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KGW Q&A | Reopening schools

Morgan Romero spoke to OHSU pediatrician Dr. Alex Foster and OHSU-PSU School of Public Health professor Dr. Leslie Bienen about reopening schools.

PORTLAND, Ore. — This week, Oregon school districts started taking control of their reopening plans, and the debate around a return to any form of in-person learning is intensifying.

Some school districts, like Lake Oswego, have made the decision to bring kids back to school as early as next month. Others, including the state's largest district, are being more cautious, waiting until educators and school staff get access to a COVID-19 vaccine.

The fundamental, but complicated, question is: What are the risks and benefits of getting kids back to school? Unsurprisingly, there's a variance of opinion among doctors and educators.

In a KGW Q&A on Friday, KGW's Morgan Romero spoke with OHSU pediatrician Dr. Alex Foster and OHSU-PSU School of Public Health professor Dr. Leslie Bienen.

Full transcript

Morgan Romero: Hi, everyone. I'm Morgan Romero with KGW. This was originally supposed to start at noon, but we had some technical issues, as is live television. So welcome. We're a little bit late, but we definitely wanted to bring in these experts for you today and answer a lot of the questions that you undoubtedly have about school reopening and a return to in-person learning for some background information. Governor Brown gave school districts the flexibility this week to decide on their reopening plan. School districts throughout the state of Oregon have control over whether they're going to reopen for in-person learning. Some districts like Lake Oswego have already decided they're going to introduce K-5 and have some students back in for some form of hybrid learning. And meanwhile, other districts like the state's largest, Portland Public Schools, have said that they're maybe not going to let teachers and staff back in until they all have access to COVID-19 vaccinations. But again, a lot of you have questions and we want to get to the experts. So we're going to bring in two people from OHSU and the OHSU-PSU School of Public Health, first, [OHSU pediatrician] Dr. Alex Foster and second OHSU-PSU School of Public Health professor Dr. Leslie Bienen. And you guys, can you please provide me a little bit of your background? First, Dr. Foster, you know, we were bringing you in to talk about school reopening, kids, transmission of COVID-19. Can you share some of your background with our viewers, so they understand who you are and where you're coming from?

Foster: Sure. thank you for having me. I'm on the pediatric hospital staff at Doernbecher Children's Hospital. I'm also trained as an epidemiologist and that's my position in the School of Public Health, where I also am the director of the MD-MPH program and have been engaged in the data around the school, the challenge of, of when to safely reopen our schools from early on in part, because of the recognition that I have as a pediatrician of the value that education brings.

Romero: Thank you. Happy to have you on. And Dr. Bienen, you are a faculty member at the OSU-PSU School of Public Health. Where does your background come from?

Bienen: OK. So, I'm a veterinarian and a faculty member at the School of Public Health. My research background is in infectious diseases that cycle from wildlife through livestock, to humans. So very apt for SARS. And I specifically looked at infectious diseases across large landscapes. And I also teach in the undergraduate program. So, veterinarians have always been a huge part of public health. I mean, I'm not on the ground in public health as a veterinarian, but that's certainly a huge part of our training.

Romero: OK. Thank you so much. We're so happy to have you guys, you know, like I told you both the biggest question here, the fundamental question, is what are the risks of bringing kids back into school? And what are the risks of keeping them home? And I think a lot of those, you know, both sides have very valid points and there are risks in each facet. And so it is this fundamental question of safety and health concerns around reopening schools and bringing kids, staff, and teachers back. So first, I know Dr. Bienen and you may not be able to hear Dr. Foster so well, let's start with you. Do you think at this point in the state of Oregon, looking at COVID-19 metrics, looking at, you know, transmission rates among children, among adults, that it is safe to restart in-person learning in these bigger areas and maybe counties that have higher cases of COVID-19, because we should mention many students, tens of thousands of Oregon students have been back in the classroom to some degree in rural districts and in private schools, but kind of for the rest of Oregon, do you feel it's safe?

