So what do those who are looking at the science behind students in the classrooms and coronavirus have to say?
NBC 7's Steve Luke spoke with Dr. Mark Sawyer, an infectious disease specialist at UCSD and Rady Children's Hospital who is on a panel advising the San Diego Unified School District about its re-opening plans.
Some of the more surprising highlights: Sawyer says San Diego and its local schools may be at a tipping point: "If we open schools when there is too much activity in the community, too much disease in the community, then we are going to have a problem in the schools. So we are right on the verge of that ..."
Also, Sawyer said he thought that if students at Mission Vista High School in the Vista Unified School District had been following social-distancing protocols, there may have been no need for more than a hundred people to be quarantined after their exposure to a student with the virus:
"I think, if, in fact, everyone was 6 feet apart and wearing masks, then that's the whole idea. You would not quarantine. Instead, you would increase your monitoring for any new symptoms in the students who might have been exposed but probably weren't, and you would just be more vigilant and you would keep on continuing."
Below is a complete transcript of their conversation:
Steve Luke: Well, Dr. Mark Sawyer, an infectious disease specialist at UCSD and Rady Children's Hospital is joining me now. Well, Dr.; Sawyer, first of all: Thank you for taking some time out to talk about the science behind reopening schools. It's something so many people are interested in right now.
Dr. Mark Sawyer: It's my pleasure and you know it's a very complicated story.
SL: Well, you're one of -- what is it? -- 11 doctors that were on that San Diego Unified reopening panel?
MS: I actually don't know the number but it's about that many, and there were people from all walks of science that helped the school district think about how to open a school.
SL: The district and the teachers union have continually said that reopening must be based on science. Everyone right now is quoting science and waiting on science, so, you know, it might be a big question to start off with but: What does science say about a return to the classroom in late October 2020?
MS: I would summarize it with two things: Science tells us that if we don't wear masks and socially distance, this virus will keep coming back, and we're seeing that just in the last week and a half across the United States and, in fact, across the world. It's starting to bounce back as, every time we relax our precautions, it comes back. The other thing science tells us is if we reopen schools when there is too much activity in the community, too much disease in the community, then we're going to have a problem in the schools. So we're right on the verge of that, I would say, in San Diego. We have our disease pretty much under control but it keeps threatening to get out of control, and that's why, so far, you've seen some school districts open across San Diego County and some have not.
SL: Specifically, your expertise has been relied on, I guess more heavily, at least from public knowledge through San Diego Unified because you're on that panel there. Is there any reason why, today, schools should not reopen in some form or fashion because of the number?
MS: If you asked me that two weeks ago, I would have said it's probably time for schools to open because we have a steady decline in cases. But then things started to turn around, so today I'm a little less certain about the timing and what's really optimal. I want to see what happens over the next week or two and hope that we can get it back under control, and then I'll feel more free to say, 'Now's the time.'
SL: Is the district waiting on you and the others to give the green light? Is that how it works?
MS: I don't believe so. I think we were called on to give our opinions to the district and help them formulate a plan, but they're making their own decisions about when to open.
SL: The district did just announced their reopening phases, so they're in Phase 1 now, which has kind of a Phase 1.5, which is coming up next. I'm not sure if you're familiar with what they've just released this week.
MS: I have not seen that.
SL: Well, Phase 2 is when students will return to campus in groups, basically at 50 percent on campus, so it would be that … those cohorts, and so I think that is really when people will feel like this is real, that their kids are back on campus. Assuming all all the PPE, ventilation and safety protocols that your group has outlined are in place, and the district has said that those protocols are in place physically at the campuses, you know, that … Where is the gray area between opening or not for them?
MS: I think the school district has done a great job of preparing for opening. They've really thought through all of that issues, from the circulation of air and school classrooms, spacing students apart, putting up barriers. So they're as prepared as they can be. So, to me, the only remaining grey area is what's happening out in the community at large, and if we're having a surge of infection, then maybe that's not the time to move to the next phase, and if we're settling back down, then that probably is the time to move to the next phase.
SL: We've seen the reports of San Diego County teetering between the red and the purple tier, which is, I think, what you're alluding to. Some think the return to the purple tier should delay schools. Of course, that whole color-coded system is a political line in the sand, right? That's, you know, not scripture, per se, but it does get based somewhat, right, off of actual case numbers behind these tiers. Doe the red to purple matter that much, that line, or is it a bigger number that you're looking at when we hear, like, the word 'spike' ….
