How the Worcester Public Schools Medical Forum Should have gone…

By Jordan Berg Powers

Doctors, School Committee members , and Superintendent Binienda on the Medical Forum zoom

I have been thinking a lot about the disastrous and frankly dangerous presentation from the Worcester Superintendent and selected pediatricians on why we should send our kids back to school immediately. How could the meeting have gone differently? How could you present the best available scientific information in a way that wasn’t so ham-handed and instead allowed parents to make the best available decisions?

One of the arguments I have heard repeatedly is that the doctors were merely repeating the American Academy of Pediatrics. (AAP)

If I were to say “Black Americans suffered from slavery” and you were to repeat that as “Americans suffered from slavery.” Technically that is mostly correct but you are missing a ton of important context and some information. 

The Worcester Superintendent’s presentation via these Doctors was missing a ton of context and information that made the whole thing ridiculous.  

That is all without diving into the fact that the AAP guidelines are already being walked back, as they themselves are not in line with the best science from the Center for Disease Control. Nor are they representative of what other countries who went back to school did successfully and I would argue as importantly what they learned as those countries also at some point were forced to close their schools. 

AAP starts off with the premise that children missing school is damaging to them, that children as a whole need the human interactions that school provides. I can say anecdotally, my child Ella, is a different person after she has hung out (even as we do so physically distant) with kids as opposed to being with her parents all day. All children are different, but I am sure many children are like Ella to some degree or another in benefitting from in-person instruction. 

That is the AAP’s orientation- that we as a society should do everything possible to get kids back into school is an important context when understanding their guidelines. You should be honest where you are starting from, that you are willing to forgo CDC best practices to get kids back into school when framing practices you are suggesting. 

Second, and this complexity was completely absent from the Worcester Public School Superintendent’s presentation- there are DIFFERENT approaches based on age. Children 10 and over appear to spread Covid-19 as easily as adults and get Covid-19 like adults. (also as many anecdotal examples show under 10 year olds are getting the virus at alarming rates – our understanding of all this is minimal)  So you need to treat them like the adult staff. That is a large portion of the kids that would be returning to school that even the AAP guidelines state clearly you need different approaches and not one size fits all. 

The AAP wants any decisions to be made in conjunction with the infection rate. Worcester is currently considered a hot spot by our State Government. AAP states, “Special considerations and accommodations to account for the diversity of youth should be made, especially for our vulnerable populations, including those who are medically fragile, live in poverty, have developmental challenges, or have special health care needs or disabilities…” but no such consideration was mentioned or proposed. Instead, the people speaking told all listeners not to worry so much. What is Worcester’s plan to deal with the Students of color, vulnerable populations, and students who live in poverty? These aren’t subsets of Worcester’s school population. That is the majority of our student body. 

If I were presenting, I would have at least ceded a question or had a plan available to acknowledge you had thought about this dynamic. I would want to communicate that we see these struggles and are planning accordingly. Instead all white doctors never even brought up this AAP caveat (an underdeveloped caveat at that for the AAP). 

AAP breaks down their recommendations by age. That was totally missing in the Worcester meeting. They break down students into Pre-K, Elementary, Secondary. (Elementary to secondary is a big jump and AAP treats secondary as HS and elementary as like Kindergarten and that doesn’t actually make sense based on the science, but still, they make this effort). 

Here is what it says: 

“For example, the Centers for Disease Control and Prevention (CDC) recommends that schools “space seating/desks at least 6 feet apart when feasible.” In many school settings, 6 feet between students is not feasible without limiting the number of students. Evidence suggests that spacing as close as 3 feet may approach the benefits of 6 feet of space, particularly if students are wearing face coverings and are asymptomatic. Schools should weigh the benefits of strict adherence to a 6-feet spacing rule between students with the potential downside if remote learning is the only alternative.” 

The AAP doesn’t cite their source for this 3 feet, but taking at their word again that is VERY different from saying it doesn’t matter at all which was stated on the call. And again this is more true for Pre-K then it is for older kids. As you get above 10 years old that 6 feet starts to be critical. AAP recognizes and changes recommendations accordingly. 

