As we continue to navigate these unprecedented times, KCBS Radio is getting the answers to your questions about the coronavirus pandemic. Every morning at 9:20 a.m. Monday-Friday we're doing an "Ask An Expert" segment with a focus on a different aspect of this situation each day.
Today, we'll talk about the next steps in combating the virus, especially when it comes to reopening schools with Dr. Cyrus Shahpar, Director of the Prevent Epidemics Team at Resolve to Save Lives.
Tell us a little bit, before we get going, about your work, your organization and what the big picture goal has been.
Yeah I work for a newer organization. We're led by former U.S. CDC director, Tom Frieden. Before COVID we worked around the world to help countries get ready for epidemics and outbreaks mostly in Africa. And since COVID, since January really, we've shifted over to really a global response to COVID again in Africa, but also in the United States. Kind of supporting technical guidance, things that you would expect would come out of CDC: helping jurisdictions, counties and states manage their response and really use data to drive decision making.
This has been such a challenge because this thing landed like a lead bomb on people. Maybe they should have been more ready, but the reality is most of us were merrily sailing along in our lives and suddenly found ourselves in a pandemic.
Yeah, I think, by most measures, the U.S. Is one of the best prepared countries in the world in terms of infectious disease events, but we've seen it turned into the worst performer. I think there's some things that weren't anticipated in terms of coordination and leadership, you know, the difference in our responses across the country and those have complicated what we've done.
You've been working in this space for a while and as you mentioned, generally in other places to prepare for epidemics or potential pandemics. What are the key elements of a game plan that seemed to work?
Yeah, I think one of the key elements is adapting to the information. So you can't say, "a month from now, we're going to do this exact measure" because you need to use data to inform your response and you need clear coordination from leadership. In order to tackle an event of this size you need to be guided by science and you need to look across at what others are doing and what works and apply that to your situation. So in the case of the United States, of course, other countries were impacted earlier, what did they learn? So we don't have to relearn those things. We can maybe start from a better place.
Let me ask you this too, because we've been doing the segment for weeks and weeks now, but the notion that things have in fact changed, the science has changed, we've learned new things, things we might've thought were really true maybe not so much, other things have now emerged. What message do you give to lay people or political leaders when they challenge the notion that that's not what you said last week?
I think good science can involve changing. We didn't know a lot about face mask use in the community. Most of what we had was theoretical because we haven't had a pandemic like this in over a hundred years. So nobody here has experience with something like this at this scale. And then as we learned other countries around the world using face masks in the community that that seemed to decrease transmission, there were lab studies of course, looking at the impact of that. And we changed to highlight the importance of face masks, and now it's a core tool we have. And that's good science. It's not backtracking, it's not being say rigid and not adapting to new information, but that's an example of adapting to the situation and improving the response.
Okay. I know your team has recently put out a public health approach, sort of a guideline or handbook to how to reopen schools. Let's focus on that for a moment. This has been so challenging. You talk to any teacher or parent or school administrator, and the challenge seems so enormous to figure out what to do next. What should they be doing next?
Yeah, it is a huge challenge. We know education is essential. We know the impact of not having school. We know less about the risk to children, but we do know some things. I think we have to look to see how we can reduce risk in schools and try our best to get kids back into school. We know that you know, education has suffered, the poorest kids are falling the furthest behind. So we need to open carefully, not rush it. But part of what happens in schools and whether or not we do it, the most important factor really is what's going on in the community and are we controlling it in the community. So if we help control it in the community, we are more likely to open schools.
Okay, well let's get to questions then, these have been sent in via email to askus@kcbsradio.com. First one says: it seems like a lot of European countries have been able to return kids to classrooms without any big problems. Should we see that as a model for here or not? I'm concerned because our infection rate is so much higher than most other countries right now.
Yeah. I think that's a good point. What is going on in the community? As I said, that's the most important. So a place like the Bay Area is different than Arizona, where to be honest, opening schools right now is not something that should be on the table, there's just too much virus out there. And then a place that doesn't have many cases of course, is more likely to open. So certainly Denmark and Finland opened schools in mid-April and May. No significant evidence of a resurgence starting with younger kids first. But the situation they're in is much less in terms of community transmission. So we need to look at what's going on in the community and see what kind of measures they took in other countries where they did open already. And some of the things they did were, they kept the groups small, they had outdoor classes, people wore masks including teachers and students and they re-engineered the school to make sure that they reduced the high touch surfaces, interaction with others, cleaned vigorously. Those are some of the things we need to do here.
