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How schools can open safely in the fall

Masks, social distancing, nasal testing: These unpleasant coronavirus control measures are far from over for K-12 children returning to school after the end of summer vacation.

The COVID-19 vaccine is unlikely to be available to children under 12 before classes resume in the fall. But a new study found that when elementary school children disguise themselves and keep some distance from each other throughout the school day, an infected child is likely to transmit the infection to an average of less than one other student over a 30-day course.

But if schools abandon masks, abandon efforts to reduce mixing among children, and fail to detect and isolate those that can be infected, outbreaks can certainly occur, a modeling exercise shows.

However, these outbreaks do not have to be large, leaving local school boards and mayors with a difficult choice.

If they do not want to accept the infection of a relatively small number of students, they may need to consider adopting some potentially unpopular measures, including hybrid presence / online learning, strict isolation measures for infected students’ classmates, and continued use of face coatings.

Within 2,000 follow-ups at their primary school with a relaxed approach to camouflage, social distancing, and isolation, an infected child may have spread the coronavirus to an average of 1.7 other children in 30 days, the researchers found.

This may sound like a strong argument for dropping the most severe public health measures in primary schools. But this does not take into account the essential element of chance that the model revealed. About 8% of cases, five or more children are infected by one infected student within 30 days.

This is still a small outbreak with a relatively small probability. But it can feel very real to the families involved.

And in high schools that return to classroom training, the risks are even greater when measures to reduce coronavirus transmission are scarce. This is largely because older adolescents appear to be spreading and contracting the coronavirus at speeds closer to those of adults than to younger children.

With students on campus five days a week and given social distancing and masking measures, an outbreak sown by a high school student can cause 23 to 75 additional infections among classmates, employees, or classmates’ families within a month. Weekly tests can reduce this number of downstream infections to five over the same period.

Importantly, the model does not take into account the effect of vaccinations among those aged 12 to 17. The COVID-19 vaccine, manufactured by Pfizer and BioNTech, is approved for use in 16- and 17-year-olds from December and for those aged from 12 to 15 from May.

The new findings were published Monday in the Annals of Internal Medicine. They arose from a detailed “agent-based” computer model in which virtual individuals in a population of students, school staff, and student families interact under certain rules that dictate everyone’s behavior and contagion.

Such models cover the range of results that occurs when a diverse population of people interact under different sets of rules. So they are especially useful for weighing the relative effectiveness of policy measures that would change the way people interact.

To assess how personal instruction would be conducted under different engagement rules, researchers at the University of Maryland and Harvard School of Public Health created a model elementary school with 638 children from 432 households and 30 teachers and administrators attending its students.

High schools were larger and student movements were more complex. In this model, a total of 1,451 students from 1,223 families rotated through eight classrooms daily. About 63 teachers taught these students and gathered in staff rooms. And another 60 school staff mingled with students inside and outside the classrooms.

A number of classroom arrangements were tested: all-day, personal presence from all; the internal organization of students in “cohorts” with limited interactions beyond; halving the class size (and doubling the number of teachers); and as half of the students come to campus two days a week, the other half attend in person for two more days and all work online three days a week.

Researchers have simulated these scenarios thousands of times in different scenarios: with high, medium, or low mitigation measures in place, with and without testing for asymptomatic infections, and with different levels of isolation for test-positive students and their exposure. classmates.

The findings reinforce that the risks of returning students to campus are small, while the benefits are great, writes Dr. Ted Long, executive director of the COVID-19 test and tracking corps in New York, in an editorial accompanying the study.

“The evidence is now compelling: our schools can be opened safely,” Long wrote, noting that approximately 40 percent of American students were not invited back to the classroom because the pandemic closed schools across the country.

“If schools can reopen for personal learning, then they must,” he added, “to avoid the mental health and educational crisis that is on our doorstep.”

The study comes as COVID-19 among school-age children has become a focus of growing concern.

A new report released by the Centers for Disease Control and Prevention clearly shows that the rates of hospitalization of COVID-19 among adolescents are almost three times higher than the number of those hospitalized with influenza in a typical flu season. Moreover, just over 31% of adolescents between the ages of 12 and 17 who were hospitalized for COVID-19 this spring had to be admitted to the intensive care unit, and nearly 5% needed mechanical ventilation.

CDC Director Dr Rochelle Valensky called the figures deeply worrying.

The report’s findings “reinforce the importance of ongoing measures to prevent COVID-19 among adolescents, including vaccination and proper and consistent wearing of masks,” the authors write.

Meanwhile, the increase in COVID-19 morbidity and deaths among Brazilian children and adolescents raises concerns that the Gamma variant, a version of the coronavirus first discovered and distributed in Brazil, could affect children more severely than other strains.

The Gamma variant represents 7% of coronavirus samples that were genetically sequenced in the United States during the two weeks ending May 8 and is associated with higher transmission levels and some ability to avoid the effects of COVID-19 treatment. .

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