52 patients — and ultimately killing 13 of them. 

The county’s biggest hospital, the Kalispell Regional Medical Center, soon started seeing more admissions to its coronavirus ward. 

Erica Lengacher, a 46-year-old critical-care nurse who works nights in the ward, could cope with the stress of watching patients dying. That was part of the job.

Harder to deal with was the indifference that opponents of basic safety measures seemed to have for victims of the pandemic. 

“I just felt deep, deep sadness that while I saw patients suffer and die, there was a sense that our community had moved on and didn’t really care,” she said.

“I realize that there’s a historic tension between public health and individual liberties,” she said. “But a good portion of our community is flouting the state mask mandate, and I still can’t get my head around how this has become so politicized and divisive.”

The number of patients on the coronavirus ward has hovered around 29 in recent days, but managers are recruiting more nurses in case things get worse.

Recent outbreaks in Flathead County — where the total number of people known to have been infected doubled to more than 2,800 over the last three weeks — have been traced to large gatherings at four churches, four weddings, three political events and two trade shows.

This week the county health department advised residents to stay at home as much as possible and limit contacts outside their families to no more than six people a week, each for 15 minutes or less. The recommendations have been widely disregarded.

Tamalee St. James Robinson, the interim county health officer, said in an interview that she has the authority to make such measures mandatory but that more rules would be useless because officials were refusing to enforce those already in place.

The county prosecutor, Travis Ahner, said he was focused on crime and didn’t see a point in cracking down on businesses for mask violations.

For their part, the county commissioners released a statement this month supporting “the Constitutional rights of Montanans to make choices about personal protections for themselves.”

“Where does that leave me, just me out there?” Robinson asked.

As for the county health board, Bukacek prevailed in the latest battle over whether to limit social gatherings.

“Statistically, for practical purposes, COVID in Montana has 100% survival,” she said last week during an online public meeting of the board.

“No, it doesn’t!” shouted Dr. Jeffrey Tjaden, a local infectious disease specialist who attended to warn that without immediate action things were likely to get much worse.

A minute later, he interrupted her again to say that he was so fed up with her presentation that he was logging off.

“I’m not saying that the people who died didn’t matter,” she said after he was gone.

At the end of the night, the board members were left with a single proposal: no gatherings of more than 500 people.

They rejected it with a 5-to-3 vote.

That prompted criticism from the governor, who said he was disappointed that the board ignored experts and that “some are trying to politicize this virus” over protecting health and safety. 

“The message was presented loud and clear that if the virus spread is not controlled in the Flathead area, schools will have to close, parents will be out of the workforce, businesses will be hurt and the hospital will run out of bed capacity,” Bullock told reporters.

This week, he announced that state investigators had conducted spot checks on more than a dozen businesses in Flathead County and that authorities will ask a judge to temporarily shut down five establishments deemed “egregious violators” for flouting mask requirements and social distancing standards.

The biggest looming threat may be winter, because the virus spreads most easily when people are indoors.

In Whitefish, temperatures plunged Friday as the season’s first major snowstorm hit.

“It’s time for action, and it has unfortunately fallen to us,” Qunell told his colleagues at this week’s City Council meeting.

The city manager suggested writing a letter to the health board encouraging it to act. A councilman said another letter to businesses might persuade them to cooperate. 

Qunell didn’t see the point.

“The county’s not going to do anything no matter what letters we write,” he said.

He wanted the council to vote to close bars by 10 p.m. — before they usually get crowded and rowdy — and limit restaurants to 25% of capacity. 

But the only thing the council decided was to meet again Monday to consider imposing limits during Halloween weekend, when Whitefish traditionally puts on a popular downtown bar crawl. 

In an interview, Qunell said Whitefish must find a balance between protecting citizens and the economy that has eluded national, state and county leaders. 

“There’s been a failure of leadership from the very highest levels,” he said. “The responsibility keeps getting pushed downhill, and it’s ended up in our laps.”

Nükhet Varlik, a historian at the University of South Carolina, studies the history of diseases and public health. In this article, she reveals that epidemics and pandemics seldom completely disappear. Only one epidemic–smallpox–has been eradicated. Many others survive.

She writes:

A combination of public health efforts to contain and mitigate the pandemic – from rigorous testing and contact tracing to social distancing and wearing masks – have been proven to help. Given that the virus has spread almost everywhere in the world, though, such measures alone can’t bring the pandemic to an end. All eyes are now turned to vaccine development, which is being pursued at unprecedented speed.

Yet experts tell us that even with a successful vaccine and effective treatment, COVID-19 may never go away. Even if the pandemic is curbed in one part of the world, it will likely continue in other places, causing infections elsewhere. And even if it is no longer an immediate pandemic-level threat, the coronavirus will likely become endemic – meaning slow, sustained transmission will persist. The coronavirus will continue to cause smaller outbreaks, much like seasonal flu.

The history of pandemics is full of such frustrating examples.

Whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them.

The only disease that has been eradicated through vaccination is smallpoxMass vaccination campaigns led by the World Health Organization in the 1960s and 1970s were successful, and in 1980, smallpox was declared the first – and still, the only – human disease to be fully eradicated.

We can all do our part to reduce the danger of COVID-19 by wearing masks and social distancing. When there is a vaccine available, we should take it. It may never be completely eradicated, but we can protect ourselves and our communities by following the practices that scientists have agreed are effective.

Anya Kamenetz, education reporter for NPR, writes here about research findings that suggest the risk of reopening schools during the pandemic have been exaggerated.

Of course, there is good reason to be concerned because the U.S. Congress has not passed the funding needed by schools for safe reopening. Congress has bailed out major corporations, but allotted only $13.2 billion for the nation’s nearly 100,000 schools and more than 50 million students. Public schools were not allowed to request money from the $660 Billion Paycheck Protection Program, but charter schools, private schools, and religious schools were eligible to request PPP funding, and some received millions of dollars.

Kamenetz begins:

Despite widespread concerns, two new international studies show no consistent relationship between in-person K-12 schooling and the spread of the coronavirus. And a third study from the United States shows no elevated risk to childcare workers who stayed on the job.

Combined with anecdotal reports from a number of U.S. states where schools are open, as well as a crowdsourced dashboard of around 2,000 U.S. schools, some medical experts are saying it’s time to shift the discussion from the risks of opening K-12 schools to the risks of keeping them closed.

“As a pediatrician, I am really seeing the negative impacts of these school closures on children,” Dr. Danielle Dooley, a medical director at Children’s National Hospital in Washington, D.C., told NPR. She ticked off mental health problems, hunger, obesity due to inactivity, missing routine medical care and the risk of child abuse — on top of the loss of education. “Going to school is really vital for children. They get their meals in school, their physical activity, their health care, their education, of course.”

While agreeing that emerging data is encouraging, other experts said the United States as a whole has made little progress toward practices that would allow schools to make reopening safer — from rapid and regular testing, to contact tracing to identify the source of outbreaks, to reporting school-associated cases publicly, regularly and consistently.

“We are driving with the headlights off, and we’ve got kids in the car,” said Melinda Buntin, chair of the Department of Health Policy at Vanderbilt School of Medicine, who has argued for reopening schools with precautions.