MS: Well, I think at the most simple level that's exactly what we're looking at: The red to purple transition. You know, those are at least a measure that we can compare over time. Admittedly, it is an arbitrary number, and there's nothing magic when you go from the top of one tier to the very bottom of the next, but it means you're headed in the wrong direction. And, you know, part of the purple-tier guidance from the state is you shouldn't be opening the schools. So, you know, that's why I say we're right on the verge of being in a situation where we either should or should not open schools.
SL: What do you say to teachers, specifically, who are worried about returning to the classroom -- red or purple -- because I don't think those fears are going to go away regardless of the color unless we get up into that, you know, that smooth sailing category. I'm not sure if that's the yellow or what the next one is. What do you say to teachers who are saying that they're putting their lives at risk by returning to the classroom?
MS: Yeah, I think that this is another place where science can help us a great deal. We've learned a lot about the transmission of this virus in hospital settings and in others as well, and as I mentioned already, the school district has really planned very thoroughly how to minimize the chance to transmission, and I would say to teachers that their risk of getting infected in school, as long as they follow the guidelines, is actually very low. We know that children are less likely to transmit the infection then adults do, we know that masks work, we know that distancing works, we know that increased air circulation works. So, you know, we're not going to be able to make the risk zero, but it's not zero anywhere. It's not zero when you walk out your front door and go to the grocery store, so I think we can make the risk lower than the risk is if you went out to a restaurant today.
SL: Interesting. Ok, your colleagues at Children's Hospital, in fact, have been very vocal about the effectiveness of masks, saying that the medical workers at Rady have had interactions with, I think, more than a thousand COVID-positive individuals so far, and there hasn't been a single hospital-based transmission.
MS: That's right. That's part of the science that, at a local level, it tells us that masks work. That kind of science has been replicated all across the world. That's clear that that helps. You know, the difference in schools is that a teacher has 20 or 30 kids or maybe, you know, less than that in the tiered system, but they have to deal with a lot more kids simultaneously, and so I understand their concern, and it's a challenge to get, particularly younger kids to keep their masks on. But I think it can be done, and we have seen that young children are capable of keeping the mask on, and what the school district has done is come up with plans to make sure there's enough monitoring going on so that we maintain safety for both the teachers and the other students.
SL: But wouldn't the science say that the younger the kid, the less chance of transmission?
MS: It would, and among the plans that the school district was considering -- and I'm not sure if it's in their newest announcement -- is to open elementary schools first because those children of that age are less likely to transmit than, say, high school students.
SL: Let's say a teacher is wearing a mask in a classroom and students in the class are wearing a mask. What is the likelihood that one of those students, who may be COVID positive, asymptomatic or not -- could pass the disease along to the teacher if, again, they're both wearing masks.
MS: Well, it's hard to put a number on that, but the risk is low, and that's what we're doing in hospitals. We're wearing masks whenever we're anywhere near a patient -- or one of our colleagues, for that matter. I would say to teachers: Their bigger risk is in the teacher break room if they take off their mask and have a cup of coffee with their colleagues, that's where the transmissions likely to occur, and we've seen that with health care workers as well. They're not getting infected in the hospital. They're getting infected at home when they're relaxed with their family, with their friends, and they've picked it up that way because you let your guard down.
SL: The general rule that we're all sort of familiar with now is that 6-foot rule: Stay 6 feet apart, but in the classroom, sometimes, we're hearing that may not entirely be possible, especially as more and more students come back, depending on the size of the classrooms. Is that a safety deal-breaker or are masks and other measures effective in mitigating that less-than-6-foot rule?
MS: There are other factors that can help, and that's the kind of thing the school district has been working on. Air circulation in a room is a very important ingredient. That's why you're safer outdoors than you are indoors, so the school district has been working on the ventilation systems and studying ventilation systems to understand what safe areas are within the school as it exists now. They're building the plexiglass barriers that I think we've all seen now in restaurants and stores, to minimize the direct face-to-face transmission possibility. So, it is a challenge in schools. They weren't built at first to have the students 6 feet apart, but I think the school district has done a good job of trying to mitigate the situations where that might not be possible.
