ANA Denounces “Race and Sex Stereotyping and Scapegoating” Exec Order

ANA Denounces “Race and Sex Stereotyping and Scapegoating” Exec Order

Claiming that it will “effectively reverse decades of progress in combating racial inequality,” the American Nursing Association (ANA), the American Medical Association (AMA), and the American Hospital Association (AHA) have called upon the White House to rescind Executive Order 13950, “Combating Race and Sex Stereotyping.”

Scheduled to take full effect in November, the September 22 EO directs that federal funds be denied to federal agencies, companies with federal contracts, and recipients of federal grants that sponsor any program that “promotes race or sex-stereotyping or scapegoating.” Any company found to be defying the order is threatened with cancellation of all federal contracts or funding. Non-exempt contractors are expected to start complying by November 21, but federal agencies were immediately affected by the order. The Justice Department has already suspended its diversity and inclusion training, and the prohibition has provoked a tumult at colleges, hospitals, government offices, non-profit organizations, and other institutions dependent on federal monies.

Citing “the pernicious and false belief that America is an irredeemably racist and sexist country; that some people, simply on account of their race or sex, are oppressors; and that racial and sexual identities are more important than our common status as human beings and Americans,” the EO is a widespread condemnation of the standards underlying most mainstream diversity initiatives. The order describes the concepts espoused in recent federal training programs as a “malign ideology” and claims that “research… suggests that blame-focused diversity training reinforces biases and decreases opportunities for minorities.”

The October 14 ANA/AMA/AHA letter states that “as providers of care to diverse communities throughout the country, we urge the Administration to immediately rescind EO 13950 and allow for our continued work on inclusion and equity.” The three signatories warn that Executive Order 13950 will “stifle attempts at open, honest discussion of these issues [e.g., sexism, systemic racism] in the public and private sectors” and argue that “prohibiting federal agencies from conducting and funding trainings that promote racial reconciliation is counterproductive to addressing racism.” Noting the disproportionate impact of the pandemic upon Black and Brown Americans, the letter argues that “vital research conducted at the National Institutes of Health and academic centers to comprehend the effects of structural racism and implicit bias on health care and health outcomes is needed right now more than ever before.”

The Association of American Medical Colleges also spoke out against the order, and in a September 24 letter, stated that “The AAMC, and the academic medical institutions that comprise our membership, are committed to being diverse, inclusive, equitable, and anti-racist organizations. We believe this training is needed now more than ever. The AAMC intends to continue our trajectory of pursuing and even increasing such training. We urge our member institutions and other affected organizations to do so as well.”

While the academic world is largely seeking to challenge the order, two colleges, the University of Iowa and John A. Logan College, have already announced that they are shuttering their diversity programs, at least on a temporary basis.

Why It’s Time to SHIFT Nursing

Why It’s Time to SHIFT Nursing

The Year of the Nurse and Midwife hasn’t really turned out the way any nurse I know (including myself) would have imagined.

You thought the NCLEX was hard? What about the gripping fear that comes from realizing the way you’re being asked to use your N95 would’ve resulted in you failing out of nursing school clinicals? Or the horror you feel about being unable to give patients what they most need: a loved one to hold onto as they transition out of this life? Or the overwhelming anxiety that you might carry an infectious and potentially deadly disease home to your spouse, your children, or your aging parents?

Turns out COVID-19 is the pop quiz none of us ever wanted to take.

While we love the free pizzas, the 7 p.m. applause and the increased visibility, we nurses also see what so many outside of our profession don’t. Nurses witness firsthand the unacceptable toll this pandemic has taken on health care workers, with more than 900 dead in the United States so far—and even more horrifying, COVID’s toll on health care workers of color, who make up 62 percent of that fatality list.

We know that while the data collected are woefully inadequate so far, this disease is having a heartbreakingly disproportionate impact on our patients who are Black, Indigenous, and people of color.

Beth Toner, RN, MJ, MSN
Beth Toner, RN, MJ, MSN

Those of us who chose this profession to make a difference in others’ lives are willing to work hard to ease the suffering of others. We know our patients. We know they are far more than the condition that landed them in our care. It is food insecurity, inadequate housing, low wages, and unreliable (or no) transportation that have as much effect on people’s health as the medication they take and the health care they receive.

