This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
Lots of fresh air, plenty of space for physical distancing and a comprehensive plan to keep sick students out of the classroom to prevent outbreaks.
That might sound like a parent’s wish list for reopening schools in 2020, but they’re actually tactics that worked to keep kids healthy during disease outbreaks over a century ago.
Open-air learning environments, or “forest schools“, were places where students could attend classes while at a lower risk of infection from diseases like tuberculosis and the Spanish Flu.
After first emerging in Germany in the early 20th century, the concept came to Toronto in 1912 when hundreds of kids spent their days learning and socializing outdoors, as detailed in this in-depth TVO story.
But with less than a month to go until schools reopen across the country in the current global pandemic, experts say Canada’s plans to get kids back in the classroom safely are missing some key lessons from history.
Students attend class at an outdoor ‘forest school’ in Toronto’s High Park on July 29, 1913. Without proper ventilation in classrooms, schools should consider moving lessons outside, say experts. (City of Toronto Archives)
Low COVID-19 numbers in community key
Canada currently has a relatively low number of COVID-19 cases circulating in the community, which is an essential precursor to reopening schools safely, but ignoring proven strategies to reduce the spread of the virus in classrooms could put that in jeopardy.
“The single best way to make schools safe is by driving the caseload in the community as low as possible,” said Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa.
Researchers looked at an outbreak of COVID-19 at an overnight summer camp in Georgia that resulted in 260 kids infected. Campers were not required to wear masks, slept 15 per cabin, and windows weren’t kept open to ensure proper ventilation.
But at the time the camp took place, there were still hundreds of new COVID-19 cases reported in the state daily.
“A lot of panic right now is coming from people looking at data from places where there’s an uncontrolled epidemic,” said Dr. Lynora Saxinger, an infectious diseases specialist and an associate professor at the University of Alberta’s faculty of medicine.
Israel may provide a more relevant cautionary tale for jurisdictions where community spread is low. Israel moved to reopen schools quickly in late May, when the coronavirus epidemic had been successfully controlled, but cases exploded soon after, largely because it didn’t limit class sizes, prioritize physical distancing, mandate mask wearing or ensure proper ventilation.
“Closed, crowded, and close-contact spaces are high risk for COVID transmission – and schools meet all those criteria,” said Ashleigh Tuite, an infectious disease epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health.
“We’ve known for a while that we want to have a return to school in the fall, and we’ve had time to prepare for that.”
But Tuite said she’s frustrated that with less than a month to go, there isn’t a comprehensive plan in place to prevent potential outbreaks in schools.
“I think we’re setting ourselves up for failure,” she said. “We really need to set up our schools in a way that parents and children and staff feel safe to return and that minimize the potential for these outbreaks to happen.”
Keeping sick kids out of school essential to stopping spread
“The most important things to do are actually before the kids and adults are in the building,” said Dr. Andrew Morris, an infectious disease specialist and medical director of the antimicrobial stewardship program at the Sinai Health System and the University Health Network in Toronto.
“Almost all the discussion and effort has been around what happens once kids are in the school, but we need to have a strategy that keeps infected kids out of the school.”
Many jurisdictions, including Ontario, B.C. and Alberta, are telling staff and students (with help from their parents or caregivers) to self-screen for COVID-19 symptoms daily, and stay home or seek medical attention if sick.
From no plan to facilitate contact tracing from bars & restaurants, to no extra effort to mitigate school risk, the Ontario govt is proving itself to lack the administrative sophistication and desire to tackle complexity when we need it most. This doesn’t bode well. <a href=”https://twitter.com/hashtag/onpoli?src=hash&ref_src=twsrc%5Etfw”>#onpoli</a>
One way of doing that is through what’s known as syndromic surveillance, where kids who miss classes are assessed, tested and isolated by local public health officials if they’re infected before they can cause wider outbreaks in schools.
Pooled surveillance is another tactic that can be used to detect transmission in schools before it becomes apparent, which is when entire classrooms are tested at random in order to find unseen COVID-19 cases.
“If you’ve got a kid that’s sick in the class, there’s a very high likelihood that if they’re there every day for five days they’re going to infect at least one other kid,” he said.
“To some degree, you almost can’t overreact when you have a case in a classroom and if you think you’re overreacting, you’re probably doing the right thing.”
Saxinger said while there’s no way to ensure zero risk of COVID-19 cases in schools, it’s important to clamp down on potential outbreaks and isolate infected students and classes quickly to prevent entire schools shutting down.
“That’s something people have to wrap their heads around – that having a class being quarantined because someone was positive is going to be kind of normal and that in fact picking that up is good, versus not picking it up.”
Ventilation overlooked in Canadian schools
Another key area experts say is lacking in the gear up to reopen schools across the country is a focus on adequate ventilation, despite new federal guidelines from the Public Health Agency of Canada that call for increased air circulation and outdoor classrooms whenever possible.
Schools are notorious for having minimal access to windows and for using antiquated HVAC systems that can rely on recirculated air – leaving unanswered questions as to how schools are expected to ensure a steady flow of fresh air in classrooms.
“I haven’t seen any discussion of that at all in Ontario context,” said Tuite. “You hear stories about schools where the windows are painted shut.”
