Like every other parent with a school-age child, I want schools to reopen in the fall including the one Im attending.
On the best of days, my son can be described as spirited. After four months of being cared for by his grandparents, he is practically feral. He needs the physical and social outlet that school provides, and I need the anatomy lab to reopen because human dissection is an irreplaceable part of my medical education.
But I am also an epidemiologist, and after reading the Centers for Disease Control and Preventions guidelines for school reopening and the various accompanying news coverage and think-pieces, I cant convince myself that following its rules will keep my family or yours safe.
Why? Because the primary way Covid-19 is transmitted is through respiratory droplets that careen through the air, and yet the capricious nature of air circulation and the lack of filtration systems in our already underfunded public school systems is absent from the conversation.
Since New York state started reopening, I have received emails from my medical schools working group about the plan to bring us back to campus. Its plan is to follow the basic script seen in school reopening strategies all over the country: frequently sanitized high-touch surfaces, 6-foot distances, unidirectional hallways, reduced capacity elevators and classrooms, health questionnaires, and contact-free temperature checks upon entry (more on that in a minute).
My school is not negligent, but like many other educational institutions, its efforts are dangerously misdirected. We are collectively engaging in what Derek Thompson describes in the Atlantic as hygiene theater, in which organizations looking to reopen focus intensively on arduous decontamination strategies to mitigate surface transmission even though that is not the primary route for Covid-19 transmission, and some scientists argue that there is no direct evidence the virus spreads this way at all. Id also like to add temperature checks to the hygiene theater playbill, as they too fail to successfully screen potential Covid-19 carriers, but have somehow made their way onto every screening list Ive seen.
Why is this happening? The CDC is supposed to determine the national priorities for American health.
Of the eight bullet points in its staff safety section, four address surface transmission. The three bullet points dedicated to respiratory droplets warn people to stay 6 feet away from each other, cough into their elbows, and wear a mask.
The current CDC guidance about ventilation is as follows, Ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible, for example by opening windows and doors. But if opening windows or doors increases the risk of asthma, or falling out the window, the guidelines go on to advise that they should be closed. That is all the guidance has to say. It does not mention air filtration, or the fact that we have pretty good data to suggest that without addressing air filtration and circulation, the 6-feet rule does not prevent transmission indoors.
Here are the things that caught my attention as an epidemiologist as schools played Tetris with classroom furniture and agonized over hybrid schedules.
On May 6, Erin Bromage, a microbiologist at the University of Massachusetts at Dartmouth, published a widely read article detailing the role of air circulation at three major indoor transmission events: a call center in South Korea, a restaurant in Guangzhou, China, and the infamous choir practice in Washington state. Each of these events taught us that transmission happens when you spend significant time indoors. Being 50 feet apart with a low dose of the virus in the air, over a sustained period, was enough to cause infection and in some cases, death. This happens because infectious particles from individuals are pushed by the ventilation system to the other side of the room. Bromages post appeared 127 days before the first day of school in New York City.
HEPA filters are able to effectively capture particles the size of SARS-CoV-2. The CDC currently recommends their use for this purpose in hospitals, but their capacity to prevent the spread of Covid-19 in other public buildings remains under-explored. Though the CDC has stayed silent on the use of HEPA filters outside hospitals, on May 25 a group of ENT doctors made the case for installing them in doctors offices where aerosol generating procedures are being performed, because of evidence they can help prevent the spread other infections such as SARS-CoV-1, measles, and influenza. That was published 108 days before the first day of school in New York City.
On May 27, a group of 36 scientists from around the world in a variety of fields penned an article in the journal Environment International titled, How can airborne transmission of Covid-19 indoors be minimised? As they wrote, Here, in the face of such uncertainty, we argue that the benefits of an effective ventilation system, possibly enhanced by particle filtration and air disinfection, for contributing to an overall reduction in the indoor airborne infection risk, are obvious. Its obvious to me as well, and deserves to be our primary concern in reopening schools, far more urgently than distance or Lysol. That was 106 days before the first day of school in New York City.
McKinsey & Company reviewed research regarding airborne spread of SARS-CoV-2 and on July 9 posted an article suggesting possible upgrades to existing heating, ventilation, and air conditioning (HVAC) systems. A key recommended change was to increase the number of times HVAC systems exchange air per hour, which would push the infectious particles outside and prevent them from being blown across the room. This article appeared 63 days before the first day of school in New York City.
When I mentioned these possibilities to a friend who teaches in the New York City schools, she replied, Dont worry about our HVAC systems. Theyre all broken.
Instead of using limited time and funding to engage in hygiene theater, we should be investigating how to address ventilation. Or at the very least, be honest with the public about some institutions inability to make interior spaces safe.
As a result of months of misapplied focus on surface disinfection, the importance of air circulation and the potential use of filtration is missing from the national debate on school reopening. My sons school and mine are both concerned with delivering our education safely. My sons preschool director was worried sick about not being able to adequately decontaminate on a daily basis because she loves both the kids and her school.