SL: A lot of talk about testing with schools. The district's program manager for nursing and wellness recently was quoted as saying that the county has the capacity to test as often is needed with four dedicated staff-testing sites for staff members, and 47 of them for students. How often would you say students and teachers should be tested?
MS: That's one of the trickiest questions out there because a test is only good for the day that you have it. So you're not contagious today>? Great. Go to school, but the next day you could become contagious and you wouldn't know unless you test people every day, which I don't think is reasonable, certainly not of all the students. So, my understanding is that it's still being worked on, at the school-district level, to make sure that testing is available. Certainly, we need people who have any kind of symptoms to not be in school and get tested so that we know whether those symptoms were from COVID or from something else, and if they were from COVID, then that school or group of people can be on high alert for other people who might start to develop symptoms and suggest that you're having it spread within the school.
SL: Have you been following the stats across the country? Because a lot of school districts, not just in California but in other states, have opened up. Is that part of the science, in how it's gone there? And what would you say the results have been and how is that influenced your thoughts over the past three months, basically, since that panel;s recommendations were released to San Diego Unified?
MS: Yeah, I think, you know, every state and every school district, they're making their own decision based on lots of factors, sometimes political factors, sometimes scientific factors. So it's really hard to generalize based on what's happened, but, again, this is where we get the notion that the level of disease in your community is important in deciding whether to go to schools. I think schools that have opened successfully, in general, have been in communities where the level of disease is low, and the schools that have had big outbreaks right after they opened up are in communities where that's not the case. So, for me, that's a key ingredient, is you don't want to open your schools when and the disease is running rampant around your community. If you have things under control, than I think it can be done safely.
SL: Just a couple more questions for you: One of them involves the district of Vista, and I know that's not your area of expertise -- you've sort of been working more closely with San Diego Unified -- but in the news today, they've reopened and a student tested positive, and they basically sent more than 100 kids and four teachers, because he was in four classes, home for a 14-day quarantine. That seems like a lot of people impacted if they were all wearing masks. Is that overboard, is that right on track with what you would say science would require? Fourteen days for all those people?
MS: Well, certainly, 14 days is the recommended quarantine period if you know you've been exposed. So it's very hard for me to comment on that specific example since I don't know the circumstances, but from what you describe, the one thing that you'd like to avoid is having the student in four different classes because that just increases the risk that if somebody is positive at school that they're going to spread it to more people. So one of the principles of reopening schools and, in general, is to minimize the number of different people you interact with during the day. So, you know, I would have to know the details of those exposures to know whether that's an overreaction, but it's certainly going to minimize the further transmission within that school by taking those measures.
SL: But if there were people not within 6 feet of him and they were all wearing masks, do you still have to quarantine if you were in the same room with someone who tests …
MS: I think, if, in fact, everyone was 6 feet apart and wearing masks, then that's the whole idea. You would not quarantine. Instead, you would increase your monitoring for any new symptoms in the students who might have been exposed but probably weren't, and you would just be more vigilant and you would keep on continuing. That's what we do with health care workers who've been in the room of somebody with COVID. If they wear a mask, they'd keep working, but, you know, we monitor health care workers every single day for symptoms, and if you get symptoms after being around somebody with COVID, then you're gonna need to stop and say, 'Ok, you know, do I have COVID or do I have something else?'
SL: Circling back one final time to San Diego Unified. I don't want to put words in your mouth, but the question everyone has is: When, when, when, when will science -- and you've answered it several different ways -- if we were to boil this down, would you say, 'Hey, if we remain in the … red tier, then if it's fine (when the district decides on all the other matters), that it's fine, and if we're in the purple tier, then maybe the brakes?
MS: My answer to your 'when, when, when?' question is, 'Soon, soon soon,' and I do think that if we stay in the red tier in San Diego County, the school district will likely move forward with opening plans in the phases that you described earlier.
SL: Anything else that you'd like to say? Questions that I didn't ask you that you think's important?
MS: Well, I'd like to go back to the beginning of our discussion and remind people that the way to combat this infection, this pandemic, is to wear your mask out in the community, wear your mask at home for that matter, if you're having visitors, even family visitors, because that's where the transmission happens, and if we can keep that under control, then schools can open, businesses can open more than they have so far, and we can get back toward life as we knew it, although we're never going to be completely back for some long period of time.
SL: Dr. Sawyer, thank you for your time. Really appreciate it.
MS: Thank you.
