Applying Precedent From Pandemics Past & Getting School Open

In legal matters, precedent weighs big; “considered as authority for deciding subsequent cases involving identical or similar facts”¹.

Here I bring the case we should use precedent from the last pandemic — swine flu (H1N1) in 2009. The fact pattern is more than similar, so kids will be back in school. In person. Immediately.

My Perspective

I come at this respectfully from a number of angles as a community member of Oak Harbor/Island county, WA

First, I own Island Drug and was a partner of Island County to distribute the National Stockpile medicines and H1N1 vaccines in 2009. This partnership will continue in the same capacity for Covid-19.

Second, I am parent of 2 girls entering middle and high school. I want them to receive the full Oak Harbor experience — we have a great school system.

Third, I am involved at the charity level relevant to this discussion. I am active in Rotary. We feed kids in the school district at risk of missing meals on weekends — even expanded for Covid related need. We also spearheaded an effort to fund and distribute PPE and cleaning supplies (made at Island Drug) early on in this pandemic.

Fourth, I have spent considerable time researching this virus. We know who it infects and why. I summarized my findings in a 55 page paper with 230+ references. Have a look.

Another important perspective to keep in mind. The shutdowns were based on preserving hospital capacity. NOT ON AVOIDING SPREAD, but slowing it — which we have done! In the meantime, we ramped up testing to UNprecedented levels. Did you know, the number of Covid-19 tests performed is approximately equivalent to 50 years worth of flu tests? ‘Cases’ are not the metric — an indicator sure. Deaths and hospitalizations shall be the focus. Besides, how will we ever get to herd immunity if we stay isolated?

I know, and have been involved with, many of the key people at all levels of this pandemic response locally. They are good people. Arguments brought here are done so respectfully, following precedence.

The H1N1 Precedent

Like Covid-19, H1N1 of 2009 was a novel virus — influenza type, not a corona virus. Influenza and corona have some viral similarities. They are both transmitted similarly.

So let’s look at some areas where we expect similar actions.

School Closure

School shutdowns did occur during H1N1. But, not to the same degree, nor the same timing/duration.

Closing Schools Early On — not near the end

CDC

Balance the Risks

Previous Decision Matrix

I would assert we are in the recovery phase with no severity to speak of, which translates to school closure not recommended.

CDC image above looks very similar to this curve below — the recovery phase.

(note the school-aged group)²

Further, at the time of this writing, our county is averaging 1 case/day, 0 deaths since May, and 0 hospitalizations. Hard to assert that is anything but a recovery.

Periodicals from H1N1

Whidbey News Times Excerpts from H1N1 below:

“Every day schools are sending home children who arrive with a fever,” Assistant Superintendent Lance Gibbon said in a news release. “They’re not hard to spot because they are tired and listless. Those students need to stay home so they do not infect others.”

Students with a fever of 100 degrees or higher must be kept home and cannot return to school until their temperature is normal for 24 hours (without the aid of medication), according to the news release.

It’s not known whether the bug affecting Oak Harbor schools is the seasonal flu, H1N1, or something else. Doctors aren’t testing for H1N1 except in serious cases that require hospitalization.³

The media reports a second strain of swine flu could occur this season.

If H1N1 did enter Oak Harbor schools, Schulte says, “We’ve passed through the first bout easily.”

The school district is asking parents to help stem the flu by keeping sick children home. Students with a fever of 100 degrees or higher must be kept home and cannot return to school until their temperature is normal for 24 hours.⁴

Last Wednesday, a middle school boy in Oak Harbor was confirmed to have the swine flu virus. Nobody panicked. School officials notified parents and told them to keep their children home if they appear to have flu symptoms. They commendably acted promptly and openly. A week earlier, in the first confirmed case on the island, a South Whidbey woman came down with the swine flu. Again, there was no panic, simply some recommended precautions issued by the Island County Health Department.

Local jurisdictions hit by the swine flu earlier in the outbreak acted quite differently. A single case of flu would close entire schools, which happened everywhere from New York City to Texas to Seattle. But as more information became available the panic level subsided and by late May, it was widely known that swine flu was not a particularly dangerous public health threat.⁵

The Oak Harbor School District website urges parents to keep children home who have flu symptoms. Fever, headache, dry cough, congestion, body aches and extreme fatigue are the most common symptoms of the contagious respiratory disease, which can range from mild to severe.⁶

Face-masks

Full disclosure, I am not a fan. We didn’t wear them as pharmacists providing antivirals and H1N1 vaccines in 2009. Most people have gone along with this as a compromise to buy food and such. Let’s look at the guidance from 2009:

Pretty different than today right?

This is beyond significant. We advocate in person to develop relationships. Kids need this social interaction. Masks blunt a critical component of conversation. Facial expressions. Check this abstract from a study entitled Role of Facial Expressions in Social Interactions:

A recent study, contrasting human and humanoid robot facial expressions, suggests that people can recognize the expressions made by the robot explicitly, but may not show the automatic, implicit response. The emotional expressions presented by faces are not simply reflexive, but also have a communicative component. For example, empathic expressions of pain are not simply a reflexive response to the sight of pain in another, since they are exaggerated when the empathizer knows he or she is being observed. It seems that we want people to know that we are empathic. Of especial importance among facial expressions are ostensive gestures such as the eyebrow flash, which indicate the intention to communicate. These gestures indicate, first, that the sender is to be trusted and, second, that any following signals are of importance to the receiver.⁷

I read that as masks make our conversations more robotic. Not good.