You could have presented that in a way that didn’t sound like you were trying to sell me snake oil. You could say that risks are lower for elementary school ages and that this is the plan to make the classrooms compliant with 6 feet and 3 feet for all students with varying importance as they get older. Plus the plan to ensure that teachers are safe in these environments.

Missing from AAP, and it’s a big missing component is the lack of ventilation. We know that if people are inside all day, breathing inside without the air leaving and new air coming in, the load of Covid-19 is dangerous to ALL people regardless of age. 

“The main mode of COVID-19 spread is from person to person, primarily via droplet transmission. For this reason, strategies for infection prevention should center around this form of spread, including physical distancing, face coverings, and hand hygiene. Given the challenges that may exist in children and adolescents in effectively adhering to recommendations, it is critical staff are setting a good example for students by modeling behaviors around physical distancing, face coverings, and hand hygiene.” AAP

But our schools are without easy access to hand washing, according to teachers and students; soap is sometimes hard to find even in those bathrooms. Keys to the bathroom are not readily available to all students and to do all this while staying physically distant is time-consuming. 

Let alone who is going to pay for all that extra Purell and soap needed? Where is the budget for that? Certainly, were I trying to get people to send their kids to school I would mention a plan on how to ensure consistent hand cleaning. 

AAP’s most controversial and weirdly contradictory position on testing. They start off with, “Virologic testing is an important part of the overall public health strategy to limit the spread of COVID-19. Virologic testing detects the viral RNA from a respiratory (usually nasal) swab specimen.” We don’t have widespread testing available. If we are going to go back to school, mentioning a plan to partner with the state for ramped up testing and tracking would have been prudent. AAP goes on to downplay the importance of testing which is actually odd. 

But the AAP is clear that screening and temperature checks should be the backbone of how to ensure sick kids aren’t coming to school. “…methods to allow parent report of temperature checks done at home may be considered. Resources and time may necessitate this strategy at most schools. The epidemiology of disease in children along with evidence of the utility of temperature screenings in health systems may further justify this approach. Procedures using texting apps, phone systems, or online reporting rely on parent report and may be most practical but possibly unreliable, depending on individual family’s ability to use these communication processes, especially if not made available in their primary language. Although imperfect, these processes may be most practical and likely to identify the most ill children who should not be in school.” 

On the call, the Doctors literally said there is no reason to screen people for temperature. This is so wrong for so many reasons. First, we should screen because of the flu. Without Covid-19, parents should still be making sure during flu season kids don’t have a temperature. Giving out thermometers last year at the beginning of the school year made a lot of sense for this reason. Second and this is the obvious one. Temperature checks are CRITICAL first screens in addition to all the other symptom checks. 

We could have been given a recommendation on how classrooms or schools will do a quick check. At an outdoor camp that our daughter Ella goes to, we answer some questions when dropping her off. Far from foolproof they provide the first step. 

Also, and I think this is critical, other countries listed as models were all doing some form of temperature checks. So the US, with our high rates of infections way beyond the other countries where students have gone back to school, are doing temperature checks for their students. There isn’t a real reason this is downplayed by AAP except that it is time-consuming and their orientation is that students get class time at nearly all costs. 

Finally PPE, there is a lot of importance put on PPE in the AAP recommendations. What is the plan for PPE? What we got was the importance of students decorating their own so they want to wear it. But is there a plan to require it? Where is the money for PPE? AAP suggests the need for abundant PPE availability, yet there was no discussion nor plan put forward to make it happen. 

There is so much more to unpack from the terrible presentation. And that is all without highlighting how poor the AAP guidelines are and how they aren’t in line with CDC recommendations. 

The superintendent could have been spending her time planning answers to these questions. We could have had doctors who presented a balanced informational approach that highlighted some of the risks and benefits to in-school learning. All of this could have been based on AAP guidelines. None of that happened and we are at risk because of it. 

Like the President pushing conspiracy theories, students, teachers, and school staff will die from the misinformation that was presented by the Worcester Superintendent and the doctors on that presentation. Yes we need to be 6 feet, yes temperature checks are important, yes kids can get sick and yes we need a real plan because of those facts.