Yet this pandemic has shown us just how fragile this system we call health care is. How can we take care of patients if we can’t even take proper care of ourselves?

Here’s the good news: There’s never been a better time for nurses to make themselves heard and push hard for the changes we have been calling for since, well, forever. The National Academy of Medicine is hard at work on the next Future of Nursing report and it will focus on how nurses can be supported as they address the problems in communities that prevent so many from living their healthiest lives.

A new report from the WikiWisdom Forum—which spent nearly six months listening to nurses across the nation discuss the heartbreaking conditions on the COVID front lines—has made recommendations on how to avoid a similar tragedy in the next pandemic, which will surely come. The report calls for everyone—policy makers, the public, and nurses themselves—to listen, protect and support nurses.

I’ve heard similar themes from the nurses who playing starring roles on SHIFT Talk, a new podcast supported by the Robert Wood Johnson Foundation, that addresses bullying, PTSD and preceptorship in our profession. The host and guests tackle tough topics and point out that the pandemic has only made worse the problems nurses have been facing for a long time.

But again, there are a few bright spots. Nurses are so resilient. Not only will we get through this, we will, I believe, get through this stronger. We have solutions to the problems the nation’s health care system faces. We know what we, and our patients, need.

It’s time to speak up boldly. It’s time to fight the injustices so many of our patients—and so many of us—face. It’s time to stare down systemic racism within our profession. It’s time to bring a variety of voices to the table. It’s time to make the shift and make this a Year of the Nurse we will remember for all the right reasons.

AACN: In a Pandemic, Evidence Trumps Expediency

AACN: In a Pandemic, Evidence Trumps Expediency

The American Association of Colleges of Nursing (AACN) is taking a firm stand in favor of science and critical thinking. For nursing students and nurse educators, evidence-based practice (EBP) is a touchstone that helps save lives. Policymakers, however, face pressure from so many conflicting demands and interests, that even in a public health crisis, officials can be tempted to sink the science if they can gain more approval by espousing specious ideas that rely on popular appeal. The AACN has apparently had enough of this. On September 29, the association issued a statement to public officials, spokespeople, and policymakers: a pandemic situation is a time to bridle the impulse to promote factitious decisions based on wishful thinking or a desire for popularity. When human lives are at stake, the decision-making process must rest on scientific evidence.

The AACN statement, “Science Must Drive Clinical Practice and Public Health Policy,” pulls no punches. Bluntly remarking that “During times darkened by fear of disease and mistrust of science, nurses must mark a bright line between evidence-based healthcare guidance and opinions based on economic expediency or political ideology,” the document urges that “All healthcare decision-making, whether it be for individual patients or the nation, must be anchored in the best scientific evidence available. All individuals have a responsibility to seek truth and reject misinformation or propaganda, especially those in leadership positions….”

The AACN states their official position in the following words: “The best available evidence should guide all healthcare decisions. This is true for the individual healthcare professional at a patient’s bedside and for civic leaders who make local, state, and federal healthcare policy. Even when fast-moving public health crises make it impossible to find sufficient amounts of peer-reviewed research, public policy decisions must be based on carefully evaluated healthcare information and the guidance of fully qualified experts.”

The release of this statement at this particular time—and its tone—suggest that events have reached a tipping point. The credibility of the CDC has eroded, politicians are still ignoring established evidence that people are safer in populations that wear face masks in public, and some national advisors continue to cling to the debunked theory that herd immunity is the solution to COVID-19.

What can nurses do? The AACN recommends a number of actions that can help protect the public well-being. Briefly summarized, the action points include:

  • Correct false healthcare information at every opportunity
  • Be ardent defenders of evidence-based science and respect for expert knowledge
  • Be aware of conflicts of interest—professional, financial, or political—when evaluating data and evidence
  • Speak out against censorship of scientific ideas or the silencing of legitimate experts
  • Use evidence-based practice, a problem-solving approach that involves the conscientious use of current best evidence, in making decisions about patient care

The full AACN statement can be found here.

