COVID-19 Thread [V2.0]

[TURBO]

My wife and I are both teachers, different counties... She got the vaccine yesterday, while I have no date even set yet. My district "thinks" it will be sometime in February.

 

The inconsistency is pretty ridiculous.

[Machu Peach]

It's another catch-22. If there is strict adherence to priority tiers vaccination will slow down (and there will be waste) and people will complain. If strict adherence to priority tiers is relaxed people will complain about the inconsistency. There's just no balance that's going to make everyone happy.

 

I personally feel that vaccinating any essential worker (other than those directly related to elder/COVID care), including teachers, before everyone over 65 is hard to justify. As a result, I'm not too upset that I'm currently not scheduled for vaccination despite working a research hospital, interacting with patient samples, and being essential enough that I have not had a single day of missed work or remote work, even when almost everything was closed.

[igor67]

There was a trickle last week with the pilot programs in MN, but if the doses show-up as promised starting this Thursday a rather large fraction of teachers in MN will have had their first shot by next week, non teaching staff and daycare workers are in the mix so I don't know how big the pool is, but the promised 15,000 is about 1/4 of all licensed teachers in the state. MN has put together a nice dashboard showing how the various sub distributors are doing. Most of the big hospital groups have been highly efficient at distributing their vaccines, same with mass vaccine cites. The CVS, Walgreens partnership to get into assisted living homes has not which matches something I read in Wisconsin as well. The category of local providers has also not been super efficient which I think is understandable given the logistics on needing to vaccinate in batches that category covers out-state hospitals and clinics.

[wallus]

Things will go much better once the one time J & J vaccine is in the pipeline.

[Machu Peach]

Given the prevalence of teachers and WI residents here, I think many will be happy to read this study.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e3.htm

[nate82]

Given the prevalence of teachers and WI residents here, I think many will be happy to read this study.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e3.htm

 

Not really new news there were already independent studies that showed this to be true for some time now.

 

I believe I posted an article about this previously in this thread.

[igor67]

I have spent a good chunk of the morning reading the study and I think it makes a pretty good case study in why it pays to be able to back track on sources.

I was clued in to the subtle issues last week from this publication from the ONS in England

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948617/s0998-tfc-update-to-4-november-2020-paper-on-children-schools-transmission.pdf

 

The core issue is one of methods, there are a lot of studies looking at the issue but most of them use contact tracing schemes that will systematically undercount infections in younger students as they are less likely to be symptomatic. Boiling it down the ONS study didn't find statistically different transmission rates in younger students compared to older students when they used more intense contact tracing methods. The methods are outside my normal expertise and I got some help from https://twitter.com/dgurdasani1/status/1351092571435655173.

 

Sure enough if you back track the CDC study reference number 5 (https://pubmed.ncbi.nlm.nih.gov/33315116/ ) it is a meta analysis of school studies. And while they conclude younger students are lower risk they clearly state in their discussion the limitation that most of the studies aren't doing a full surveillance type study. Meaning you run into situations where the first person in the household to look sick is counted as the first case, and then they test other people at which point the younger child who was asymptomatic gets detected. The reference further mentions that rather wide array of answers in the literature as reflecting diverse methods and not a consistent approach. I did pick one of the references they did mention as doing a surveillance type study and it was only looking at a total of 234 cases in Norway.

 

In thinking about cases where experts end up being wrong, and a plurality of experts seem to be in the open schools camp this checks a lot of boxes.

1) The idea is popular for other reasons- that clearly fits here people want to reopen schools

2) There is an identifiable method shortcoming

3) Sloppy scholarship looses some of the early questions across multiple citations

 

It is certainly reasonable to look at the data and conclude that younger students are a lower risk, I actually think it is most likely the case even after my critiques but I doubt it is a very big effect. I also have spent enough time in that area over the last year to say that if the kids were wearing masks at the reported rate they may well have been way safer in school than in the community.

[stoutdude04]

It's a catch 22. Give people a date that isn't 100% certain and they're disappointed if there are delays. Don't give people dates until it's absolutely 100% set in stone and they're disappointed in the lack of communication/lack of planning. I don't think there's a balance that's going to make everyone happy.

 

I think some people may be overestimating the predictability of the manufacturing of biology active, cGMP-compliant products and reagents. It's not like one can say they're going to get exactly X doses off of each run.

