Today’s guest columnist is Dr. Karim I. Budhwani.
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Many parents, teachers, and administrators are agonizing over the safety of students and ultimately their loved ones as Alabama schools open in the next few weeks.
It’s clear that schools are fundamental to the personal and intellectual development of children. We are told that benefits of in-person school outweigh coronavirus risks. However, we are also told that Alabama is shattering coronavirus records. Rock and a hard place. With that in mind, here’s a quick reflection on strategies for safely reopening schools in COVID times.
First the basics. If viral activity increases, the pandemic worsens, leading us toward unsavory constraining options. So, reducing viral activity is a worthwhile goal.
But, in order to reduce viral activity, we must understand the modes of viral transmission and factors that promote transmission.
So far, at least 3 modes of transmission have been posited. Let’s assume that all three modes are relevant: (a) fomites or contaminated surfaces, (b) respiratory droplets, and (c) aerosol or airborne. Let’s assume that which mode of transmission is dominant varies based on environmental and various other parameters which may be within or beyond our control.
Chief among factors that promote transmission are, well, people. Transmission increases as we (a) increase number of unassociated people coming in contact, (b) reduce the space that they occupy, and (c) increase the time for which they stay in contact.
Now let’s explore strategies that could make back-to-school safer for students, teachers, and administration.
- Cover Mucosae and Conjunctiva
In other words, mask up. Regardless of which modes of transmission are dominant, it would make sense to cover mucosae (nose/mouth) and possibly conjunctiva (eyes). This is not a political matter. It is simply a matter of getting back to school safely, despite COVID-19.
Let’s assume that all symptomatic and positive tested people are self-isolating away from school. Which means that only the uninfected, the presymptomatic and the asymptomatic are at school.
Setting coughs and sneezes aside for a minute, in every breath we emit thousands of tiny respiratory droplets. Now, imagine the droplets from a person who is shedding the virus — with a mask and without a mask. In either scenario, virus is being shed. But its reach is blunted with masks. Masks can restrict the reach of the virus from people (direct), surfaces (fomites), and air ducts (aerosol).
So, mask up.
- Avoid the Three C’s
Despite high population density, Japan managed to keep SARS-CoV-2 transmission at bay by a simple philosophy of avoiding three C’s: Closed spaces, Crowded places, and Close contact. From a back-to-school perspective, this could translate into (a) more outdoor activity to avoid closed spaces, (b) smaller class sizes to minimize crowded places and instituting “cohort bubbles” to isolate cohorts from each other even over breaks, carpool, lunch, etc. and finally, (c) physical distancing guidelines of 6’ or more to avoid close contact.
- Disinfect objects and clean subjects
There is some debate regarding the magnitude of transmission risk from contaminated surfaces. Regardless, it is generally good practice to disinfect common surfaces including counters, knobs, dry erase pens, etc. Particularly items that we commonly touch with our hands.
While contaminated objects may have fallen from their dubious distinction in SARS-CoV-2 transmission, subject vectors continue to remain paramount. Fortunately, combating this is simply a matter of good personal hygiene. Specifically, keeping our hands and face clean with appropriate and regular hand washing. If access to soap and warm water is restricted, hand sanitizers could be the next best option.
Before moving from this, well, subject, it should be noted that if aerosol transmission is dominant, recirculated air could diminish benefits from smaller class sizes, cohort bubbles, and even physical distancing indoors. Masks can help. Rotating groups outdoors can help. Using better filters in air ducts may also help.
In addition to these, some generally applicable strategies should also be considered in the school reopening calculus. Strategies such as proactive self-monitoring of symptoms and, more importantly, the provisions to isolate without stigma or penalty. Temperature and oxygen saturation have become common self-monitoring tools, however, any change in smell and taste are also effective and cheap indicators.
Another variable to modulate response is viral activity in the community. Think of this as inverse dancing – slow down when the tempo (cases) increases. Be more vigilant as cases rise in your community but don’t slack too much when cases decline. As these can rise sharply due to lag from incubation periods. This part is like Beethoven’s fifth: short-short-short-long!
Which brings me to my final two points: (a) stay fit and healthy and (b) endeavor to reduce stress. The latter is very important but surprisingly takes a backseat in COVID-19 discussions. Whiplash from rapid news cycles, mixed messages, developing science and evidence, psychosocial trauma from lockdowns, economic distress from 40 million unemployed, 17-point email messages on new school policies, and on and on induce high emotional exhaustion and sharp increases in stress levels. Guess what happens under stress? Our immunity is weakened. Making us more susceptible to infection!
So, our best defense against this virus and the pandemic could have been with us all along. A healthy you, a de-stressed you. But also a vigilant you, a compassionate you. An informed but not panicked you.
Hope this post is helpful.
Be safe. Be sane. Be sage.
Dr. Karim I. Budhwani is CEO of CerFlux, Inc. and Visiting Scientist in the School of Medicine at UAB and in the Department of Physics at Coe College. CerFlux, headquartered in Birmingham, is developing personalized medicine technology to transform cancer treatment here and around the world.
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