WHO Issues 5-Point Charter on Health Worker Safety

WHO Issues 5-Point Charter on Health Worker Safety

Although health workers constitute about 3% of the population in most countries, they comprise 14% of COVID-19 cases reported to the World Health Organization (WHO), and in some countries account for up to 35% of COVID cases. WHO Director-General Tedros Adhanom Ghebreyesus noted this in a September 17 statement and added, “The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and save lives.” As “one of the keys to keeping patients safe is keeping health workers safe,” on Thursday the Director-General issued a 5-point charter on healthcare worker safety in conjunction with Patient Safety Day.

The 5-point WHO charter urges its partner countries to:

1. Develop and implement national programs for the occupational health and safety of health workers

WHO recommends that education and training programs for health workers at all levels include health and safety skills in personal and patient safety and that healthcare licensing and accreditation standards incorporate requirements for staff and patient safety. Member countries should also review and upgrade national regulations and laws for occupational health and safety to ensure that all staff members have regulatory protection of their health and safety at work.

2. Protect health workers from violence in the workplace

Promote a culture of zero tolerance to violence against health workers. Labor laws, policies, and regulations need to be strengthened, and all healthcare workers should have access to ombudspersons and helplines to enable free and confidential reporting and support for any health worker facing violence.

3. Improve the mental health and psychological well-being of healthcare workers

Healthcare facilities must establish and maintain safe staffing levels, and ensure fair duration of deployments, working hours, and rest breaks. Mental and social support services, including advice on work-life balance, risk assessment, and mitigation should be readily available to all staff.

4. Protect healthcare staff from physical and biological hazards

Health care systems must implement patient safety, infection prevention and control, and occupational safety standards in all health care facilities. Facilities need to ensure availability of personal protective equipment (PPE), adequate quantity, appropriate fit, and acceptable quality. All facilities should maintain an adequate, locally held, buffer stock of PPE and provide workers with adequate training on appropriate use and safety precautions. Further, at-risk healthcare staff should receive vaccinations against all vaccine-preventable infections, and in the context of emergency response, be given priority access to newly licensed and available vaccines.

5. Connect the dots between policies on patient safety and healthcare worker safety

Institutions should integrate staff safety and patient safety incident reporting and learning systems, and define the linkages between occupational health and safety, patient safety, quality improvement, and infection prevention and control programs.

Regarding the latter point, the charter states that “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe.”

For more details on the charter see the WHO announcement, “Keep Health Workers Safe to Keep Patients Safe.”

SC Grants Graduate Nurses Temp Permission to Practice

SC Grants Graduate Nurses Temp Permission to Practice

To cope with diminishing resources during the state’s spike in COVID cases, the South Carolina Department of Health and Environmental Control and the State Board of Nursing have issued a temporary order permitting graduate nurses to treat patients during the crisis.

At Medical University of South Carolina’s Florence Medical Center, Chief Nursing Officer Costa Cockfield stated, “This is a win-win situation, the nursing students have a pathway to work while waiting to take the licensure exam. Likewise, the hospital benefits by getting the new graduate oriented and into clinical practice much faster.”

With NCLEX testing sites closed due to the pandemic, the state has been suffering from critical nursing shortages that have been unrelieved by any inflow of new RNs. Under the new order, graduate nurses who have not been able to take the NCLEX can temporarily fill staffing gaps despite lacking a license. The new rules apply to graduate nurses who have registered for the NCLEX and have graduated from an accredited nursing program. The grads are required to work under the supervision of an RN at all times.

Tony Derrick, Chief Nursing Officer at McLeod Medical Center, said, “There is certainly a place where… [these graduate nurses] could fit in to assist as a resource, and while they’re doing that, they’re learning, so I think it’s a positive win for both the student nurse for resource allocation as this pandemic continues and I don’t think it hurts to have this as a good resource.”

South Carolina is one of the few states to issue an order to temporarily admit graduate nurses into the workforce. In March, Ohio governor Mike DeWine signed a bill allowing newly graduated nurses to obtain a temporary license prior to passing the NCLEX, but so far few states have followed suit. Prior to the state’s surge in COVID cases, the Texas Nurses Association, the Texas Board of Nursing, and the Texas Organization for Nursing Leadership issued a joint statement advising that “Prelicensure RN students from diploma, associate degree and baccalaureate degree nursing programs and PN/VN students from certificate nursing programs could augment and support nursing services in health care facilities.” The American Organization for Nursing Leadership released a policy brief recommending similar measures, but such proposals have not gained traction among officials and legislators.

