NC Schools Plan A "no less safe"

ABC Collaborative Doc: No reason to think Plan A is any less safe than Plan B

At a Feb. 23 meeting of the Chatham County Schools Board of Education, a doctor who is part of the ABC Science Collaborative commented on reopening schools to in-person instruction, masking, and social distancing.

The remarks by Dr. Michael Smith begin approximately at the 2:32:00 mark.

Smith is one of the leaders of the ABC Science Collaborative and is a Professor of Pediatrics at the Duke University School of Medicin with a specialty in Pediatric Infectious Diseases.

Highlights of his remarks include:

• The CDC and the American Association of Pediatrics both acknowledge six feet of social distancing is not feasible in every jurisdiction.

• Six feet social distancing “should not be the single most important thing in determining if schools are open.”

• The six feet rule is derived from instances when a mask is not possible or is not being worn.

• “Of the districts in Plan A, we did not see any increased level of transmission as compared to Plan B.”

• “There is no reason to think that Plan A is any less safe than Plan B.”

• “that the benefit of in-person education is much better than the theoretical risk of being closer than six feet.”

• When asked about new and allegedly more infectious strains impact on the six feet rule, Smith said “we really don’t anticipate any difference.”

Here’s the full transcript of the portion of the meeting featuring Smith:

First of all, if you look at the CDC recommendations, which I am sure many people in the room and watching have read, they do say that if possible six feet should be your target, however, if you look in the documentation it says when that’s “feasible” as compared to things like masking, which is described as a universal mandate.”

So, I think the CDC is aware that six feet is not feasible in all jurisdictions and all districts.

The other thing is, and I’ve shared this with you at previous meetings, if you look at the recommendations from the American Academy of Pediatrics, they kind of say the same thing.

If you’re an AAP member… I am an AAP member…They point out again that while six feet is the ideal, if you can’t open at six feet, that should not be the single most important thing in determining if schools are open. I think most of us in pediatrics and pediatric infectious diseases agree with that.

Two things to that point – the first thing is, you know, where does the six feet recommendation come from? And again, I think I have used with this group before my swiss cheese model. You have social distancing, which is six feet, you have masking and you have the handwashing.

The data on six feet comes from the situation where you are not wearing a mask. When I am seeing a patient in the hospital, if they have influenza or another virus which is primarily spread by droplet, there is a line on the floor and I am not supposed to cross that line unless I have a mask on. However, if I am wearing a mask, it is safe to get closer to that patient. So that’s one thing to say… where did the six feet come from?

The second thing is we have some data, though they have not been completely validated yet, but I mentioned this on a prior call that the districts that are in Plan A have been able to submit data to our group just as we did with the Plan B work. There were 11 districts that I presented last time in our pediatrics paper. Of the districts in Plan A, we did not see any increased level of transmission as compared to Plan B.

So, we’re working on that data. We can’t share it with you yet but hope to have those data for you soon.

There is no reason to think that Plan A is any less safe than Plan B.

Then, this really comes from other parts of the world, particularly Europe and the U.K., where – again, they don’t use feet, they use meters and one meter is about three feet… is kind of what is used.

So, I think putting this all together, I am very comfortable with saying that the risk benefit of having kids back in school. If you can only do it in a way that is less than six feet, I personally feel that… as does the ABC Science Collaborative… that the benefit of in-person education is much better than the theoretical risk of being closer than six feet. Again, based on data that we’ve seen so far in North Carolina. Based on what’s done in the U.K. and in the EU and – again – based on what we know about really six feet comes from situations where you are not wearing a mask. If you are wearing a mask, it can be done safely.

So that’s my comment on Plan A in general, the only other thing that I wanted to mention, and then I am happy to take any questions, is in addition to the CDC recommendations coming out, the legislative changes, the CDC also did announce last week the importance of wearing… of masking…potentially wearing a double mask. Just to clarify, this was not super clear in the media, there is no mandate that you have to wear two masks. Really, what the CDC is trying to say is “whatever mask you’re wearing, make sure that it fits well,” whether that’s wearing a surgical mask with the cloth mask on top of it or a single mask that is tight by loops. That’s the key thing. There is nothing magic about two masks per se.

Smith stopped his remarks at this point and took questions.

An unknown person on the call asked if new allegedly more infectious strains would change or impact guidance on proximity.

“In terms of infectiousness, we really don’t anticipate any difference,” Smith said.

Smith reiterated the levels of mitigation. He went on to say that a more infectious strain might “get into your cells better” via the “spike protein” but if mitigation strategies are in place like wearing a well-fitted mask, that they don’t anticipate more person-to-person transmission within a school setting.

Smith said that what he worries about “down the road” is if COVID is going to become like the flu with year-to-year changes and vaccinations would adapt with annual booster shots.

Another member questioned what the difference is with opening schools when planes and trains are still operating. Smith responded that he thought being on a plane was a bigger risk because you can’t move as much and the recycled air was concerning. Smith also added that it’s not a bad idea for classrooms to open windows when weather permits but not on frigid or inclement weather days.

“I think that being in a school is a lower risk than being on a plane, quite honestly,” said Smith.

There were no additional questions asked of Smith.