 

Additionally, I would hope that the distribution plan is being continuously updated as new data is produced and new needs emerge.

 

Fair. I guess for me, I have no problem if they said something like, 'we are on the list, but we aren't sure when we are going to get it.'

[Machu Peach]

Given the prevalence of teachers and WI residents here, I think many will be happy to read this study.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e3.htm

Not really new news there were already independent studies that showed this to be true for some time now.

 

I believe I posted an article about this previously in this thread.

You posted a link to this study (published yesterday), specifically about the spread of CV in schools in Wood Country, WI in this thread?

[Machu Peach]

I have spent a good chunk of the morning reading the study and I think it makes a pretty good case study in why it pays to be able to back track on sources.

I am very interested in discussing what you think I can learn from this "case study".

 

I was clued in to the subtle issues last week from this publication from the ONS in England

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948617/s0998-tfc-update-to-4-november-2020-paper-on-children-schools-transmission.pdf

 

]The core issue is one of methods, there are a lot of studies looking at the issue but most of them use contact tracing schemes that will systematically undercount infections in younger students as they are less likely to be symptomatic. Boiling it down the ONS study didn't find statistically different transmission rates in younger students compared to older students when they used more intense contact tracing methods. The methods are outside my normal expertise and I got some help from https://twitter.com/dgurdasani1/status/1351092571435655173.

These are complaints about an entirely different study. I've posted the MMWR (CDC) study.

 

Sure enough if you back track the CDC study reference number 5

(https://pubmed.ncbi.nlm.nih.gov/33315116/ ) it is a meta analysis of school studies. And while they conclude younger students are lower risk they clearly state in their discussion the limitation that most of the studies aren't doing a full surveillance type study. Meaning you run into situations where the first person in the household to look sick is counted as the first case, and then they test other people at which point the younger child who was asymptomatic gets detected. The reference further mentions that rather wide array of answers in the literature as reflecting diverse methods and not a consistent approach. I did pick one of the references they did mention as doing a surveillance type study and it was only looking at a total of 234 cases in Norway.

This reference is used to support the sentence "This apparent lack of transmission is consistent with recent research." The reference has nothing to do with the study's methodology or results. Again, it's criticizing a different study, not the MMWR study.

 

In thinking about cases where experts end up being wrong, and a plurality of experts seem to be in the open schools camp this checks a lot of boxes.

1) The idea is popular for other reasons- that clearly fits here people want to reopen schools

2) There is an identifiable method shortcoming

3) Sloppy scholarship looses some of the early questions across multiple citations

This is general criticism of 'experts' which is a perfectly ok thing to do. However, it doesn't specifically address any issues with the MMWR study itself.

 

It is certainly reasonable to look at the data and conclude that younger students are a lower risk, I actually think it is most likely the case even after my critiques but I doubt it is a very big effect. I also have spent enough time in that area over the last year to say that if the kids were wearing masks at the reported rate they may well have been way safer in school than in the community.

It's fair to criticize and/or not trust the study, but personal intuition, anecdotes, and observations are difficult for others to contextualize and quantify. The nice thing about well written studies, even observational ones, is that they are comparatively easy contextualize and quantify.

 

It seems the source of your (seemingly negative?) view of this study is actually issues with other studies. Am I misreading that? Do you have issues with this study that you've not mentioned (or that you mentioned and I'm failing to see)?

[nate82]

Given the prevalence of teachers and WI residents here, I think many will be happy to read this study.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e3.htm

Not really new news there were already independent studies that showed this to be true for some time now.

 

I believe I posted an article about this previously in this thread.

You posted a link to this study (published yesterday), specifically about the spread of CV in schools in Wood Country, WI in this thread?

 

I was speaking in general not just WI that schools should be opened and the research was already available for this so nothing new.

[igor67]

Sorry to clarify, as far as I can tell from the write up in the just published study, they used typical contact tracing methods that were identified in the other studies as well and not a true surveillance based methodology. Specifically this is what they wrote in the CDC study

 

"When a school was alerted to a positive case in a student or staff member, school officials identified persons who had had close contact with the patient through interviews with the patient, parents, and school staff members. Close contact was defined as being within 6 feet for longer than 15 cumulative minutes during a 24-hour period."