For more details on the decision in South Carolina, see the story at the Florence, SC CBS affiliate site.

COVID Surge Fires Debate Over School Reopening Plans

COVID Surge Fires Debate Over School Reopening Plans

As school officials debate whether to reopen this fall, physicians, teachers, and a prominent ethicist markedly disagreed on whether sending children back into the classroom is safe for their communities.

Some pediatricians are driving the push to reopen, while infectious disease specialists, family physicians, and teachers appear more wary, concerned that schools could become “new hotspots for the virus.”

At the heart of the debate are many unanswered questions, with arguably the most important being: How often are children infected, and how contagious are their infections?

The American Academy of Pediatrics (AAP) issued guidance in late June that strongly recommends children resume in-person classes in the fall.

While acknowledging that “many questions remain,” the AAP was confident in reopening given “the preponderance of evidence” that children “may be less likely to become infected and to spread infection,” as well as less likely to become symptomatic or develop severe illness when they do contract the virus.

However, NIAID Director Anthony Fauci, MD, has cautioned that there aren’t enough data to make a definitive statement about transmission in children. His colleague on the White House Coronavirus Task Force, Deborah Birx, MD, acknowledged on July 8 that children are the least tested population.

The AAP guidance does emphasize the importance of responding quickly to “new information,” but drives home its message that “all policy considerations for the coming school year should start with a goal of having students physically present in school.”

President Trump has made it clear he wants governors to reopen schools, even threatening to withhold funding from states that don’t force these reopenings.

His administration has leveraged the AAP’s own recommendations at every turn.

On July 8, during the Wednesday task force briefing, Education Secretary Betsy DeVos quoted from the academy’s guidance, stating that “keeping schools closed places children and adolescents at considerable risk of morbidity and in some cases mortality.”

At the same briefing, Vice President Mike Pence recommended that “every American” review the AAP’s guidance.

The White House has already shown its influence over these decisions. Following an angry Twitter storm from President Trump over CDC’s “very tough & expensive” recommendations for reopening schools, Pence said the agency would be releasing new guidance next week.

However, in an interview with Good Morning America on July 9, Redfield clarified that the basic CDC guidance would remain in place, but additional reference documents would be included.

AAP’s Evidence

The AAP’s statement makes clear it determined that the risk of viral transmission is the lesser danger compared with the social, emotional, and academic consequences of remaining home, and believes the evidence is on its side.

Danielle Dooley, MD, an AAP spokesperson and medical director of community affairs and population health at Children’s National Hospital in Washington, D.C., told MedPage Today that when schools closed in March, many experts assumed the virus would “behave like influenza” which spreads rapidly among children.

“But what we know now … three months later is that it doesn’t behave like influenza. Children do not appear to be ‘super-spreaders,'” Dooley said, noting that only “very limited cases” have shown children passing the virus to adults. A press representative was present during the phone interview with Dooley.

While “tens of thousands of children” of essential workers continued going to daycare centers and emergency childcare facilities throughout the pandemic, Dooley noted “there have not been cases of major outbreaks or spreading events in those areas.”

The YMCA and the New York City department of education cared for a total of 50,000 children during the pandemic, and both organizations told NPR in late June they had had no COVID-19 outbreaks.

The AAP also relied heavily on a May 15 policy brief from the Learning Policy Institute (whose funders include the Sandler Foundation and the Ford Foundation). The report summarized the experience of China, Denmark, Norway, and Singapore in reopening schools in late March or April and also includes the experience of Taiwan, which kept schools open nationally, while implementing mandatory and temporary closures in areas with high infection rates.

All five countries’ strategies were viewed by the policy brief’s authors as successful “to date” in avoiding the spread of COVID-19.

All instituted temperature checks and a range of physical distancing measures. Denmark and China reduced their class sizes and Norway instituted a maximum class size of 15 students for younger grades and 20 for older grades. The five countries also developed quarantine or school closure policies. Taiwan will suspend a particular class for 14 days if one case is discovered and will suspend school for 14 days if two or more cases are identified. In Denmark, anyone who’s sick is required to remain home for 48 hours.

