Physician Advisory Group

Team of medical doctors with protective gear - covid

WE BELIEVE THAT OUR LOCAL EPIDEMIOLOGY SUPPORTS A PLAN TO RETURN TO FULL IN-CLASSROOM EDUCATION, WITH APPROPRIATE SAFETY MEASURES.

August 4, 2020

We are pediatricians, infectious disease specialists, and public health epidemiologists who have been reviewing the medical literature, monitoring the COVID-19 public health data, and advising the SAU 70 nurses, and School Start Task Force. We have advocated taking the full measure of health and well-being of children, also considering developmental, behavioral, mental health and educational aspects in addition to the risk of COVID-19. We have seen firsthand the profound harms to children of school closures.

That being said, we do not advocate opening schools fully without considering our local COVID-19 epidemiology and the likelihood of being able to mitigate transmission moving forward. With that, we would like to share publicly the following data and recommendations:

Safety measures should include:

Wearing of Masks

We recommend mandatory cloth or medical masks, with a recommendation that masks with exhalation valves not be allowed, as they do not filter the exhaled air. Accommodations should be made for those who cannot wear masks due to medical conditions (e.g. autism). The pediatric clinics at DHMC currently make such accommodations successfully. Where appropriate, eye protection/face shields in addition to masks should be used by staff where there is a likelihood of exposure to individuals with incomplete adherence to masking.

Practice safe distances of 3-6 feet from others

Physical Distancing

We agree with the plan for 3-6 foot separation between students. Most of the demonstrated benefit from physical distancing occurs in the first 3 feet. All of the data on 6 foot separation has been in the absence of masks.The most important time for physical separation will be during times when masks are removed, such as snack time and lunch time. It will be important to discuss how this can be done safely. There have been outbreaks linked to transmission in workrooms when masks are removed to eat/drink.

Hand Washing

Availability of hand sanitizer in entrances, hallways and classrooms, and focus on frequent hand washing.

Stay at home if you are sick.

We recommend at least two checks – at home with a checklist (as well as temperature taking if possible), and then again at first school contact (bus or school entrance) with screening questions and consideration of additional temperature taking when warranted.

Covid-19 in our community:

There is very little COVID-19 currently in our Community

Children have been relatively spared

Unlike the flu and many other respiratory viruses, children have been relatively spared.

Looking at the New Hampshire data, only 136 out of 6,613 COVID+ cases have been 9 years of age and younger, with an additional 320 in the 10-19 age group. This is a total of 456 (6.9%). Thankfully, only 9 have required hospitalization (1.3% of 695 hospitalizations), and zero deaths have been reported in those <20 years of age in NH, Vermont, Maine and Massachusetts.

Why children are less likely to spread COVID-19 than adults

In a recent study from Switzerland, index case analyses showed children (16 and under) were the index case in only 8% of households with COVID. The other 92% were spread from adults.
A 9-year-old boy in France with COVID -19 had 80 close school contacts over several days, with no secondary infections.
In Australia, 9 students and 9 staff with COVID-19 across 15 schools were studied, and 735 students and 128 with close contact were examined, with only 2 secondary transmissions found.
A recent study from Korea, which has been reported in the press to show higher risk of transmission from 10-19-year olds, actually shows a quite different picture if you read the whole study and look at the data. The non-household transmission rate (which is the one relevant to schools) from 10-19-year olds is 0.9% (2/226), basically the same as the 1.1% rate for 0-10 year olds. Other data do suggest that within household transmission from 10-19 years olds is higher, but the ‘n’ is small and needs to be taken in context with the many other studies done. Our group has reviewed this study thoroughly.

Summary:

We will continue to share local data from the hospital’s experience and monitor local public health data. It should be noted that the vast majority of transmission has occurred outside of the hospital environment, and we suspect that the same will be true for school. Our success in minimizing the local burden of COVID-19 has been built on the entire community adopting state and CDC guidance on proven methods for decreasing transmission (masks, distancing, handwashing) along with adhering to state requirements on gatherings and travel. Our recommendations assume that this shared commitment to one another will continue.

On a personal note, we are grateful for the hard work and dedication of our SAU 70 administrators, teachers, and staff and will continue to work with and advise them throughout the school year. We recognize that it is not just data, but also kindness and community that will bring us together this fall.

We are committed to staying current on the literature, monitoring epidemiology, and most of all to the health and well-being of the children, staff and teachers of SAU 70.

Team

Steven H. Chapman MD, FAAP, SAU 70 Physician
Michael Calderwood MD, MPH
Sheila Feyrer MD, FAAP
Laura Greer MD, FAAP
Tricia Groff MD, FAAP
Alison Holmes MD, MPH, FAAP
Samantha House DO MPH, FAAP
Keith Loud MD, MSc, FAAP
Nina Sand-Loud MD, FAAP
Catherine Shubkin MD, FAAP
Richard Zuckerman MD, MPH

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Physician Advisory Group

WE BELIEVE THAT OUR LOCAL EPIDEMIOLOGY SUPPORTS A PLAN TO RETURN TO FULL IN-CLASSROOM EDUCATION, WITH APPROPRIATE SAFETY MEASURES.

August 4, 2020

Safety measures should include:

Wearing of Masks

Physical Distancing

Hand Washing

Stay at home if you are sick.

Covid-19 in our community:

There is very little COVID-19 currently in our Community

Flattening the curve and steady decline

Children have been relatively spared

Zero cases as of August 4th, 2020

1.6% of total Covid-19 cases in state

Why children are less likely to spread COVID-19 than adults

Summary:

Team

Frequently Asked Questions
(Visit the FAQ section for answers to a variety of questions.)

Physician Advisory Group

WE BELIEVE THAT OUR LOCAL EPIDEMIOLOGY SUPPORTS A PLAN TO RETURN TO FULL IN-CLASSROOM EDUCATION, WITH APPROPRIATE SAFETY MEASURES.

August 4, 2020

Summary:

Frequently Asked Questions (Visit the FAQ section for answers to a variety of questions.)

Frequently Asked Questions
(Visit the FAQ section for answers to a variety of questions.)