It shouldnt be her responsibility to research ventilation theory and filtration techniques and air flow patterns. Its not my job as a medical student to Google these things trying to get enough information to decide what to do about my sons school, and mine, starting imminently. And its not up to the administrators at my school, who I know have been working around the clock these last few months, to figure this out.
This is supposed to be done by the CDC. Here we are, about a month before public schools are supposed to begin, and the CDC is still failing to signal the crucial importance of addressing ventilation.
We need to include air circulation patterns and filtration options in the conversation. If were not willing or able to fund necessary upgrades to school ventilation systems, lets admit that. Until we have that public discussion, I am not comfortable exposing my family to schools. Because if I cant trust that the people making these decisions are reading the literature, how can I trust them with my familys health?
Alexandra Feathers is an epidemiologist and first-year medical student at SUNY Downstate.
- To deal with the A levels fiasco fallout, medical schools need a cash injection - Times Higher Education (THE) - September 8th, 2020
- Mercer University Breaks Ground on New Medical School Campus in Columbus - Mercer News - September 8th, 2020
- COVID-19-induced 'sophomore medical student syndrome' | TheHill - The Hill - September 8th, 2020
- New crop of medical students are headed to the lab - Stanford Medical Center Report - September 8th, 2020
- U of M Medical School researchers look to beach water for COVID community infection - KARE11.com - September 8th, 2020
- When's the right time to choose a medical specialty? - American Medical Association - September 8th, 2020
- Gujarat medical school to carry out autopsies of COVID-19 victims to study effects on body - Republic World - Republic World - September 8th, 2020
- Durham student with dreams of med school wins $100,000 in lottery game - WRAL.com - September 8th, 2020
- How to help medical students keep tabs on their mental health - American Medical Association - September 8th, 2020
- Industry VoicesCould less emphasis on the MCAT bring more diversity to medicine? - FierceHealthcare - September 8th, 2020
- Medical exams postponed amid strike and resurgent virus - University World News - September 8th, 2020
- TCOM creates office of student success - fortworthbusiness.com - September 8th, 2020
- COVID-19 Disproportionately Impacting Those With Developmental Disabilities - Disability Scoop - September 8th, 2020
- Med Students 'Feel Very Behind' Because of COVID-Induced Disruptions in Training - The Southern Maryland Chronicle - September 8th, 2020
- A bill would spend $1 billion on diversifying medical schools to close the racial health gap - NBC News - August 10th, 2020
- Pandemic acts as dress rehearsal for new medical school curriculum - Washington University School of Medicine in St. Louis - August 10th, 2020
- The Unnamed Hero - Pager Publications, Inc. - August 10th, 2020
- Testing is the key to a successful fall reopening on campuses (opinion) - Inside Higher Ed - August 10th, 2020
- TUNE IN: Alexandria Addressing Back-to-School Worries in Virtual Town Hall - The Zebra - August 10th, 2020
- Community Healthcare honored during National Health Center Week - Times Record News - August 10th, 2020
- When Things Arent OK With a Childs Mental Health - The New York Times - August 10th, 2020
- Making sure patients, physicians know about the advances in treating female cancers - Norton Healthcare - August 10th, 2020
- 'We Are Here to Help Them' | Harvard Medical School - Harvard Medical School - August 10th, 2020
- In the face of challenges posed by a pandemic and racism, the White Coat Ceremony underscores the importance of our shared humanity - AAMC - August 10th, 2020
- Physician Group Wants Medical Schools To Waive The MCAT This Year - Physicians News Digest - August 10th, 2020
- Born with 1 hand, she's an inspiration in virus fight - ABC News - August 10th, 2020
- What to Expect in Medical School - AAMC for Students ... - August 8th, 2020
- International med students ease the path for others with new mentor group - STAT - August 8th, 2020
- Texas schools reopening mandate sets off another local control debate - The Texas Tribune - August 8th, 2020
- Amid COVID-19 Pandemic, Morehouse School of Medicine Welcomes Its... - Diverse: Issues in Higher Education - August 8th, 2020
- Guntersville native joins Andrews Sports med team | Free Share - Sand Mountain Reporter - August 8th, 2020
- COVID-19 changing study of medicine on Long Island - Newsday - August 8th, 2020
- Health Care Workers Of Color Nearly Twice As Likely As Whites To Get COVID-19 - WUSF News - August 8th, 2020
- Dancing Wildcats Enjoy Smoother Transition to the Field of Medicine - UKNow - August 8th, 2020
- Kindness is the best medicine - Argus Leader - August 8th, 2020
- Kindness is the best medicine | Coronavirus | rocketminer.com - Daily Rocket Miner - August 8th, 2020
- With academic health center, the imagined can be reality - Las Vegas Sun - August 8th, 2020