The institute acknowledged that countries that reopened their schools “differ significantly from the experiences so far in the United States” with regard to their capacity “to test and track cases” and to “isolate individuals who have been exposed to infection,” all factors linked to their success in avoiding viral spread. The policy brief further stated that it “has not investigated the health implications of using any of these practices in the United States and does not endorse the safety or effectiveness of these practices or of any medical practices.”

Dooley also cited a systematic review in The Lancetpublished in April, which cited data from the 2003 SARS outbreak in mainland China, Hong Kong, and Singapore indicating that closing schools “did not contribute to the control of the epidemic” while recent modelling studies of COVID-19 estimate that closing schools alone “would prevent only 2%-4% of deaths.”

AAP also cited an editorial published in The BMJ in May that leans on studies of widespread community testing in Iceland and South Korea which found children were “significantly underrepresented” in positive cases. The authors also cited a case study of a cluster in the French Alps in which one child with COVID-19 failed to transmit the virus to anyone “despite exposure to more than a hundred children in different schools and a ski resort.”

The AAP recommends that older children in elementary and secondary schools wear face coverings, social distance, and space their desks 3-6 feet apart when feasible. They also suggested that schools eliminate lockers, and transition to a block schedule for older students (where classes run longer each day, but terms are shorter) and when possible, rotate teachers for each new class rather than crowd hallways with students transferring place to place.

For children in pre-kindergarten, the academy did not suggest face-masking and physical distancing, believing both too difficult to implement in that age group. Instead it advocated separating kids into cohorts, using outdoor spaces whenever possible, and limiting unnecessary visitors.

The AAP recommended that students use alternatives to buses when possible, and assign seats in cohorts for those who do take the bus. The guidance also suggested one-way hallways, limiting the number of children on a playground at once, and potentially using classrooms or outdoor spaces for meals.

When asked about children as vectors of the virus, NIAID director Anthony Fauci, MD, said on Thursday during a press conference at the virtual International AIDS Conference that there’s “an assumption that we know for sure that children are poor transmitters when as a matter of fact, we don’t have enough data to make a definitive statement in that regard.”

He noted that there are “some suggestions that they are poor transmitters” and have less chance of an adverse outcome, but the research on transmission is ongoing.

“Right now, we are doing a natural history study on 6,000 families in the United States to determine definitively whether that suggestion … is actually based in actual scientific data,” Fauci said.

At the coronavirus task force briefing on Wednesday, Birx said current infection data are “skewed” to older adults, in part because initial testing protocols sought people with symptoms.

In recent weeks, case counts in children and teens 17 years of age and younger have been creeping up, nationally now at 5.9%, versus less than 2% as of April 2. In California, infection rates in this age group have more than doubled from 3.4% two months ago to 8.2% this week.

In a statement on Friday, the Infectious Diseases Society of America and the HIV Medicine Association suggested that school systems should be concerned about “instances in which children have fallen seriously ill … and in which children have died,” given that dynamics of the virus are unknown, and that teachers and other adults may be vulnerable to disease and death. The groups called for policies on symptom screening of students and staff as well as testing, and a recognition that a substantial proportion may be asymptomatic yet capable of transmitting.

On July 10, the AAP in coordination with the American Federation of Teachers (AFT), National Education Association (NEA) and AASA, The School Superintendents Association, issued a joint statement that looked like a reaction to statements from the White House calling for all schools to reopen.

While continuing to stress that “children learn best when physically present in the classroom” the new statement warned that public health agencies should base their recommendations on “evidence not politics.”

The four stakeholder groups also emphasized that local school leaders, public health experts, teachers and parents should drive decisions regarding “how and when to reopen schools, taking into account the spread of COVID-19 in their communities and the capacities of school districts to adapt safety protocols to make in-person learning safe and feasible.”

The groups also pointedly stated that “schools in areas with high levels of COVID-19 community spread should not be compelled to reopen against the judgment of local experts.”

Schools’ Role, Beyond Educating Kids

Dooley said evidence has shown that online learning is “not sufficient to meet children’s academic needs.”

“We’re already looking at children being now months behind in their school curricula,” she said.

