COVID: Schools & Age-Related Morbidity and Mortality

JF Ludvigsson et al NEJM 2021; 384: 669-671. Full text: Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden In this letter to the editor, the authors report on outcomes in Sweden, which kept schools open during the pandemic; time period: from March 1-June 30, 2020 (schools end around June 10th). Key findings:

  • Among 1-16 years of age (~1.95 million in total), 15 required ICU admission; there were no deaths in this age group
  • “Fewer than 10 pre-school teachers [1-6 years] and 20 schoolteachers received ICU care up to June 30, 2020.” Excluding health care workers, the occupational risk was similar to other occupations, with relative risk of 1.10 (0.49-2.49, 95% CI) and 0.43 (0.28-0.68, 95% CI) for preschool and school teachers respectively.

My take: This study suggests that school teachers are at similar risk for COVID-19 infection as other essential workers. In Sweden, during this timeframe, distancing but not masking was recommended. Thus, transmission rates could be lowered further.

Related article: SR Kadire et al. NEJM 2021; 384: DOI: 10.1056/NEJMclde2101987. Full text: Delayed Second Dose versus Standard Regimen for Covid-19 Vaccination This article provides rationale for both vaccine options.

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Reopening Primary Schools -What’s At Stake

R Levinson et al. NEJM 2020; DOI: 10.1056/NEJMms2024920. Full Link: Reopening Primary Schools during the Pandemic

An excerpt:

Children miss out on essential academic and social–emotional learning, formative relationships with peers and adults, opportunities for play, and other developmental necessities when they are kept at home. Children living in poverty, children of color, English language learners, children with diagnosed disabilities, and young children face especially severe losses.

School-provided social welfare services support the health of U.S. communities made  vulnerable by systemic racism, inadequate insurance, family instability, environmental toxicity, and poorly paid jobs.1 More than 50% of all U.S. school-age children rely on their schools for free or reduced-price daily meals. Despite efforts by school districts to maintain these services even when school was conducted remotely, a majority of children have been unable to access the full nutritional benefits to which they’re entitled.5 Schools also provide physical, mental health, and therapeutic services to millions of students per year. Many of these services have proved inaccessible to children — particularly low-income children of color and children with noncitizen family members — when schools are physically closed.1 Finally, safe and consistently open schools are essential for many parents and guardians (particularly women) to be able to reenter the workforce — including the health care sector…

Most locations (except Israel) whose schools are open had already achieved low community transmission rates (<1 new case per day per 100,000 people) and have remained focused on maintaining population-level infection control…

The safest way to open schools fully is to reduce or eliminate community transmission while ramping up testing and surveillance…These precautions are especially important insofar as 17.5% of teachers are 55 or older…

The fundamental argument that children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial. If we all agree on that principle, then it is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall.

My take: This commentary makes strong arguments for reopening schools; however, in countries where this is succeeding, community transmission of SARS-CoV-2 is low and we are nowhere close to low.

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COVID-19: Universal Mask Wearing (JAMA) and Israel’s Concerning Experience with Opening Schools

JAMA Editorial (July 14, 2020) JT Brooks, JC Butler, RR Redfield (all authors from CDC), JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.13107Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now

An excerpt:

In this issue of JAMA, Wang et al present evidence that universal masking of health care workers (HCWs) and patients can help reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.1 In the largest health care system in Massachusetts with more than 75 000 employees, in tandem with routine symptom screening and diagnostic testing of symptomatic HCWs for SARS-CoV-2 infection, leadership mandated a policy of universal masking for all HCWs as well as for all patients. The authors present data that prior to implementation of universal masking in late March 2020, new infections among HCWs with direct or indirect patient contact were increasing exponentially, from 0% to 21.3% (a mean increase of 1.16% per day). However, after the universal masking policy was in place, the proportion of symptomatic HCWs with positive test results steadily declined, from 14.7% to 11.5% (a mean decrease of 0.49% per day). Although not a randomized clinical trial, this study provides critically important data to emphasize that masking helps prevent transmission of SARS-CoV-2…. the public needs consistent, clear, and appealing messaging that normalizes community masking. At this critical juncture when COVID-19 is resurging, broad adoption of cloth face coverings is a civic duty, a small sacrifice reliant on a highly effective low-tech solution that can help turn the tide favorably in national and global efforts against COVID-19.

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Some of the uptick in cases likely related to lack of concern and not using masks

COVID-19: Meat Processing Personnel, School Opening Problem and Nosocomial Infections

It is widely recognized that the meat processing industry has been hit hard; here’s the data: more than 16,000 cases in April-May from 23 reporting states:

School opening decisions are now being worked out.  While reports have indicated that school opening is going fine in many places in Europe, their caseload is much much lower.

From Mike Lukovich’s Twitter Feed:

Related blog post: What Our Office is Recommending: Schools and IBD Patients

Also: this link, RIVM Children and COVID-19, describes experience with opening schools in Europe and Australia

Also, an interesting Wall Street Journal Article (Behind Paywall): Hospitals Struggle to Contain Covid-19 Spread Inside Their Walls