- Need to Take the MCAT? You'll Still Have to Do It in Person - The New York Times - August 8th, 2020
- A UT undergrad helped build the app that will assist students coming back to school this fall. Here's what it can do. - UT News | The University of... - August 8th, 2020
- Med School Professor Removed from Fellowship Director Post, Apparently for Publishing Anti-Affirmative-Action Journal Article - Reason - August 7th, 2020
- Good Shepherd celebrates one of it's first graduates on track to realize dream of becoming doctor - WDSU New Orleans - August 7th, 2020
- Change the course of the pandemic: UMass Medical School, Boston tech company at center of national push to - MassLive.com - August 7th, 2020
- Duality Health Begins Rapid Blockchain Innovation Cycle with Health Product Innovation Team at Dell Medical School - Tyler Morning Telegraph - August 7th, 2020
- Deciding whether to send your child back to school? Heres what the experts say to consider - nj.com - August 7th, 2020
- Kaine introduces bill that would support medical schools in underserved areas - WDVM 25 - August 4th, 2020
- Medical school affiliates on lack of diversity, burden of the 'minority tax' - The Stanford Daily - August 4th, 2020
- International medical school graduates need an easier path to practice in the US | TheHill - The Hill - August 4th, 2020
- The 'dura mater' handles medical training and motherhood with aplomb - DePauw University - August 4th, 2020
- Emory University doctor and former teacher suggests staggered starts, plexiglass lunch barriers to avoid COVID-19 spread in schools - 11Alive.com WXIA - August 4th, 2020
- President Houshmand and CMSRU Dean Reboli named to South Jersey BIZ Power 50 list - Rowan Today - August 4th, 2020
- 'Its a good mix of medicine and social justice': Medical student gets experience at NATIVE Project during pandemic - The Spokesman-Review - August 4th, 2020
- Addressing inequalities in women's health research | Contemporary OB/GYN - Contemporary Obgyn - August 4th, 2020
- New medical residents experience a different kind of welcome into URMC - University of Rochester - August 4th, 2020
- 'Not surprising': International graduate students respond to short-lived ICE directive - The Stanford Daily - August 4th, 2020
- MASKED-COVID Study to Assess Renal-Related Complications of COVID-19 - DocWire News - August 4th, 2020
- Addressing inequalities in women's health research - Contemporary Obgyn - August 4th, 2020
- Seeing the Health Care Profession Through the Eyes of a Medical Scribe - Hamilton College News - August 4th, 2020
- University of Medicine and Health Sciences Launches State-of-the-Art Virtual Tour - PR Web - August 4th, 2020
- Researchers With Game - Ohio Wesleyan University - August 4th, 2020
- List of medical schools in the United States - Wikipedia - August 3rd, 2020
- Disc Medicine Expands Leadership Team with Industry Veterans to Advance Hepcidin Modulating Therapies Toward the Clinic - PRNewswire - August 3rd, 2020
- Solomon Rajput '14 takes on Michigan incumbent for seat in Congress - The Dartmouth - August 3rd, 2020
- Fighting the Coronavirus, from New York to Utah - The New Yorker - August 3rd, 2020
- Boston doctor named hospital hero relied on human connection to get through COVID peak - Boston Herald - August 3rd, 2020
- Starkman: Beaumont Executive Paid $932000 by Hospital Vendor Whose Implants Were Pushed on Surgeons - Deadline Detroit - August 3rd, 2020
- Students need to be tested every 2-3 days for colleges to safely reopen - Yale News - August 3rd, 2020
- Taking Medicine and Tech to the Next Level: Ranney on New Brown-Lifespan Center for Digital Health - GoLocalProv - August 3rd, 2020
- Medical Schools Have Historically Been Wrong on Race - The New York Times - August 3rd, 2020
- After the Match: The Match in the Age of COVID-19 : Emergency Medicine News - LWW Journals - July 31st, 2020
- North Philly coronavirus risk: Temple University's return to campus is irresponsible - On top of Philly news - Billy Penn - July 31st, 2020
- Researchers Discover Stem Cells in Optic Nerve that Preserve Vision - Newswise - July 31st, 2020
- Pre-med students spend the summer studying COVID-19 - DePauw University - July 31st, 2020
- The Author of Blacks in Medicine on Race, Racism, and Health Outcomes - KCET - July 31st, 2020
- Five Questions With: Dr. Ben Abo on Snakes and Television - EMSWorld - July 31st, 2020
- We asked 20 medical experts whether they're sending their own kids back to school. Here's what they had to say - CNBC - July 31st, 2020
- NYU Long Island School of Medicine Is First School on Long Island to Start 202021 Term, May Be Microcosm of 'Hybrid' Class Model - NYU Langone Health - July 31st, 2020
- Medical education in the time of COVID-19 - Science Advances - July 31st, 2020
- Rutgers New Jersey Medical School - July 31st, 2020
- Discrimination in the medical curriculum: are medical schools providing students with equal access to the medical profession? - The European Sting - July 31st, 2020
- Marshall School of Medicine 1 of 9 schools to offer Mission Act scholarships to veterans - Huntington Herald Dispatch - July 30th, 2020