At a June 10 hearing of the Senate Health, Education, Labor and Pensions (HELP) Committee, ranking member Patty Murray (D-Wash.) said she worried school closures could exacerbate inequities in education.

Researchers project that “Black children could lose over 10 months of learning, Latino students could lose over 9 months of learning, compared to white students who are projected to lose 6 months of learning,” she said.

She also cited the story of a mother in Yakima, Washington, whose children are sharing one iPhone for distance learning and who’s not certain she can continue to pay the phone bill.

Despite these challenges, Murray underscored the importance of school districts following the advice of public health officials and letting “science drive decision-making.”

Dimitri Christakis, MD, MPH, a pediatrician at Seattle Children’s and editor-in-chief of JAMA Pediatrics, agreed that distance learning for young children simply doesn’t work.

“No one thinks you can teach a kindergartner, a first-grader, or second-grader entirely over Zoom,” he said.

In cases where it has worked, a parent has been present and helping, but that isn’t sustainable in the long-term, particularly for parents who work outside of their homes, Christakis said.

“I think we have to confront the reality that for primary school kids, not having the schools open means that a sizeable percentage of children are not learning at all,” he said.

If a child isn’t reading at grade level in the third grade, he or she is 3 to 4 times less likely to graduate high school, Christakis said, and even less likely if the student comes from a low-income family.

“We’re going to see the impact of this years from now, in terms of high school graduation rates,” he predicted.

But Dooley emphasized that beyond academics, schools are “absolutely critical” for children’s social and emotional well-being, providing free or reduced price meals and health services including mental health programs.

“Schools are also critically important for socialization for children,” she said.

The concern over the emergence of mental health challenges among kids is one factor driving Dooley’s support for reopening.

In her practice, she’s seeing children and families “every single week” struggling with anxiety and depression, as a result of not being in school, not having contact with peers, and being socially isolated.

She’s also seeing challenges with food insecurity — 30 million children receive free and reduced price lunch in schools — and children who’ve gained weight because they aren’t involved in physical education classes, she said.

Howard Taras, MD, a pediatrician at the University of California San Diego Center for Community Health and the district physician for the San Diego Unified School District, also sees the importance of in-person learning for children.

“At every stage of development, children learn how to make friends, and learn how to deal with bullies, and they learn how to test their personalities, and try different ones on,” Taras told MedPage Today. “There’s just all these things going on that are also part of the normal, natural education of children aside from formal education of children.”

That in-person contact with supportive adults is also important, Taras said.

“Abuse is often detected by school personnel,” and while child abuse rates appear to have plummeted, it’s possible that abuse has actually increased but simply isn’t being reported, he said in an email.

Other Perspectives

If the AAP is full throttle on reopening, the American Academy of Family Physicians is perhaps in first gear.

Gary LeRoy, MD, president of the AAFP, told MedPage Today in an email that family physicians “understand the importance of in-person learning for children.”

“They also understand the potential health risks of sending children back to school during a national pandemic,” he added.

Looking ahead to the 2020 school year, LeRoy stressed the need to carefully monitor COVID-19 cases in individual cities and communities “to help signal if and when the risks of attending school begin to outweigh the benefits.”

Any guidelines on returning to school should be “evidence-based and flexible” because the science concerning the spread of COVID-19 is still evolving and we “cannot predict where the next outbreak will appear.”

Asked whether the AAP’s own guidance would apply in states where cases are currently climbing, Dooley explained that the academy “would hope that even in areas that are seeing a surge in cases, that school systems are still working towards an opening of schools in some format, in-person for children, because this is really vital for their survival.”

Kris Bryant, MD, president of the Pediatric Infectious Diseases Society (PIDS), said it’s important to consider all sides of this discussion.

PIDS currently does not have an official position on schools reopening; she emphasized that she was giving her personal opinion.

Bryant echoed many of the concerns mentioned by other pediatricians around the danger of isolation for children’s development and mental health and the “variable” benefits of distance learning depending on how well-resourced a family is or isn’t.

While she described data from Iceland, for instance, showing no transmission among children as “encouraging,” she remained skeptical.

“When everything is said and done. I’m not convinced though that we will see zero transmission from children to adults or zero transmission from child to child,” Bryant said.