Bienen: Morgan, I could not feel more strongly that it is safe and that we are doing children a horrible disservice to not have them back in classrooms. Certainly I would not be saying that if I thought that I was putting people's lives at risk or even my own life at risk by sending my own child. We just have not kept up with the data in this state about what it's safe to do, in terms of schools. Every day, new studies come out saying the same thing, that is the risk is very, very, very low and the risk and harms to children are very, very, very high, and specifically around widening equity gaps in learning and reading and math and all these things. So yeah, I have no hesitation in saying where that calculus lies that we are making a huge mistake by continuing with remote learning.

Romero: Absolutely. Ask you a follow up question to that, but first Dr. Foster, do you think it's safe to return to in-person learning for most of Oregon schools right now?

Foster: Yeah, I think it is. The challenge is, you know, in terms of looking at the risk is obviously related to COVID and there are, as the governor identified today, there are with appropriate safety precautions in place in the state, the Oregon Department of Education has outlined a lot of those in its Ready Schools, Safe Learners document, but it's basically, you know, masks, distancing and both hand hygiene, as well as cleaning high-touch surfaces. With those precautions in place, the evidence has shown that transmission in the school is minimal and schools are a safe and stable environment for kids. You know, that said we are in certainly in higher in areas of higher incidents of COVID right now, schools are not islands. They are not, were we, if we opened schools in a high risk area, there would be cases of COVID identified because schools and communities do interact, just to be very clear on that, so that shouldn't be a surprise. So, but the transmission, the risk of actual transmission, both to back to the community and to families from being in school, specifically is, seems to be very low.

Romero: And we talk about, we look at the data that shows what you just said. You know, the data from the UK, from schools in other states, obviously not Oregon, but it shows that the data, you know, transmission is very low among students to students, students to adults, adults to adults. But I think that the biggest question here, and I think what a lot of pediatricians even can agree on those that I've interviewed is that the concern should certainly lie in adults acquiring the virus outside the community and bringing it into the school with that. I'll ask you Dr. Foster, would that be maybe the biggest concern about having schools reopened is adults acquiring COVID outside in the community and bringing it into the building?

Foster: I think that's fair based on the data that we have and not just that, but adult, for you mentioned the UK data, which is pretty rigorous in terms of the ability that they did in terms of testing and contact tracing for their outbreaks and when the schools were open. And roughly half of the small outbreaks that they had were determined to be teacher-to-teacher transmission or staff to staff staff, I should say more generally. So that, that does seem to be the highest risk situation is reasonably low from teacher or staff to students. But I think to identify the highest risk group and it's, it's hard. Cause you know, I mean similar in the hospital, we you know, just thinking about ways to be more innovative about how adults act in the school is going to have to be part of this. Similar to how we've done it in the hospital, we don't sadly, you know, have much social interaction anymore. We do our work and then we eat separately and things like that. We have to take precautions.

Romero: Yeah, absolutely. That's a perfect follow-up. We asked all of our viewers and audience on a bunch of different platforms to send us their questions, because like we mentioned at the beginning, a lot of people have questions and concerns about this. So, Julia Mazur Stevens asked us what are the risks of bringing kids back to school that teachers and staff may face? We did just touch on this, but Dr. Bienen, and I'm going to ask you to answer this question for me, from your perspective.