Let me ask you, is there a magic number you would be comfortable with in terms of what the community case rate or positivity test rate would be? I mean, everybody's looking for some kind of a switch where we can say that's good or that's not.
I think there is no magic number. Oftentimes I get asked for a magic number: there isn't any. But I think, you know, certainly it has to do with the combination of factors in terms of risk to a particular school or child, the community being the most important, but also the school itself, is it prepared? Does it have a plan? How strict are they about adhering to guidance? When you go pick up your kids, are teachers wearing masks? Are they doing things like organizing into smaller cohorts and cleaning a lot and having good ventilation? These are all factors that would weigh into a decision of whether or not the school is a safe place in a community. So in terms of community, we do look at things like test positivity. A place that has, say, more than 10% positivity: it's hard to imagine that a virus isn't likely to hit schools. So that could be a threshold that you might use.
And when you talk about community, that's an interesting concept because our school districts tend to be organized over fairly large communities - a city or a part of the city - whereas a community where there's a hot outbreak of this might only be a few blocks in a neighborhood or one particular gym.
Yeah. And I think it's hard cause we have to try to keep up to date on that. And I'm a parent of two small kids here in Alameda and I look to see, okay, in my community, how many cases are there? What's the risk look like in this specific place? Recognizing that children are coming to the school from all over, the city, for example, or even other cities. Just to get an idea, as I said, of the spread of disease in the area when I make my decision.
Asia has had more experience with SARS and other virus situations. What has been their model for schools?
Yeah. I mean, it wasn't as broad of an event this pandemic, of course. And I think they've done a lot, I'm sure you've seen pictures online of some of the classrooms they have in terms of re-engineering schools, putting all the desks in one direction even though that's a little bit of a dated concept. Having masks, even for small children, I know that with younger children it's difficult to see how they would wear masks, but they have more experience. It's more common to see masks in that society and so they're more successful in terms of adherence of younger children. And, yeah, reopening schools. Now that doesn't mean they don't have to close some from time to time. To think that there's going to be a zero risk environment, that's not going to happen. But being able to detect cases early, to open schools as safely as possible, that's the strategy they've employed.
My son is seven years old. What are the possibilities he could contract the virus and be contagious and bring it home to us?
Yeah. So we looked at the science of children, which is certainly evolving. Based on what we know now, it's fairly certain that kids get less severe illness. So if they do get sick, they don't get as sick, much more mild cases seen in children. There is some rare cases of kids getting severely ill, some dying, of course, you know about this multi-system inflammatory syndrome, but that's extremely rare. Two in about a hundred thousand kids. So kids have less severe disease. They also appear to have less transmission in terms of getting disease or transmitting it to others. That evidence isn't as strong but in terms of the studies that have been done, kids all around, less likely to transmit to others, less likely to get disease themselves and less severe illness.
What about the bringing it home part? In other words, if a child does pick up the illness at school, the risk to the family at home.
Yeah. So in terms of kids transmitting it to others the evidence has shown that's not as likely as say, adults going to adults.
I'm a teacher, 62 years old with diabetes. Frankly I'm terrified to go back to school. Are there any ways they can safely open schools with people like me teaching?
Yeah. I think to be honest, the situation you described would be considered a higher risk, more vulnerable person. They should investigate ways to not have to teach inside the school, maybe shifting to online learning. And every school needs to have a plan that includes both in-person and online learning. If there is a case in a school, for example, and they need to shift, or if the community spread increases and the school has to close, schools need to be ready to try to have that ongoing education happening. So for somebody who's in a vulnerable group, the first step would be to try to explore ways where you don't have to go back in the classroom. And then of course if you do, trying to minimize risk the same way you do when you go to the grocery store: wearing a mask, watching your distance, washing your hands, these kinds of things.
Baseball is trying to test its ballplayers every two days. This question says, how often should students and teachers be getting tested?