She stressed the need to “look at the experience of other countries that have already gone down this path … [and to] try to identify models that are similar to our situation in the U.S.”

Arthur Caplan, PhD, an ethicist and population health expert at NYU Langone Health, called the AAP’s guidance “optimistic.”

“I think we’re reopening schools just like in some ways Texas, Arizona, Florida reopened restaurants, bars, and beaches,” Caplan said. “And I don’t think it’s going to work any better.”

“I’m terrified that what’s going to happen is, kids will go back, they won’t have had their shots for measles, or mumps,” he continued. “The flu will come and COVID will stay, and we will have one viral, toxic stew that will lead to many hospitalizations and deaths, not just from COVID but from these other infectious diseases.”

The CDC identified a year-over-year drop in orders for noninfluenza childhood vaccines and for measles-containing vaccines funded through the Vaccine for Children Program (VFC) from early January through mid-April 2020 compared with roughly the same period in 2019. (The program provides federally purchased vaccines to roughly half of all children 18 or younger in the U.S.)

What About Teachers?

Lily Eskelsen García, president of the National Education Association, told CNN’s Erin Burnett on Tuesday that she worries what school reopenings will mean for teachers.

“I had 39 sixth graders one year in my tiny little classroom with one window,” she said. “My classroom was a germ factory.”

Every year she knew one of her students would pass a cold onto her, García said, adding: “This is different. This is a virus that kills people.”

She acknowledged the argument by pediatricians that “‘we have to consider the mental health of children’ – of course we do – but they didn’t say at the expense of their physical health, and they didn’t say that you should do it under all circumstances. They said when it’s safe and where it’s safe.”

Gov. Greg Abbott (R-Texas) announced last week that public schools in his state will reopen this fall, but without a state-level requirement for testing or masking.

In response, Zeph Capo, president of the state’s AFT affiliate, called on the governor to consider students’ and teachers’ safety.

“We want to see kids return to school in some way, but prudence requires that there be a health and safety plan in place to reduce the chances of spreading the deadly virus,” Capo said in a statement, suggesting that the state require every school district to develop a plan for a safe reopening and submit it to the Texas Education Agency.

National AFT President Randi Weingarten said all schools need plans to ensure they don’t become the “new hot spots of transmission.”

“A no-mask, no-testing, no-worries attitude is exactly what will spread the virus,” Weingarten said.

Bryant said she tells parents asking about their children returning to school that there is no “one-size-fits-all” answer. It depends on the individual child’s health, the school’s protocols, and the level of transmission in the community, she said.

While it isn’t feasible to keep schools closed until the virus “goes away, because that’s likely to be a long time,” Bryant expects a rocky transition.

“[T]here will be cases,” she said. “We need a plan for what to do when cases occur.”

Parents are accustomed to sending a child with a mild illness or a cold to school, she noted, but in this context that decision could have serious consequences: from now on, “sick children need to stay home.”

The Experiment Continues

While a recent Gallup poll suggests 56% of parents of children in grades K-12 support their children returning to school full-time, that leaves another 44% who have qualms.

The Clark County, Indiana school district near Bryant is offering a three-tiered model: all in-person, a hybrid of in-person and online, and an entirely virtual option.

Bryant said the model recognizes that some children may be at risk for infection, have an underlying condition, or live with someone who’s immunocompromised and need that at-home option.

“[W]hen school systems have the capability to do that and transmission in the community suggests that bringing everybody back and resuming school as usual is not the best choice, it’s great,” Bryant said. Her colleagues are also currently developing a white paper focused specifically on schooling challenges for immunocompromised students.

The AAP’s guidelines also emphasize the importance of being flexible and practical, Dooley noted.

“We may have to revise plans as we go along, and as we’re learning what works best … both from our country, but also the experiences of other countries, ” Dooley said.

She also underscored the need for robust research to monitor the return to school and to identify best practices for “mitigating the spread and the risk of the virus.”

Still, Dooley emphasized the need to “start from that starting point of having children physically present in school and then working together between our health system, our public health department, [and] our education system on how we can do that as safely as possible.”

Originally published in MedPage Today.

By Shannon Firth, Washington Correspondent, and Cheryl Clark, Contributing Writer, MedPage Today, with contributions from Associate Editor Molly Walker

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