Bienen: Yeah. So I think it's really important when you think about that question to think about what's going to happen when kids are not back in school. So many teachers have children, right? And they're, a lot of them are of the age where they even have high school children. When high-school children are out of school, their risk is very likely shown to be higher of getting COVID from a friend. When they have hours and hours in school with masks and those things, their risk to each other and potentially to their families is quite a bit lower. So I would say that you have to look at the counterfactual. Teachers aren't just staying home because they're teaching remotely. Children aren’t just staying home, particularly older children. So the absolute key, like Alex said, is to get teachers back in buildings and do everything to minimize staff, to staff transmission. That's probably the biggest problem, like you said. And we know how to do that. Masks are incredibly effective when both people are wearing masks, transmission has been shown to be reduced to 95%, similar to a vaccine. So I think that's one reason why we should not wait for everyone to be vaccinated. I’m absolutely for vaccinating high-risk teachers, not asking them to go back to school, vaccinating people with a high-risk family member in their household. But normal-risk teachers can return to school without having to wait for the vaccine, if they can be careful about what they're doing, and that is wearing masks, not eating together, things like that. I think that is by far where we need to be concentrating our efforts and having health departments work very closely with staff in schools to make sure that protocols are not breached. That is absolutely where the data are saying where problems arise. And to my knowledge, nobody has died. The few teachers that have contracted it from each other have all been OK, hopefully because they are low-risk individuals who were back in schools, but still we want that number to be zero. And one thing that public health has shown, which is a very pragmatic profession, is that you can make one mistake and you're probably OK. If you make two mistakes, your chances of being OK are not that great. And then when you make three mistakes, you're very likely to have a problem. So that is, you could take your mask off for a few minutes. Are you going to be OK? Probably. If you take your mask off and eat lunch, no, that's not a good idea, with someone else. And then if you take your mask off and you eat lunch and you didn't wash your hands or whatever, then you're, you're really upping your rates. So we want to keep those mistakes, you know, to zero or one wherever possible.

Romero: I'm so glad you touched on the personal protective measures. Because that was certainly a question that we had been fielding a lot. You know, adults have that autonomy to take care of themselves. We've been doing this for 10 months and if you know how to stay safe, then you know how to stay safe in a school setting. Barry asked us on Facebook specifically, why not wait? You touched on this. Why not wait until the vaccine is widespread before forcing people to risk their health? It's just right around the corner. I'll ask you, Dr. Bienen. And then I'd love Dr. Foster to answer this as well.

Bienen: Yeah. I mean, it's right around the corner, I guess is the question I have. The rollout has been pretty slow. And we know from the hundreds of thousands of school hours we have collected in other studies that it can be done safely. So I guess I would turn that question back and say, why wait? I mean, we know that every day kids are home, that they're having bad outcomes. Kids are in home, suffering abuse and neglect. Twenty percent of Oregon children are learning in a home with an addicted parent. You know, those are really, really, really tough situations to ask children to learn at home. Why would we want to prolong that another day when we know that it can be done safely? So I'm absolutely all for getting teachers vaccinated. I'm happy that the governor bumped them up. I'm not entirely sure it's going to be right around the corner. I mean, it's going to take some time. You know, if it were in the next few weeks, then I would say, great, cause it's going to take that long for schools to kind of gear up anyway. But waiting, you know, until April or May, I just think that's absolutely untenable at this point. I mean, we know what the science says. The schools should start today planning to how to get everyone back in the building. And in a few weeks, if the teachers are vaccinated by the time those plans are ready to go, great. But I certainly would not sit around waiting for it.

Romero: Yeah. Good perspective. All right. Dr. Foster, do you agree or do you have a different take?

Foster: I think I mostly agree. It's about layers of protection and layers of, you know, the vaccine's not perfect either. It doesn't confer immunity. It is great and it will be very helpful in addressing the pandemic, but you know, it's about layers of protection. Sort of what Doctor Bienen said, or is what I understood her to say was, you know, masks are a piece of it. They're not perfect, but they're pretty darn effective. Distance is also helpful. Vaccines are going to be an additional layer of protection, particularly for folks at higher risk, but also in terms of reducing spread between individuals, reducing the amount of the virus, presumably that hasn't been proven yet. But that, that one spreads to, to another, even if you are infected. So it's a great question. I think the challenge is that, as we've seen vaccine rollout is challenging and the timing issue of, you know, how do we balance risk and benefit? I mean, I think it would be safe to return without the vaccine, assuming though that you put in the precautions. So it's a great question, but I, you know, I think at the end of the day, yes, you could return in the absence of the vaccine, but the vaccine will be very helpful as an additional layer of protection.

