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.
advertisement
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).
advertisement
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.
Visit link:
Why isn't ventilation part of the conversation on reopening schools? - STAT
- "Shift Happens" - November 8th, 2009 [November 8th, 2009]
- Getting Started With Your Personal Statement - November 8th, 2009 [November 8th, 2009]
- I started this blog 1 year ago. I'm ready to become a medical doctor. - November 8th, 2009 [November 8th, 2009]
- Poll Results: "What is your GPA?" - November 8th, 2009 [November 8th, 2009]
- Why Ross University School of Medicine? - November 8th, 2009 [November 8th, 2009]
- Why Ross University? (Continued) - November 8th, 2009 [November 8th, 2009]
- Filling out applications with the last 4 years in mind. - November 8th, 2009 [November 8th, 2009]
- "Active and Passive Euthanasia" - November 8th, 2009 [November 8th, 2009]
- 300 Word Personal Statement - First Draft - November 8th, 2009 [November 8th, 2009]
- 300 Word Personal Statement - 2nd Draft - November 8th, 2009 [November 8th, 2009]
- "Where did you do EMT training at?" - November 8th, 2009 [November 8th, 2009]
- "is this jonathan that went to brazil in the summer of 2006?" - November 8th, 2009 [November 8th, 2009]
- First Application is Away - Ross University - November 8th, 2009 [November 8th, 2009]
- AMCAS—The American Medical College Application Service - November 8th, 2009 [November 8th, 2009]
- The Student Doctor Network - November 8th, 2009 [November 8th, 2009]
- Crime Incident - Public Safety Announcement: STUDENTS - November 8th, 2009 [November 8th, 2009]
- AMCAS Deadlines & Delays - Answered - November 8th, 2009 [November 8th, 2009]
- Headstart on Secondary Applications - The Student Doctor Network - November 8th, 2009 [November 8th, 2009]
- The Complete Medical School & Admissions Guide - Revisited - November 8th, 2009 [November 8th, 2009]
- Interview Status - Ross University - November 8th, 2009 [November 8th, 2009]
- Finished my first interview. - November 8th, 2009 [November 8th, 2009]
- "You have a 95% chance of acceptance..." - November 8th, 2009 [November 8th, 2009]
- "I was just wondering if I have to go to medical school i will have to start college allover again." - November 8th, 2009 [November 8th, 2009]
- Interview Feedback - Allopathic Medical Schools - Ross University School of Medicine (Dominica Caribbean) - November 8th, 2009 [November 8th, 2009]
- ACCEPTED! - November 8th, 2009 [November 8th, 2009]
- Step 1 Revisited - November 8th, 2009 [November 8th, 2009]
- A Few More Thoughts On Moving - November 8th, 2009 [November 8th, 2009]
- Update - November 8th, 2009 [November 8th, 2009]
- Closing In - November 8th, 2009 [November 8th, 2009]
- Internet/Computer Hell - November 8th, 2009 [November 8th, 2009]
- Back On The Net - November 8th, 2009 [November 8th, 2009]
- 1 More Day - November 8th, 2009 [November 8th, 2009]
- Loan Deferment Blog - November 8th, 2009 [November 8th, 2009]
- Graduated! - November 8th, 2009 [November 8th, 2009]
- What Happened? - November 8th, 2009 [November 8th, 2009]
- Interesting Case - November 8th, 2009 [November 8th, 2009]
- What Made Me Stupid? - November 8th, 2009 [November 8th, 2009]
- Blah. - November 8th, 2009 [November 8th, 2009]
- Call - November 8th, 2009 [November 8th, 2009]
- Medicine in the Media - November 8th, 2009 [November 8th, 2009]
- Was Medical School Worth It? - November 8th, 2009 [November 8th, 2009]
- Off I Go... - November 8th, 2009 [November 8th, 2009]
- Is It Worth It, Part 2 - November 8th, 2009 [November 8th, 2009]
- Oriented - November 8th, 2009 [November 8th, 2009]