Further, teachers need to read facial expressions for a variety of reasons. Are they confused, happy, sad, or maybe even under the weather? Check these PubMed searches for more on smile frequency and facial expressions in school.

The science hadn’t changed from 2009 to about May 2020. Then suddenly, mask mandates are in vogue. I vote for adopting guidance as close to 2009 as possible. Besides, the eyes have (ACE2) receptors this coronavirus uses to infect⁸. Do we need face shields too? Goggles maybe? On top of treating each other like they have the plague (when they don’t)?

International Data On School Openings

Sweden was unique. They avoided closing much of anything. Including schools. Their neighbor, Finland, took the trending mass closure approach. Here is the summary of a joint statement from the two country’s health authorities:

“This report is a comparison between Finland and Sweden, two in many ways similar countries who applied different measures regarding schools during the covid-19 pandemic. There is no difference in the overall incidence of the laboratory confirmed covid-19 cases in the age group 1-19 years in the two countries and the number of laboratory confirmed cases does not fluctuate with school closure or change in testing policy in Finland. In Sweden, the number of laboratory confirmed cases is affected by change in testing policy. Severe covid-19 disease as measured in ICU admittance is very rare in both countries in this age group and no deaths were reported. Outbreak investigations in Finland has not shown children to be contributing much in terms of transmission and in Sweden a report comparing risk of covid-19 in different professions, showed no increased risk for teachers.

In conclusion, closure or not of schools had no measurable direct impact on the number of laboratory confirmed cases in school-aged children in Finland or Sweden. The negative effects of closing schools must be weighed against the positive indirect effects it might have on the mitigation of the covid-19 pandemic.”⁹

Another Finnish perspective; “Outbreaks in schools are inevitable,” says Otto Helve, a pediatric infectious disease specialist at the Finnish Institute for Health and Welfare. “But there is good news.” So far, with some changes to schools’ daily routines, he says, the benefits of attending school seem to outweigh the risks—at least where community infection rates are low and officials are standing by to identify and isolate cases and close contacts.¹⁰” This speaks to our situation on Whidbey Island. The case counts are super low. Deaths and hospitalizations, non-existent.

Are children more or less likely to take part in the spread of Covid? Looks to be less likely;

A summary of studies determined:

“Children appear significantly less likely to acquire COVID-19 than adults when exposed
There is reasonable evidence that there are significantly fewer children infected in the community than adults
Children are rarely the index case in a household cluster in the literature to date
It is not clear how likely an infected child is to pass on the infection compared to an infected adult, but there is no evidence that they are any more infectious
The most parsimonious explanation for all the above seems to be that children are less susceptible to becoming infected, therefore fewer of them have become infected, there are subsequently fewer infected individuals in the community, and children have therefore infrequently brought the infection into their homes.”¹¹

The Royal College of Paediatrics and Child Health penned an open letter on returning to school. They express concern that keeping kids out of school could cause “the effects of COVID-19 will linger far beyond the pandemic itself and will limit the life chances of children and young people for years to come.”¹² Read that again. Our collective actions are not without potential long term consequence.

Yes, We CAN Have Kids In Person

In Maryland, which had more cases and almost twice as many deaths as WA, the governor is encouraging all counties to reopen schools¹³.

In WA, it’s more complicated with many phases. However, Island County is low risk currently according to the Health Department. Why aren’t we having kids in all classrooms?

¹⁴

The Feds appear to support in-person here:

¹⁵

Here is an interview with the WA Superintendent of Public Instruction Chris Reykdal:

SUPERINTENDENT: “Well, our state Department of Health and our governor has issued a framework. So this is obviously under the control of the governor, and they have created this high, medium, and low risk category framework for school openings. Again, it’s a strong suggestion. Local boards can choose right now whether they want to open, but they are following this health guideline pretty much across the board,” Reykdal said.

INTERVIEWER: So for the counties that are even high risk, why not open up school for in-person learning there as well?

SUPERINTENDENT: “They could, that’s their option right now. I think they’re not doing that because I don’t think they believe that evidence is that one-sided. I think there’s obviously now evidence all over Georgia, Florida, and Texas where they opened and there’s lots of transmission of the students and staff, and they don’t know whether that’s an origin of kids to staff or staff to students. But I just believe that folks feel on balance right now in those communities that it’s not the safest option,” Reykdal said.¹⁶

So, feds say go. State Sup says local school boards can open but FEEL now is not the time?

I pulled a few excerpts from various state and local guidance documents to highlight more justification.