Romero: Yeah. I mean, that's truly the biggest thing that we're hearing from teachers and staff and the stories that I've been covering the last week and what we're seeing on social media from people that work in schools and that are adults, particularly if they have somebody in their household that's immunocompromised, you know, they don't have a choice. A lot of students have the choice to stay home and do digital learning, you know, should their parents be essential workers, that's not ideal. But they have a choice, but teachers and staff don't have a choice, but to go back. And so for a lot of them who are immunocompromised or have somebody in their household who might be, that's a really difficult place to put them in where they're like, ‘Hey, I'd rather be sure with this vaccine or 94% or 95% sure that I have protection before going back.’ So it's difficult.

Bienen: Can I say something about that?

Romero: Yeah, absolutely. Dr. Bienen.

Bienen: Yeah. So absolutely those people should not go back. I mean, and I can't imagine that districts would force them into that situation. I mean, and I know their unions have negotiated that piece in other places that have opened like Chicago, and Chicago is starting to open. You know, the thousands and thousands of districts across this country have negotiated that problem. And we know that some families want to remain remote and so teachers will have that opportunity particularly until they were vaccinated.

Romero: Yeah. You would hope that that districts have that plan in place. Dr. Foster, what do you think about it?

Foster: About higher risk individuals?

Romero: Yeah. About kind of, you know, teachers saying or staff saying, I'm immunocompromised. I hope my district has a plan in place or I have a significant other or family member who's immunocompromised. And I'm worried about going back before I have that protection from a vaccine.

Roster: Oh, right. Absolutely. I mean, I agree with everything she said in terms of those individuals, especially, shouldn't be forced to go back. But I mean, I think that's a fair question for PPS, honestly.

Romero: Yeah. Yeah. We got another question from a viewer, Finn Hanrahan said, is it true that it's safer to open school for younger kids? And if so, why is that? I'll let you guys decide who might tackle that first?

Bienen: Maybe I can start because I spent quite a bit of time looking at high school data and a lot of districts have said, ‘you know, we, we're going to start with younger kids.’ To some extent that does make sense because we know that viral replication in younger kids is not good. They don't have the same receptors as older children and adults or older teens. So that does make sense. I think there's a couple of new studies that have come out, though, that have really supported the idea that we need to get high schoolers back as well. So one in particular, a really brilliant and elegant study that's brand new that said, basically the author said, ‘Look, testing is a morass that we don't how to deal with because districts are testing totally differently. Some districts are spot testing everybody once a month. Some districts are just testing people who show symptoms. It's very, very hard to compare based on testing. So let's just look at the outcome we care about, which is hospitalization, right? We don't want people to get sick. And they looked at every single county in the U.S. and compared whether hospitalizations went up in districts where schools were open. And what they showed was that when community spread was below a certain level, there was zero rise in hospitalizations, even in districts that were open, including high schools. So that's, that's a really key piece of information. I looked at Multnomah County's hospitalization rates, and that's what they were looking at, and every single week, we were well below the cutoff that this study used as high community spread. So basically what they said was when hospitalizations get above 44 per 100,000, we don't really know whether opening schools is a good or bad idea because the data gets very wild at that point. Like are these districts where everything is open, having more spread because people aren't wearing masks? Like it just becomes very hard to tell. So they use the cutoff at 44 hospitalizations per 100,000 people. You can look at every single week or hospitalizations in Multnomah County. And we have some of the higher spread in Oregon. We've never exceeded that threshold. Most of our weeks were like four, eight, 12. The highest week we had this entire time since last March, we were at 22, so extremely low compared to what they were looking at. And I think that's really, really telling. They also, and like I said, those were in places where high schools were also open. High schools have been trickier for several reasons, that is that students socialize outside of school with each other, you know, not under parental control. So the biggest problem that I've seen in opening high schools is that a bunch of students in the same cohort will test positive. They don't really know if they've gotten in at school or if they were all socializing together and they have to shut down that cohort. And that can be very stressful on educators and on everybody. So that's more of the bigger problem. It's not necessarily that any more staff are getting infected, they're not, but it is a problem that they more often have to go to remote learning and be prepared to do that. The good thing about high school is those students can be home alone, generally speaking, right? So this problem of having to find childcare when you shut down, isn't as big a problem. But I would say when opening high schools, the flexibility piece is really important, that districts be prepared for that eventuality.

