Dean's COVID-19 Commentary

Schools across the nation have started in-person, including the three campuses of the Colorado School of Public Health. Two recent posts in the CDC’s Morbidity and Mortality Weekly Report address the pandemic and the safety of K-12 students and staff.

One report describes an avoidable school-based outbreak in Marin County, California. An unvaccinated teacher became symptomatic, but continued teaching for two days, reportedly reading to the class without a mask. Subsequently, 12 of 24 students in the class became ill with whole genome sequencing pointing to a common source of infection. Unfortunately, the sample from the index case — the teacher — was not sequenced. In terms of airborne transmission, the attack rate was higher in the children in the first two rows in the classroom. The infection did spread into another classroom through an unclear route. The outbreak documents that a failure to follow protocols can have untoward consequences — an apparently irresponsible teacher was unvaccinated, symptomatic, and unmasked in the classroom. 

The second report provides evidence that schools can be open with relative safety. It describes rates of COVID-19 in transitional kindergarten through 12th grade (TK-12) in Los Angeles County, providing rates separately for cases defined as originating in school and for the entire county. The principal finding is that the incidence rate for cases among TK-12 students from September 2020 through March 2021 is much lower than the rate for the county overall in this age group. Rates for staff were also lower than the overall Los Angeles rate, but not so dramatically. The authors conclude: “The findings suggest that implementing recommended prevention measures might protect children, adolescents, and adults from COVID-19 in TK-12 schools.”

While the evidence, “common sense,” and the precautionary principle favor non-pharmaceutical interventions in schools, opposition continues against mask requirements in schools and vaccine mandates. Those against such measures voice arguments about a right to parental decision-making, government overreach, and even concerns about the adverse consequences of wearing a mask. Unfortunately, there are media reports of rancor, hostility, and physical altercations. In a reasonable decision related to an irrational policy, the Florida Supreme Court overturned Governor DeSantis’ order against imposition of mask mandates in schools.   

Looking for a book to read about quarantine? If so, pick up Until Proven Safe: The History and Future of Quarantine by Geoff Manaugh and Nicola Twilley. The book originated prior to the COVID-19 pandemic. It has not been hastily thrown together, like some in the ever-growing pandemic pantheon. Its chapters weave the history of quarantine with explorations of unique quarantine situations, such as return from space travel and the international transport of agricultural products. Manaugh and Twilley end with a discussion about a reimagined quarantine in the future that is built around smart technology. The book starts with a detailed look at the history of quarantine, a term originating with the Italian word quarentena, or 40 days. Historically, the need for quarantine was recognized as trade brought goods and disease into trade centers and ports. Manaugh and Twilley cite the imposition of quarantine at Dubrovnik on the Adriatic Sea as a formal starting point for quarantine. Their review of the architecture of quarantine facilities is fascinating. They offer a detailed account of the lazzarettos of Venice and move on to other locations, including the United States. From the 1500s, health documents — “health passports” — were issued and required for travel. Certain vaccinations have long been required to enter particular countries, e.g., yellow fever, but now there is a high level of contention concerning health passports for COVID-19. History forgotten?

I was not aware that some agricultural products may go through lengthy and elaborate quarantine. The United Kingdom houses the International Cocoa Quarantine Centre where cacoa plants spend two years in passing from one country to another so as to avoid carrying contamination. The book also describes the measures taken to assure that space craft do not bring microbes to the bodies where they land and that the moon-landing astronauts were not infected. One chapter deviates from quarantine and addresses isolation of radioactive materials that need to be cordoned from contact for millennia. The chapter centers on the Waste Isolation Pilot Plant (WIPP) in Carlsbad, New Mexico, where low- to mid-level radioactive transuranic wastes from the nuclear complex are being stored – forever. The radioactive materials are placed deep underground in a salt cavern, but warnings are required for future civilizations over the millennia so that they will avoid and not disturb the site. Decades ago, I served on a committee for the EPA that considered this challenge. Discussions were framed around such constraints as: “we will not consider ‘Road Warrior’ scenarios,” referring to the post-apocalyptic movie. Per Manaugh and Twilley, this challenge remains unsolved.  

Colorado’s epidemic curve continues its upward tilt. We will gain critical insights into its future course over the next few weeks with schools in session. Hoping for a downturn, and welcome back students.

Jonathan Samet, MD, MS
Dean, Colorado School of Public Health