 

So unless I am misunderstanding something fundamental they repeated the same types of method that had been called into question.

[PeaveyFury]

Really great, interesting study & thanks for linking. A few really interesting observations here:

 

"Student masking compliance was reported to exceed 92% throughout the course of the study. Older children were reported to be equally compliant with masking as younger children. High levels of compliance, small cohort sizes (maximum of 20 students), and limited contact between cohorts likely helped mitigate in-school SARS-CoV-2 transmission and could be responsible for the low levels of transmission detected in schools."

 

I am legitimately astounded by that percentage, and would have thought it to be much lower. Especially considering my own observations of rural Wisconsin as a 'lawless wasteland of social distancing compliance', kudos to these districts for having sound policies and adhering to them. I'm further surprised by the "older children equally as compliant as younger" data point, as again I'd assume that there would be challenges with keeping teenagers compliant. Interesting finding!

 

"The actual mask-wearing rate might have been different because only approximately one half of teachers participated in the study. Teachers with lower masking compliance in their cohort might have been less likely to complete the survey, which limits the reliability of this measure."

 

I think this is indicative of a larger societal problem in that some of the data skews because of 'response bias'. Early in the pandemic, I know there were questions about the high percentages of people who reported mask compliance in NYC while still getting infected, and one theory was that some portion of the respondents flat out lied when put on the spot. There's obviously no way to know what the resulting skew is, but I appreciate that the study acknowledged this potential issue.

 

I think the conclusion is that logical compliance measures for mask wearing, social distancing, and smaller cohorts seem safe at this point. I know that teachers I've talked to personally have suggested that the former become difficult as the cohorts become full classes, as many indicated that there simply isn't enough room in most classrooms to properly distance students and staff. Do the teachers here have a similar opinion on that?

[Machu Peach]

Sorry to clarify, as far as I can tell from the write up in the just published study, they used typical contact tracing methods that were identified in the other studies as well and not a true surveillance based methodology. Specifically this is what they wrote in the CDC study

 

"When a school was alerted to a positive case in a student or staff member, school officials identified persons who had had close contact with the patient through interviews with the patient, parents, and school staff members. Close contact was defined as being within 6 feet for longer than 15 cumulative minutes during a 24-hour period."

 

So unless I am misunderstanding something fundamental they repeated the same types of method that had been called into question.

Then perhaps it's not fair to describe it a "pretty good case study on" their (or my) failure to "back track on sources"?

 

They do address potential asymptomatic spread via the absences of child-to-staff transmission. You might disagree with the methodology and that's fair to do, but it has nothing to do with failing to "back track on sources."

 

It also highlight something I've complained about before. The term "asymptomatic" is largely useless. With other diseases we use "subclinical", but with COVID even people who should know better say "asymptomatic."

[igor67]

I have fixed lab tables as my seating. The tables are designed to sit 4 students, and by the current state guidance my room need a waiver on space to be built (aka it is smaller than the state would like) I now routinely have to sit 5 students at those tables, so without splitting in half (and even then I'm not sure I can actually do 6ft for 15 students) yeah the distancing is a big issue. Most of my non science colleagues have mobile desks so they should be able to go into the 15-20 student range.

[Machu Peach]

I agree that the mask compliance is very high. Wood country is home to the massive Marshfield Clinic, so it likely has a disproportionate number of children with parents in healthcare related fields. Maybe that's helping them cultivate a culture of compliance?

 

...and yea, one always worries about response-bias with these survey-type studies. 50% response rate seems really good (major congrats to the study authors and the teachers for that) but it's still a major variable.

[igor67]

That's helpful feedback Machu, my opening was pretty unclear. My intent with the statement was that going backwards in the citations while a pain and certainly something that people (myself certainly included) will shortcut, it is important. After all you can't back track every paper. My word choices were muddled in part because I was thinking about it from a pure science perspective, a teacher perspective, and a I have to vote on actual policy perspective. Those are very different audiences and what came out was a not so good mash-up of strategies.

[logan82]

Really great, interesting study & thanks for linking. A few really interesting observations here:

 

"Student masking compliance was reported to exceed 92% throughout the course of the study. Older children were reported to be equally compliant with masking as younger children. High levels of compliance, small cohort sizes (maximum of 20 students), and limited contact between cohorts likely helped mitigate in-school SARS-CoV-2 transmission and could be responsible for the low levels of transmission detected in schools."