Romero: I'm so glad you touched on that. And that's certainly a topic I want to revisit later is what happens when one person tests positive, I mean, is there effective contact tracing, but I do want to get to that in a bit. Dr. Foster, do you believe that the data substantiates the fact that adolescents get COVID-19 at higher rates are more susceptible, they can track the virus easier and that's more of a concern of bringing them back to school versus younger kids?

Foster: Yes. I mean, it's, I think there are a couple pieces to, that is one that it seems as though so part of it's related to testing, right? So that's children who are younger tend to have fewer symptoms and because they have fewer symptoms are less likely to get a test. So at least initially it was difficult to determine the degree to which there might be asymptomatic transmission in younger children, but that has been pretty settled now in terms of the school setting, in terms of it being elementary schools would be a very, they are a very safe environment, given the precautions that we already talked about for. In terms of the risk with older children, it's similar. And you know, some of the high schools that have been around Oregon, they haven't seen transmission in high school. So with the precautions in place, you know, everything that Dr. Bienen just said, I agree with, in terms of the data supporting that in the absence of precautions, there is an increased risk of transmission, adolescents act more like young adults. And we don't fully understand why that is, but at least from an epidemiologic perspective, they, they, they certainly have the potential to spread more. But in the, in the context of using the precautions, it seems to be safe.

Romero: OK. We do want bring up another viewer question. Kelly Tilden asked, is there a holiday surge in Oregon? We've been seeing that in many other states. If so, how does that impact the risks of returning to school now. It seems other states have higher rates and they're making it work. Dr. Bienen, I will ask you first.

Bienen: I would say we didn't really see the big surge here that people were worried about. We definitely had a surge in November. It certainly wasn't the disaster that was predicted. You know, there's a natural break after Christmas anyway. And the coming back now in January, I don't think it's a reason to revisit going back because most of the schools that I'm hearing from are really talking about February anyway, which is reasonable because the second semester is starting and transitioning now, you know, with a couple of weeks left in the semester would be kind of silly and disruptive. But as far as getting everything going in February, no, I don't think it's a reason. And the really massive thing to keep in mind here is that Oregon's rates are very, very, very low, even though, you know, we've had some surges and things sort of bumping around in November, our data for January is a little bit hard to interpret because the OHA reported that they had a data glitch where they dumped a bunch of data from June through December into January. Not really sure why. So there were a couple of days that saw like a big peak, they were not actual peaks. They weren't reporting errors. So no, I would say no, I don't think there's really been a huge holiday search here. And the bit of rise we've seen, you know, I don't think that will be an issue in early February. In general, our rates are just very low still, we're the third lowest in the country, and yet I would say we have the fewest percentage of kids back in school, or here in the Portland area, San Francisco and LA, which is having a big surge, but we really aren't.

Romero: Yeah, we've been saying over the last several months as more schools have reopened that Oregon does have some of the most stringent policies in the nation. Dr. Foster, what is your take on that?

Foster: I mean, I think it's a little bit early in terms of as far as the data thus far, we haven't seen much of a surge post the holiday, but I think it's too early to say, honestly in terms of the latency or the time it takes to that you can potentially transmit this and then the time it takes to develop symptoms and seek testing, I think it's a bit early to say. And I am not criticizing Dr. Bienen’s assessment, I'm just saying, I think it's early to say that we got away with the holidays without a subsequent surge. I think the real challenge with surges in schools though, to that we should talk about this, just this, the staffing and the challenges of even if the transmission is low in the community, and I know the schools are addressing or trying to, is that that's a real challenge in terms of the stability and doing this going forward for the next few months. I think it's a challenge. We need to overcome that schools are going to try to, but, you know, even if schools aren't a source of transmission, if there’s a significant surge in the community, that's going to cause a lot of quarantine and you know, the little pods or bubbles or whatever you want to call them to have to shut down. So it's a staffing challenge, but I think we could, yeah.

