July 20, 2020
Following up on the last two week's articles on schools and COVID, I thought that it would be useful to discuss teachers and risk moving forward. In an effort to not repeat the findings from last week, I will reference last weeks prevention plan for the elderly which mirrors all at risk adults here for those that missed it.
Teachers are about to place themselves into situations where contracting SARS2 becomes increasingly possible although still low risk based on most studies to date with the exception of one cautionary tale, Israel.
They experienced a vastly different outcome when they reopened their schools as has been reported. A large SARS2 spread occurred in the public school system throwing a curveball into the apparent low risk data. As with all things COVID related, we are guessing as the variables are constantly changing and clearly regional. It makes little sense that in one locale the children are significantly involved in the infectious process where everywhere else the opposite occurs. But, such is the world of COVID data.
As with pediatricians and other professionals that care for the hearts and minds of our children, we do this out of love and duty. We are all grateful for the teachers of this state and nationally. Thank you for all that you do and will do.
In North Carolina, the state government has made a reasonable effort at risk mitigation in the coming school year. Individual school districts are making vastly different plans moving forward. CMS has chosen to stay at home for the fall. Many others have chosen a hybrid model. In a once in a hundred year pandemic, the powers that be are all guessing at what will and should be best practices for attending school. This is just the reality of it. Being in school physically, in my mind, is the right choice, but, reasonable minds can disagree and they do.
As the events unfold over the ensuing year, we will learn how well the distance online versus the hybrid teaching models fair for the children. There is ample opportunity for both to succeed and or fail. The biggest risk for the children in the at home model online is the lack of access to proper digital streaming capabilities, distraction and poor nourishment (if they previously relied on the school system to provide 2 meals a day). I worry about abuse, mental health stress and stagnation of development. These are issues that I pray the school system's are focusing primarily on to aid in a successful educational experience for all children. See a recent NYTimes article below for more opinions on this topic.
For the teachers that are heading back to the classroom. The data to date shows that standing in the front of the classroom, wearing a mask and limiting exposure to any one child for a prolonged time can significantly reduce the risk of a COVID infection. Viral load and time of exposure appear to be a big part of the illness risk and severity. For example, the first ill person in a household usually recovers quickly and without significant issues. The individuals that quarantined with the index case are more likely to fair less well as they presumably had more exposure over a longer period of time. Age has a lot to do with risk of getting sick and how sick. The young continue to have little risk overall. (Jing et. al. 2020)(Li et. al. 2020)
Who is at significant risk:
1) Individuals over the age of 65
2) Individuals with cardiovascular disease, type 2 diabetes, hypertension, cancer, lung disease, sickle cell disease, kidney disease and to a lesser extent autoimmune disease
3) Those with prolonged exposure to an infected individual especially without protective equipment
What can you do if you are at risk and will be teaching a school child this fall? Here is a link to the Institute for Functional Medicine's prevention Strategy which is detailed.
1) Continue to take all of your medicines as directed. Early data shows that statins, antihypertensive drugs, anti coagulants and immune modulators are important for mortality prevention.
2) Change the antecedent triggers of metabolic syndrome: I see that a strong tilt toward an anti inflammatory diet is critical. See the link under Quicklinks three for details. If you decrease inflammatory and immune suppressing foods like refined carbohydrates and poor quality fats, you stand a strong chance of reducing your risk. Eat a whole foods diet that is mediterranean or anti inflammatory in nature. Strictly avoid all refined carbohydrates including sugared beverages and flour based products. Adding in large volumes of colorful vegetables and fruits provides a bounty of polyphenolic compounds that are very beneficial.
3) Look to add supplements like zinc and zinc ionophores like quercetin while increasing mineral vitamin containing foods. This is critical for immune function but also has the added benefit of reducing viral replication and inflammation globally. Talk to your provider about appropriate dosing.
4) Increase your consumption of omega three fatty acids as small oily fish, or fish oil to add precursors for resolvins, protectins and defensin chemicals for the resolution phase post infection. These are anti-inflammatory prostaglandins that are very powerful.
5) Before you get ill, maintain adequate levels of vitamin D and A for T regulator cell activity. Eat lots of bright red/orange/yellow vegetables and fruits. Get 30 minutes of direct sun a day or consider getting your levels checked and supplement accordingly per your providers recommended doses. Vitamin D is known to help reduce NLRP3 inflammasome activity which helps reduce an overactive immune response. Increasing your intake of vitamin C as citrus fruit and/or a supplement can also be beneficial for immune viral attack.
6) Get 8-9 hours of sleep nightly. Melatonin which rises at night as we get ready for sleep is critical for innate immune based inflammasome repression and control. Avoid blue light screens at night after the sun goes down. Dim lights in general an hour before bedtime.
7) Practice daily meditation and prayer for stress reduction. Stress is a nightmare for immune function. Choose happiness
as often as possible despite a negative situation. Positive mental states enhance immune activity.
8) Consider wearing a mask at home, avoid all bodily fluid exposure and transfers especially via beverages and food, socially distance wear possible. The volume of viral exposure has a lot to do with that initial viral load and the subsequent infectious morbidity as health care workers have shown worldwide.
9) Wash your hands with soap and water for 20 seconds frequently and avoid touching your face completely unless your hands are thoroughly washed.
10) Love your children no matter what as they are the next and best generation for our beautiful country.
As the school year approaches, prepare to compromise in your mind for the betterment of children.
NYTimes Scientific Consensus
Jing Lancet Infectious Disease
Li Clinical Infectious Diseases
Ellyatt CNBC Germany Study
Tarnopolsky Daily Beast Israel
Bloomberg Adalja Video
Birnbaum Washington Post
Arizona Center for IM PDF
Munro Archives of Disease in Childhood
AAP School Re-entry Document
Peter Attia Discussion
Yung Clinical Infectious Diseases
Salisbury Pediatrics Prevention Newsletter July 14