 

I am legitimately astounded by that percentage, and would have thought it to be much lower. Especially considering my own observations of rural Wisconsin as a 'lawless wasteland of social distancing compliance', kudos to these districts for having sound policies and adhering to them. I'm further surprised by the "older children equally as compliant as younger" data point, as again I'd assume that there would be challenges with keeping teenagers compliant. Interesting finding!

 

"The actual mask-wearing rate might have been different because only approximately one half of teachers participated in the study. Teachers with lower masking compliance in their cohort might have been less likely to complete the survey, which limits the reliability of this measure."

 

I think this is indicative of a larger societal problem in that some of the data skews because of 'response bias'. Early in the pandemic, I know there were questions about the high percentages of people who reported mask compliance in NYC while still getting infected, and one theory was that some portion of the respondents flat out lied when put on the spot. There's obviously no way to know what the resulting skew is, but I appreciate that the study acknowledged this potential issue.

 

I think the conclusion is that logical compliance measures for mask wearing, social distancing, and smaller cohorts seem safe at this point. I know that teachers I've talked to personally have suggested that the former become difficult as the cohorts become full classes, as many indicated that there simply isn't enough room in most classrooms to properly distance students and staff. Do the teachers here have a similar opinion on that?

I don't read any of this as we should go back to having all students in school yet. I would guess that most schools do not have the capacity to bring everyone back and maintain proper distancing.

[jerichoholicninja]

While the variant from the U.K. took about three months to dominate the outbreak in England, P.1 took only about a month to dominate the outbreak in Manaus. In addition, Manaus had already been hit extremely hard by the virus in April. One study estimated that the population should have reached herd immunity and the virus shouldn't be able to spread easily in the community. So why would the city see an even bigger surge 10 months later? Could P.1 be evading the antibodies made against the previous version of the virus, making reinfections easier? Could it just be significantly more contagious? Could both be true?

 

"While we don't *know* exactly why this variant has been so apparently successful in Brazil, none of the explanations on the table are good," epidemiologist Bill Hanage at Harvard University wrote on Twitter.

 

https://www.npr.org/sections/goatsandsoda/2021/01/27/961108577/why-scientists-are-very-worried-about-the-variant-from-brazil

 

[sarcasm]Things are looking up.[/sarcasm]

[Fear The Chorizo]

Really great, interesting study & thanks for linking. A few really interesting observations here:

 

"Student masking compliance was reported to exceed 92% throughout the course of the study. Older children were reported to be equally compliant with masking as younger children. High levels of compliance, small cohort sizes (maximum of 20 students), and limited contact between cohorts likely helped mitigate in-school SARS-CoV-2 transmission and could be responsible for the low levels of transmission detected in schools."

 

I am legitimately astounded by that percentage, and would have thought it to be much lower. Especially considering my own observations of rural Wisconsin as a 'lawless wasteland of social distancing compliance', kudos to these districts for having sound policies and adhering to them. I'm further surprised by the "older children equally as compliant as younger" data point, as again I'd assume that there would be challenges with keeping teenagers compliant. Interesting finding!

 

"The actual mask-wearing rate might have been different because only approximately one half of teachers participated in the study. Teachers with lower masking compliance in their cohort might have been less likely to complete the survey, which limits the reliability of this measure."

 

I think this is indicative of a larger societal problem in that some of the data skews because of 'response bias'. Early in the pandemic, I know there were questions about the high percentages of people who reported mask compliance in NYC while still getting infected, and one theory was that some portion of the respondents flat out lied when put on the spot. There's obviously no way to know what the resulting skew is, but I appreciate that the study acknowledged this potential issue.

 

I think the conclusion is that logical compliance measures for mask wearing, social distancing, and smaller cohorts seem safe at this point. I know that teachers I've talked to personally have suggested that the former become difficult as the cohorts become full classes, as many indicated that there simply isn't enough room in most classrooms to properly distance students and staff. Do the teachers here have a similar opinion on that?

I don't read any of this as we should go back to having all students in school yet. I would guess that most schools do not have the capacity to bring everyone back and maintain proper distancing.