Romero: Yeah. I interviewed a pediatrician this week whose main message was you with this new strain popping up, we don't know much about it. We do know though that it appears to be easily transmissible, perhaps more so, more contagious than the prior virus. So this mutation being brand new, being, you know, spreading in surrounding states and surrounding countries. So Alice asked, what about the new strain coming out? Does that factor in, at all. Should schools be weighing that when deciding whether to go back to in person or to in-person learning? And I think that that really falls in line with what we were just talking about, Dr. Foster.

Foster: Yeah. I mean, it's, you know, what we've learned in this pandemic is you have to respond to new information. So right now I believe the CDC is working on surveillance related to sequencing to determine the extent to which that new strain is circulating. If it, you know, if we were to get new information that shows that that's strain is circulating significantly in Oregon, that would certainly be a piece that we would that the state and the school districts would want to pay attention to. I agree that being open to, we should not get down a path that we have to open the schools, regardless of whatever happens. You know, that would also not be a safe mindset to be in, but we have to adapt to new information. But right now, at least to be clear, we don't have data that suggests it is widespread enough, that that strain is widespread in Oregon. And the precautions that are still in place have in, even in those settings have been shown to be effective in schools.

Romero: Okay. And Dr. Bienen, and I want to ask you, you know, we talked about immunocompromised significant others, and Dr. Foster even touched on the fact that essential workers, you know, doctors this entire time have had to take all these personal precautions. So one person asked us if my spouse ends up going back to in-person instruction, what precautions should we take when they leave home, leave school, and then arrive back home? We can pull that question up on the screen, because I think it is a question that a lot of people have, you know, it's something that essential workers, including perhaps Dr. Foster, have been dealing with this entire time, of stripping down their clothes and jumping in the shower and putting all of their clothes in the wash. So Dr. Bienen, what, what do you recommend?

Bienen: Yeah, I think that's a great question. I think the thing to focus on is being most careful in the environment where you could possibly catch COVID. And like I said, we’re seeing such low transmission at school. North Carolina just released a new study of 90,000 students and educators, and they had virtually no COVID transmissions and they did excellent contact tracing. It’s in Pediatrics, this most recent issue of Pediatrics. They said that they found 32 instances where they were fairly confident that there had been transmission at school. They were all adult to adult out of almost 100,000 people. So, I mean, that honestly makes teaching probably one of the safest professions out there. That's an incredibly low rate of COVID. I think that things like washing your clothes is not a good use of your time. We know that that COVID is not being transmitted on people's clothes. But washing your hands of course would be important. And then I would say, you know, you really have very, very, very little to worry about unless somebody tests positive in your spouse's cohort. And then I would obviously get tested for that person and, you know, maybe stay away from each other until you get your spouse's tests back. And I want to say something about the masking at school. I've seen on a lot of the union's requests, the demands to go back and N-95 masks as something for teachers to wear. One of the dogmas of public health is that policy isn't effective if people won't do it. And the reason I'm stating that this is really an important thing, masks are worn when they're comfortable. N-95 masks are uncomfortable, you are most likely to take a mask off if it's bothering you. Those little blue ones that you wear, you know, when you go to the dentist or whatever, those are very comfortable, they're very light and they work very well. So a kind of mask that you're going to be like taking off is not good, and it's not necessary to have an N-95 mask. So I think all staff in buildings should be wearing comfortable masks that they won't be tempted to take off. And that's, what's going to keep staff safe. And in this case, the person's spouse safe. So personally, I think for teachers should be asking for N-95 masks is just a huge mistake and it's going to lead to people not wearing them.

Romero: That's so interesting. I want to ask a follow-up question to something that you said earlier, Dr. Bienen, you mentioned that there were no deaths from educators or students related to contracting the virus at school. I covered a story on Sunday where people were putting up flags saying, you know, 500 educators and students or children had died related to COVID-19. And we are seeing some stories, you know, that teachers have contracted the virus. Contact tracing is difficult, right, but teachers have contracted the virus in a school setting. I mean, do you know anything about that? Because we do know many educators, small fraction, obviously, but, but many educators have died.