- GLBT in Medical School - November 8th, 2009 [November 8th, 2009]
- GLBT in Residency Applications - November 8th, 2009 [November 8th, 2009]
- I Survived - November 8th, 2009 [November 8th, 2009]
- Reflections on the First Week - November 8th, 2009 [November 8th, 2009]
- All Good Things Must End - November 8th, 2009 [November 8th, 2009]
- The Lone Coyote is Back - November 8th, 2009 [November 8th, 2009]
- Pre-med student switches gears to teach in Chicago school - Chicago Tribune - March 8th, 2010 [March 8th, 2010]
- Old-school barbecue coming to spot near Fort Worth medical district - Fort Worth Star Telegram - March 8th, 2010 [March 8th, 2010]
- Nursing home drug use puts many at risk - Boston Globe - March 8th, 2010 [March 8th, 2010]
- Dr. Anita Figueredo, first female surgeon in San Diego, dies at 93 - Los Angeles Times - March 8th, 2010 [March 8th, 2010]
- Stimulus funds pay for monkey research in NC - MiamiHerald.com - March 8th, 2010 [March 8th, 2010]
- Medicine as an economic engine - Buffalo News - March 8th, 2010 [March 8th, 2010]
- UM medical school feels the squeeze - MiamiHerald.com - March 8th, 2010 [March 8th, 2010]
- HARVARD MEDICAL SCHOOL ADVISER Bell's palsy not as serious as it appears - Detroit Free Press - March 8th, 2010 [March 8th, 2010]
- Baylor medical school works to get back on track - Houston Chronicle - March 8th, 2010 [March 8th, 2010]
- From community college to Amherst College and Yale Medical School - WalletPop (blog) - March 8th, 2010 [March 8th, 2010]
- Man questions merit of coke monkey study - UPI.com - March 8th, 2010 [March 8th, 2010]
- School Board has questions it wants answered about onsite medical clinic - Terre Haute Tribune Star - March 9th, 2010 [March 9th, 2010]
- Stimulus Funds Pay for Monkey Research - NewsMax.com - March 9th, 2010 [March 9th, 2010]
- Babylon schools head: Teen's collapse unrelated to athletics - Newsday (subscription) - March 9th, 2010 [March 9th, 2010]
- Cost Of Medical School Rises In Recession - NPR - March 9th, 2010 [March 9th, 2010]
- Flu Shots in Children Help People of All Ages - New York Times - March 9th, 2010 [March 9th, 2010]
- A prescription for improving science education - Scope (blog) - March 9th, 2010 [March 9th, 2010]
- Live kidney donors do not die sooner: study - Reuters - March 9th, 2010 [March 9th, 2010]
- UW football player suspended after alleged assault - Seattle Post Intelligencer - March 10th, 2010 [March 10th, 2010]
- More Comparative Studies Needed to Guide Physicians Study finds less than a ... - ModernMedicine - March 10th, 2010 [March 10th, 2010]
- Conservationists worry about Mo. med school plan - KOAM-TV - March 10th, 2010 [March 10th, 2010]
- Dr. William D. Lynn - Baltimore Sun - March 10th, 2010 [March 10th, 2010]
- Suspect in North Dallas shootings became reclusive after parents died, family says - Dallas Morning News - March 10th, 2010 [March 10th, 2010]
- Drinkers Gain Less Weight - Harvard Crimson - March 10th, 2010 [March 10th, 2010]
- Long-Term Health Risks Low for Kidney Donors - WebMD - March 10th, 2010 [March 10th, 2010]
- School resource officer remains in critical condition - Middletown Journal - March 10th, 2010 [March 10th, 2010]
- New Lucian Leape Institute Report Finds That U.S. Medical Schools Are Falling ... - PR Newswire (press release) - March 10th, 2010 [March 10th, 2010]
- Dual degrees program expands for Mayo Medical School students - Post-Bulletin - March 10th, 2010 [March 10th, 2010]
- Comparative Effectiveness Research is a Must - TopNews United States - March 10th, 2010 [March 10th, 2010]
- Long Beach OKs medical pot ordinance - Contra Costa Times - March 10th, 2010 [March 10th, 2010]