Excerpts From Guidance Documents¹⁷

“To be very clear, it is my expectation that schools will open this fall for in-person instruction.” Chris Reykdal Superintendent of Public Instruction
your fall opening may be a hybrid face-to-face/online model or any combination of modalities and schedules that meet your local community needs, while also affording all students in your district access to their basic education rights.
We achieve this by developing equity-based policies and supports that empower educators, families, and communities.
Focus on the Whole Child
rapid transitions between face-to-face and continuous remote learning,
Leverage Local Expertise
K–12 school environment is considered a medium risk transmission area
a cloth mask is not sufficient without additional controls.
School districts are required to adopt reopening plans through local board resolution. Those plans need to be on file with OSPI and the State Board of Education within two weeks of a district’s fall starting date.
For the 2020–21 school year, school districts should plan to operate with face-to-face, in-person instruction and follow DOH’s guidelines, consistent with 180-day and 1,027 instructional hours requirements. (Editorial comment here: concern developing that instructional hours won’t be used as efficiently as normal — less teaching, more work time. We need to have actual instruction.)
Split or rotating schedules with continuous remote learning
Districts should prioritize providing face-to-face instruction as public health conditions allow, instituting physical distancing and other preventative practices to keep students and staff healthy. (Editorial comment: minimal cases, 0 hospitalization, 0 deaths in months. Seems like health conditions allow.)
school administrators remain ultimately responsible for establishing the education services appropriate for their student
local health officer should advise the school administrator and the school community regarding the level of COVID-19 activity, as well as the local community’s access to testing, and the health department’s capacity to respond to potential cases or outbreaks in schools with time investigations and contact tracing.
Local health officers remain responsible for controlling the spread of communicable disease.
The decision to resume in-person learning is a complex decision that requires weighing both risks and benefits. When considering thresholds for resuming in-person learning, DOH considered both the health risks of COVID-19 to students, school staff and the surrounding community, as well as the benefits of in-person school to children and their families.
In-person learning provides a broad range of benefits to our children. In addition to providing educational instruction, schools support the development of social and emotional skills; create a safe environment for learning; address nutritional, behavioral health and other special needs; and facilitate physical activity. The absence of in-person learning may be particularly harmful for children living in poverty, children of color, English language learners, children with diagnosed disabilities, and young children and can further widen inequities in our society.

Our teachers appear supportive of in person (THANK YOU!)

K-4 parents overwhelmingly want in-person options

Summary

The guidance favors in-person — explicitly. Yet, many districts will have classrooms empty.

The guidance requires rapid transitions between face-to-face and remote. Yet, we have a phase-in plan approved with WEEKS between evaluation(why).

¹⁸

Classrooms remain empty.

The school can put kids in the classroom — in some capacity — on day one. They should.

A Way Forward

Combining the precedent on record from H1N1, plus the guidance as written, with international experience we shall put students in classrooms. We shall maintain respect for both the choice to remain home AND coming to school.

At a minimum, we shall offer hybrid at all schools, IMMEDIATELY. Most parents want this. It is not unreasonable for a condition where 99.99% of this age group survives Covid-19 contraction.
Parents should keep the choice both to keep kids home AND send kids to school. If they or their close kin at home have high Covid-19 risks, we should honor their choice to remain home. We need to honor in person the same. Parents have enough information to evaluate risk and decide. Expand choice for all.
We need to keep pace on curriculum. If hybrid, group A and B learn the same material no matter the location. Live classroom broadcasting accomplishes this. We should discard the prospects of a condensed curriculum with less actual instruction time.
Like during H1N1, focus on keeping the sick home. Not the healthy.
Consider sleep, move start times later for middle/high school (see below)

This is not a complete list. But, any discussion must include parents having an option to foster growth of their children via in-person learning.

The course of action must be directed at the school board. We are collecting names of those who want in person in the form below.

An additional opportunity for improvement — Sleep

I wrote previously how catastrophic early starts are for teens especially. Biologically, they go to bed later and wake up later. Please read thru this eye-opening (pun intended) information — it is likely affecting your middle/high school age loved ones. ADHD, for example, associates with poor sleep.

They released our schedules. High schoolers are 8a-1:30p. Why can’t it be 10a-3:30p? Previously, schools stated transportation and sports complications with shifting high school start times back. Now though, with no buses and sports, why in the 2020 (my new favorite term for the bizarre/unexplainable) are we dragging high schoolers out of bed? Not only is it painful to parents (teens can be MEAN to wake up), it harms kids’ brains. Did you know emotional regulation/processing and creativity building occurs during REM sleep — which happens in the second half of sleep (dreaming phase). The same period in which we are dragging them out of bed for a zoom call that can be done literally any time later?

One benefit to the lockdowns has been modest sleep quality improvements:

sleep had increased by 15 minutes¹⁹
Social “jet lag” had decreased²⁰
people were going to bed about 30 minutes later and waking up about 50 minutes later the next morning²¹
more dreaming ²². Goes nicely with the ability to sleep in a bit, especially for late sleepers right?

If we are risking mental health to suppress a minor viral infection, can we at least provide more natural sleep opportunities? Sleep is (perhaps) the best defense against mental health decline — and countless other health maladies.

Applying Precedent From Pandemics Past & Getting School Open — NOW

My Perspective