Bienen: As far as I'm aware, there aren't any that contracted COVID at school. I mean, a lot of the educators that died and that's a very, very small number, when you think about the number of educators in this country you know, they're people, they're humans, they're traveling, they're socializing, going to see family, just like other people. And probably a lot of them are much more careful than the general public and other professions. But as far as I'm aware, none of those deaths were linked to school transmission, you know, most schools were closed for a really long time, right? So educators, obviously like everyone else were getting COVID outside of school, but if you put that figure over the denominator of 3,000,000 teachers, that's 0.01, 4% fatality, it's very, very, very, very low. I mean, honestly, teaching right now is probably one of the safest professions and not just because schools are closed. I mean, even in schools where that are open, I don't think that there have been deaths of teachers. I'm not aware of any, I could be wrong.

Romero: OK. Yeah, no, certainly something new to circle back on. And it's difficult to look at national data and we can really only look at like local news stories and say, ‘Hey, yeah, certainly this teacher contracted it,’ but even figuring out where somebody contracted the virus has proven to be very difficult throughout this pandemic. Dr. Foster, what is your advice? I imagine that you are consulting with public schools, you have connections with principals, but what is your advice? Should a student or a staff member or teacher get COVID-19, what should schools do? Do they shut down school or do they kind of quarantine? Those folks quarantine? The people that were in close contact with them, what do they do?

Foster: Right. So it is the, you know, school's the thing that has been shown to be fairly, fairly effective is, and it has to do with how you design the small cohorts coming back. Because if you have an, if you have an identified case, then in order to prevent the spread, it is the reasonable thing to do is to, you know, have everyone in that, their cohort that was potentially exposed quarantine for some period of time and receive testing. So it depends a little bit on, so, so that would be the, what I would say is that, that small, so sort of the way to minimize the disruption to the school is obviously to set up the school in such a way that it has small cohorts that exist within it and reducing the exchange between those cohorts or the interaction between those cohorts. So that when a case is identified, you know, 10, 15, 20 kids have to isolate and stay home, but not the entire school. That would be the advice or the balanced advice I would provide.

Romero: Yeah. That makes sense. You don't want kids to have this boomerang of going from in-person school to distance learning, and obviously districts have to have these plans. That's been kind of the stipulation the time, but you don't want to have to bounce kids around like that after all of the things that they've been through this year Dr. Bienen, would you agree keeping them in the cohort and isolating that cohort afterwards?

Bienen: I agree. And I think this is the tricky part about high school because students aren't all on the same schedules, right? And I think this has been a real thorn in the side for high schoolers and for districts to figure out how to get high schools open safely. But I do know it's being done. I'm not a school administrator, so I don't have all the details at my fingertips about what they're doing. But for example, hybrid schedules can help with this because half the school is not in the building at the same time. So potentially here, like worst-case scenario would be that half the school wouldn't be able to come. I think it's not even that bad that they have been able to separate them somewhat better than that. But potentially you are quarantining or removing more students from the school then you would have to like in a kindergarten setting where it's just one class. Ohio has done some interesting things that we should be looking at around quarantining and saying, you know, we're really over quarantining kids. We don't need kids to be out for two weeks because of a potential exposure, that if they test negative a few days after the initial exposure, let them come back, things like that. And I know Oregon has gotten a bunch of new tests available, so, you know, that would potentially help. But looking at strategies to deal with the cohort issue in high school is essential. We have to go and look at what other people are doing. I don't understand why Oregon keeps trying to reinvent the wheel here. You know, Rhode Island has gotten high schools back. Michigan has gotten high schools back. Marin County in California has been incredibly successful. My dear friend is the County Public Health Officer there, and they have 85% of their schools open including high school. And they're seeing no transmission. They've literally had six transmission events over 560,000 school days. You know, kids have school days. And they were all from adult to adult, like I said, so they're doing it. Can we please go out and figure out what they're doing? It's just it's mind boggling to me that we're sort of sitting here saying it can't be done.