WATCH | Dr. Tam discusses risks of sending kids to school, and keeping them home
Canada’s chief public health officer Dr. Theresa Tam spoke with reporters on Parliament Hill Friday about the upcoming school year. 2:27
Linsey Marr, one of the top aerosol scientists in the world and an expert on the airborne transmission of viruses at Virginia Tech, said ensuring proper ventilation is crucial to successfully keeping COVID-19 out of schools.
“It’s important to get kids back to school in person, but I think we also need to do everything possible [to prevent transmission],” she said.
“And even if it just means opening windows, or upgrading an HVAC filter, or putting an air purifier in the room – that you’re doing something that is going to reduce the risk.”
Marr said the move to push classrooms outdoors whenever possible would also drive down the risk of COVID-19 infection dramatically and should be done while the weather permits – even if temperatures drop and students need to bundle up.
“It’s worth it for the education of a generation,” she said. “Because it will be so much safer to go outdoors than to stay indoors.”
Marr said ventilation is one of four essentials that need to be prioritized in the reopening of schools in order to successfully navigate a return to the classroom; the others being ensuring enough space for physical distancing, mask wearing and avoiding crowds.
“In the cars we drive we have seatbelts, we have airbags, we have anti-lock brakes and we try to drive carefully,” she said. “Would you get in your car if the airbags are broken?”
Mask policies in schools a ‘hodgepodge’ across Canada
Mandating students to wear masks while in the classroom is another strategy that could help curb the spread of COVID-19, but some provinces don’t have strict policies in place for doing so.
In B.C., students won’t be required to wear masks, while Ontario’s plan will see masks required only for students in grades four to 12.
Alberta will also require students of those ages to wear masks, but only while in hallways, common areas and when working closely with others.
Saskatchewan will send students back to class without either requiring students to wear masks or reducing class sizes.
“The reason it’s a hodgepodge is because we know that in different places, combinations of those things have worked,” Saxinger said, referencing schools in Europe and Asia that have since dialled back strict reopening policies.
“You’re trying to find this balance of what is feasible and what’s the range of reasonable and how can we learn from this? Because frankly, there’s a lot of pandemic left and if we’re not learning from what we’re doing, we’re missing a really big opportunity.”
Dr. Lynora Saxinger says Canada has a ‘hodgepodge’ of policies around mask wearing for students because of the different strategies that have worked around the world. (Halfpoint/Shutterstock)
The new federal guidelines also say that consideration should be given to the use of masks and face shields, because the “evidence is evolving on their benefits to the wearer to reduce their risk of infection.”
But they stop short of recommending widespread mask use and say non-medical masks should not be worn by anyone who is “unable to remove the mask without assistance, due to age, ability or developmental status.”
Deonandan says that while he agrees there is an age cutoff for children who can effectively wear masks, he thinks more students should be required to wear masks in schools across the country.
“We could look into masks and face shields, the two of them together … that added layer of … self protection through a face shield, I think would pay extraordinary dividends,” he said.
Deonandan said the arguments against mask wearing for younger students in schools focus on the fact that they will fidget with them, risk exposure by touching their face, or not wear them consistently throughout the day.
For those kids incapable of wearing a mask, instead of saying, ‘Well then, masks are impossible,’ have them wear face shields only. It’s not as good as a mask for outward mitigation, but it’s better than nothing.”
“It won’t be perfect, but … don’t let perfect be the enemy of good.”
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NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.
The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.
Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.
“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”
More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.
Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.
The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.
However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.
Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.
“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.
What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.
In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.
Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.
Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.
Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.
However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.
Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.
Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)
There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.
“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
TOKYO (AP) — Japanese technology group SoftBank swung back to profitability in the July-September quarter, boosted by positive results in its Vision Fund investments.
Tokyo-based SoftBank Group Corp. reported Tuesday a fiscal second quarter profit of nearly 1.18 trillion yen ($7.7 billion), compared with a 931 billion yen loss in the year-earlier period.
Quarterly sales edged up about 6% to nearly 1.77 trillion yen ($11.5 billion).
SoftBank credited income from royalties and licensing related to its holdings in Arm, a computer chip-designing company, whose business spans smartphones, data centers, networking equipment, automotive, consumer electronic devices, and AI applications.
The results were also helped by the absence of losses related to SoftBank’s investment in office-space sharing venture WeWork, which hit the previous fiscal year.
WeWork, which filed for Chapter 11 bankruptcy protection in 2023, emerged from Chapter 11 in June.
SoftBank has benefitted in recent months from rising share prices in some investment, such as U.S.-based e-commerce company Coupang, Chinese mobility provider DiDi Global and Bytedance, the Chinese developer of TikTok.
SoftBank’s financial results tend to swing wildly, partly because of its sprawling investment portfolio that includes search engine Yahoo, Chinese retailer Alibaba, and artificial intelligence company Nvidia.
SoftBank makes investments in a variety of companies that it groups together in a series of Vision Funds.
The company’s founder, Masayoshi Son, is a pioneer in technology investment in Japan. SoftBank Group does not give earnings forecasts.
WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.
That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii’s Big Island.
Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.
“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.
Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.
When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.
The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.
The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.
Worldwide, around 585 volcanoes are considered active.
Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.
Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.
(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