So I think CDC guidance is that they should only get tested if they're symptomatic. We have a testing problem here in the United States. That problem is continuing. We don't have enough tests and the tests are taking too long to come back. It's important to remember testing will not keep the virus out of schools. We could test once a week and the virus will still get into some schools and we need to be ready for that. Testing for K-12 is unproven. Some universities are trying testing strategies, we'll see what they learn, but no matter what we need to do, the things that I mentioned earlier in terms of reducing risk.
This questioner wants to know what's going to happen to things like band and music and sports teams and even PE classes? It seems like kids need more and it looks like they'll be getting less. Any thoughts on that?
Yeah. I mean, there are certain activities that are high risk. We know choir is out. We know based on some outbreaks that have happened, the virus can spread more easily in those kinds of settings where there's loud speech. So we want to use inside voice. So certain activities like performing arts or some of the athletic activities that involve closer contact are higher risk, and those will need to be canceled for now. And there's some other things that could happen more in modified ways in terms of keeping distance, but it won't look like the school that we had before.
How much more expensive will it be to reopen schools during the pandemic, or will most of the burden simply fall on teachers and staff who will have to work a lot harder, but may not be getting paid anymore?
Yeah, certainly to do the things we need to do to keep schools safe will cost money. And so we need to provide schools with resources to do things like re-engineer the classrooms, to provide hand-washing stations and new health and safety protocols. There are costs to this. At the same time schools may not have as many resources if classroom sizes are smaller. So there is an economic component to this, and there needs to be support for schools to open safely rather than say they can open, but to have the same amount of resources. And this is stuff that we need to figure out moving forward.
And there's been a lot of talk about cohorts: this notion that you get a group of kids together and they sort of move through their day together rather than - especially at the middle school and high school level - spreading out and mixing and mingling in different classes. So this questioner wants to know, what do you think would be best? Cohorts with 50% attendance on alternate days, a split classroom with 50% attending in person and 50% online? Any ideas?
Yeah, reducing mixing among students and staff is certainly shown to reduce transmission. Having pods or cohorts is a good idea. And also if a case happens it won't spread widely if students are organized in that manner. There have been modeling studies that show the most effective strategy is a week on and a week off. Now that's not practical for many parents, for example. Then comes alternating days, then comes alternating shifts within a day. And all of those are more effective than doing nothing and going back to just regular.
Yeah and you touched on something important there. We tend to sort of talk about the schools, and a cynical schoolteacher I once knew said, "look, let's not forget what schools really are important for is daycare." And that's true because they allow families to work. So how are we going to get around that if many of these approaches rely on some sort of at home education?
Yeah, certainly. And some families can't move forward or will have economic consequences if kids aren't able to go to school. And some children, if they rely on schools for things like meals will suffer as well. And this is why we need to try to find a way, on top of education of course, which is paramount, to have schools reopened safely. Otherwise it will impact the whole family as we've learned over the past few months.
Everyone seems to think we can send kids all the way down to kindergarten age into classrooms while wearing masks. How's that gonna work when it's time to read aloud, ask questions, give presentations, et cetera?
Yeah. It's hard to consider. I have two very young children who, one of them wears a mask intermittently. I think other countries around the world, as I said, have children wearing masks and they're more used to it. I think we have to think about how we can get them to wear masks as much as possible, making it fun to wear a mask, you know, superhero type thing, or modeling best practices or making masks with children. Just the more common it seems and the more appropriate it is in terms of the households and things like that and things we can do outside of school, I think hopefully that'll drive mask adoption. Positive incentives as well at school to wear masks, recognizing though that there's an age group below which it's unlikely this mask will be worn.
And one last one: I see middle school teens playing basketball at the school grounds every evening, at least 30. They're playing without masks.
And I guess the question on that would be, how are we going to change that culture among middle schoolers, high schoolers, who right now may not be all that engaged in this?
Yeah, I think certainly there's a certain amount of risk with that activity. I've seen around here they've taken the hoops off of basketball courts just to prevent that from happening. I think it depends again on community transmission. Schools need to be rigorous in their preparedness in terms of allowing certain activities to happen. Now they can only control what happens in the school. So if people are doing those kinds of things after school, of course there needs to be, you know, controls in place either in households or in kind of park and rec associations, those kinds of things to prevent you know, community spread. But it's going to be difficult.
This interview has been edited for clarity.