 

The problem with that line of thinking is COVID in schools isn't being spread in school settings at a significant rate, even though some teachers/staff/kids are picking it up from the community and bringing it with them to school. So no mitigation measures inside of schools are going to completely prevent documented cases of people in that setting for the forseeable future as in years - vaccination or not. IMO, whether schools are open to in person instruction with these measures at this point should be done based almost entirely on what surrounding community active COVID numbers are - and hospital capacity should still be the primary metric with that. Have these measures in place with the idea being to prevent schools becoming infection vectors (which they have proven NOT to be time and time again, particularly in European countries who have had schools open since early last summer and through multiple infection peaks and valleys).

 

There isn't a sound argument based in science to keep schools closed when you look at actual results based in reality. Not now, not 6 months ago. I'm not even considering the adverse consequences to mental health, learning gaps, and lack of social development far too many kids are being forced to endure for far too long. It's not like we are where things were back in late January 2020 when hardly anyone in the US was exposed to COVID and we knew very little about it.

[PeaveyFury]

There isn't a sound argument based in science to keep schools closed when you look at actual results based in reality.

 

I think the sole argument is that all of the studies providing the scientific evidence note a dependence on social distancing and masking requirements as discussed above. I think that districts will have substantial challenges in returning to a 'normal' classroom setting while enforcing 6-feet apart desks at the very least.

 

What seems most likely is continued 'cohorting', where at any given time some students are in person while others are virtual to keep in-person class sizes down. The logistics of that seem problematic to me as a non-educator, but some districts seem to have adopted this model in some way, presumably with some success.

[igor67]

There is one very important reason for caution, evolution. For months the variations in the viral population seemed relatively harmless, but that appears to have changed now. We know that every infection regardless of source is another chance for new mutations to crop-up, and even more sneakily every defense measure we take is creating a selective advantage for mutations that can evade those strategies. History is unfortunately replete with examples of policy makers ignoring evolutionary thinking in policy design. Schools opening or not is only 1 part of that overall mitigation. So having an accurate estimate of how much additional infection is created by having students in person vs. not is rather critical. Mental health and social development I would agree are pretty well established. What we don't know at all though is how important the learning gaps are. Any education measurement out there is based on standardizing the numbers relative to other students with everyone proceeding through a normal school year. There is not any relevant data that indicates what happens if most students just don't do school for a year. It is so far outside of a normal situation that I have a hesitancy to just extrapolate and treat a lower standardized test score this year as telling me the same things about what a student needs as I would have 2 years ago.

If it helps understand why I'm not as doomy and gloomy on the education front as others the last generation of Americans to experience anything remotely similar as a disruption still managed to produce enough talent to build the atom bomb. I also would argue it would be more than justified in many cases to let large numbers of students just repeat this year, and it is a completely different question socially of how repeating a grade works if a bunch of your friends are doing it than in a normal environment.

[homer]

https://www.cnn.com/2021/01/29/health/johnson-coronavirus-vaccine-results/index.html

 

Johnson & Johnson's Covid-19 single-shot vaccine was shown to be 66% effective in preventing moderate and severe disease in a global Phase 3 trial, but 85% effective against severe disease, the company announced Friday.

[igor67]

I would love to see some modeling on how best to incorporate that into the vaccination plans. The article does a nice job of highlighting that it appears slightly less effective, but the clinical data was collected in a few places with the newer variants raging and they counted effectiveness in a slightly different way, so just comparing the 85% to the 95% for Moderna and Pfizer isn't completely apples to apples. The shelf stability and only 1 shot needed are pretty big pluses. It also looks like they didn't see any even potential anaphylactic reactions so it might be a good option for that small number of people who had a flare up after their first dose of Pfizer or Moderna.

[homer]

I would love to see some modeling on how best to incorporate that into the vaccination plans. The article does a nice job of highlighting that it appears slightly less effective, but the clinical data was collected in a few places with the newer variants raging and they counted effectiveness in a slightly different way, so just comparing the 85% to the 95% for Moderna and Pfizer isn't completely apples to apples. The shelf stability and only 1 shot needed are pretty big pluses. It also looks like they didn't see any even potential anaphylactic reactions so it might be a good option for that small number of people who had a flare up after their first dose of Pfizer or Moderna.

 

 

Also, I think people need to understand what 85% or 65% effective really means. I think CDC was hoping for 60% effectiveness.