Romero: Hmm. That is no, that's such a great perspective. I'll ask you guys each, do you consult with public schools? Have the districts been coming to you or perhaps state Department of Education been coming to you guys and saying, ‘Hey, what can, what can we, what can we do?’

Bienen: They're definitely not coming to me. And I think one of the really missed opportunities that we have in Oregon is that the county health departments, at least from what I'm seeing, aren't as embedded in this situation as they need to be. And I'm using my friend in California as an example of how it could be and how it should be. He and his deputy public health officer in Marin County are on the ground doing this with schools. He's been completely committed to getting schools back. He has met with superintendents, he's meeting with school boards, they're having town halls, they're doing all the things so that schools can feel confident that their plans are, are safe, that they have support of their county health officers. And I don't really know, cause I'm not on the county health side, you know, how our Multnomah County health department has been involved, for example, or what's happening in other counties across Oregon. Just from what I read in the paper, I'm not really seeing that there's a lot of integration happening and I think that's something that Oregon should and could be doing really, really differently. So, I asked my friend, ‘Hey, would you be willing to talk to her neighbor county health officers about what you're doing, because what you're doing should be a model for this whole country.’ And he said, yeah, he so I hope if any of you are listening, you'll take him up on that offer because he's doing incredible things in California.

Romero: I was going to say, if anyone's paying attention to this, hopefully they'll heed that advice. Dr. Foster, have you been consulted at all?

Roster: I have talked to a number of different educators and educational leaders, not Portland Public Schools. I have not done any formal consulting. I would be happy to, you know, being a faculty member at two  universities and teaching and being a physician.

Romero: Well, I think you guys essentially answered the questions that we have that fundamental, but very complicated question, are what are the risks and benefits of getting kids back to school? And it's really interesting to hear your perspective here we are in January, school has been closed for several months, and you're saying the risks of keeping kids home certainly outweigh the risks of sending them back to person-in-person learning. And it outweighs the risks of sending adults, staff, and teachers back to in-person learning. So, yeah, it'll be interesting to see what districts decide. They have to pretty much make a decision here in the next couple of weeks and the state's going to be updating its guidance by January 19. So we'll keep our eyes on that. I really appreciate you guys weighing in. Thank you so much for your time.

Expert bios


Pediatrician, OHSU

From OHSU's website: B. Alex Foster has a secondary faculty appointment in the OHSU-PSU School of Public Health as an Assistant Professor in the Epidemiology programs (MPH and PhD). In this role, Professor Foster’s work includes collaborating other SPH primary faculty members in Epidemiology and mentoring or advising EPI students.

Dr. Foster’s primary faculty appointment is in the OSHU School of Medicine; Dermatology Department. B. Alex Foster, MD, MPH is a pediatrician-public health scientist. He attended medical and graduate school in Oregon, completed residency training in New York City, and then started his faculty career in Texas before returning to Oregon.

His research interests focus on addressing obesity in childhood, particularly for low-income populations at higher risk of continued obesity and the subsequent associated complications. Dr. Foster’s research work has focused on understanding what assets communities have and building off of those, and he has also examined using parent mentors as an intervention model to support behavioral change.


Professor, OHSU-PSU School of Public Health

From the OHSU-PSU School of Public Health website: Leslie teaches primarily undergraduate courses at PSU, including Global Health and Consumer Health. She is the pilot program coordinator for PSU’s BUILD EXITO program, an undergraduate research training program that supports students on their pathway to becoming scientific researchers.

Her own research focuses on conservation medicine and on zoonotic (from nonhuman animals to humans) disease transmission. Conservation medicine strives to understand the interaction among human health, environmental changes and the health of nonhuman species. She was a co-investigator on the Bighorn Sheep Disease project, examining disease dynamics of pneumonia in bighorn sheep. She has researched and written about several bat viruses transmissible to humans and sampled livestock in Nepal for bovine brucellosis and tuberculosis, surveying farmers about their understanding of these diseases.

Leslie was a regular contributor to Frontiers in Ecology and the Environment for many years. She has published in Orion, Open Spaces, Conservation Magazine, and other places.

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