Three Things Thursday -- Back to School
Given that we are living through THREE global health emergencies (COVID, polio, and monkeypox), new vaccines are being approved, new outbreaks are occurring, and the reality that being healthy is truly a radical selfless act of loving others (read: we need to redefine what it means to be healthy), “Three Things Thursday” highlights three things I am paying attention to as an epidemiologist each week.
Hoping these posts help to educate and empower you to be healthy and create healthy communities.
Here we go… Three Things Thursday — the back-to-school edition.
It is back-to-school season (I have 11 days and endless prep until the first day of classes). And for the third year in a row, we are facing a COVID school year. In some ways, things are not as stressful as they were two years ago; we have vaccines, antivirals, and adequate testing supplies. However, this year we are going back to school in the midst of three global health emergencies (COVID, monkeypox, and polio) and are getting ready to enter influenza season.
As we prepare to return to school, we must be prepared. This means understanding what is happening in our communities, how to mitigate disease spread, and what our responsibilities are to create healthy communities and learning environments.
Here’s what I think you need to know —
Back-to-school guidance from CDC (a summary and critique)
At the end of last week, the CDC released an updated back-to-school guidance document. CDC’s goals for this school year are to support safe in-person learning and reduce severe disease caused by the SARS-CoV-2 virus. Key changes for this school year include —
The guidance takes a personalized medical approach to keep students, teachers, and staff healthy — through vaccinations, instructions to stay home when ill, and the promotion of hand hygiene and respiratory etiquette. These are all really important steps to staying healthy. However, the guidance does not address the reality that infectious diseases, including COVID, are communicable and spread from person to person. It does not prioritize public (aka community) health. We cannot protect ourselves (through individual actions) from pandemics. Instead, we need to be working together to create healthy communities. We need shared goals, agreements about what we will do, and policies to keep everyone in our communities safe and healthy.
What is needed (and what I think is missing from the CDC guidance) is a comprehensive program to mitigate the spread of all infectious diseases, including COVID, influenza, monkeypox, and polio. Such a plan would include guidance on what to do not just at the individual level, but at the social and community levels as well. (Note: I wrote about this early on in the COVID pandemic: in order to be healthy we need to take steps individually and collectively to create healthy communities).
Individually — CDC identified the key steps we can all take to protect our own health: we all must be up to date on ALL of our vaccines (with special emphasis on COVID, influenza, and polio vaccinations at this moment in time). We all need to stay home when we are sick. And daycare rules should be in effect for everyone — no one should return to work or school until they are 24 hours fever-free without medications and without coughing, vomiting, or diarrhea. The five days outlined in the CDC guidance should be the minimum number of days a person stays home with an illness.
We all need to be vaccinated and agree to stay home when we are sick.
Within our social circles — this includes close friends and family as well as classmates, teammates, and members of groups we are part of — we need to come together talk about our collective health. This might mean we set rules around gatherings. At a minimum, we should all agree that we will stay home when we are sick. But I think we also need to develop policies around meeting in locations with good ventilation (outdoors if possible) and masking — when will we wear masks around each other? what will trigger masking requirements? I think we need to agree upon options for meeting remotely if there is an uptick in illnesses (within the group or among those in the larger community). And I think we need to agree with one another that we will inform each other if we become sick. With knowledge of another person’s illness, we can take steps to break the chain of transmission through quarantining, masking, testing, or reducing the number of people we are in contact with.
We need to talk about health and safety within our social circles.
At a community level — we need leaders. We need local public health agencies in every county or city across the country. We need individuals who can navigate the evolving science and can develop policies to protect our communities as a whole. We need strategies to communicate those findings across multiple forms of media to keep the public informed and empowered. We need leaders who are planning gatherings outside to mitigate exposures, who are leading by example by masking, getting vaccinated, and staying home while ill. We need leaders who are investing in public health surveillance, health communication, wastewater surveillance, increasing the number of healthcare providers in each community, and improved ventilation systems in schools, libraries, and other public buildings. We need leaders who recognize that creating healthy communities will reap financial, political, and cultural benefits for all members of our communities.
We need to vote leaders into positions to do this work in November.
For parents sending their kids back to school…
Here’s the reality — you need to be prepared for your kids to get sick during the school year. That’s it; be prepared!
Make sure you and your kids are up to date on all of their vaccinations, especially COVID-19, influenza, and polio. Additionally, make sure you have COVID tests, over-the-counter medications, tissues, hand soap, and cleaning products at your house. I would also suggest making a plan for how you will handle an illness — who will stay home with a sick kid? where will the sick kid isolate in your home? will you mask in the house when someone is sick? (The answer should be YES!!)
The reality is you and your family can do everything right — mask, vaccinate, avoid high-risk environments — and you still may get sick. COVID-19, influenza, monkeypox, and polio are all infectious diseases that spread easily from person to person. And while you can (and should) take steps to stay healthy individually, the reality is that your health is tied intimately to the health of your family, friends, neighbors, and community as a whole. We each need to do our part to stay healthy. But we also need to recognize that we make up a health(eco)system AND we can only be healthy when everyone is healthy.
Getting sick is NOT a sign of weakness or failure nor is it something you should be embarrassed about or try to hide from others.
Illness is a part of life.
And our health(eco)system has been invaded by a host of deadly viruses. We must simultaneously take care of ourselves and work collectively to break the chains of transmission of these diseases.
Last week I was in Pittsburgh for the week, and there are signs throughout the city about lanternflies. This invasive species is wreaking havoc in the local ecosystem and there are campaigns (hundreds of fliers around the city) asking the public to kill a lanternfly if one is spotted. The community as a whole is being called upon to take action to protect the local ecosystem from this invading bug.
We need to approach health in the same way — through collective action. We need to redefine health so that it includes the whole health(eco)system. And we need to redefine being healthy as a radical act of loving others so that we can all be healthy.
Parents, we need to teach our children these new definitions of health and being healthy. And we must all demand, work towards, and vote for leaders who want to improve the health of our whole health(eco)system.
And for my sweet college students…
For those of you in my classes, I cannot wait! There has never been a better time in the history of humankind to be studying community health.
In addition to everything discussed above (yes, go back and read it all again!), please be mindful that monkeypox is spreading. And it is popping up on college campuses across the country. Unlike COVID, monkeypox is spread through close intimate (skin-to-skin) contact. And there is some evidence that it is spread through sexual intercourse (the virus has been found in semen). Having multiple sexual partners increases your chances of contracting monkeypox (along with a host of other diseases spread through sex).
A couple of other important things to know about monkeypox —
The pox marks do not always present as pustules filled with puss. They may present as tiny circles that do not rise above the skin. If you or someone you know develops a rash or spots a pox, please seek medical care immediately.
Some cases of confirmed monkeypox are presenting with just a few or just a single pox mark. Fewer pox does not mean less disease or that a person is not contagious. A pox is a pox is a pox. One pox mark is too many. If you or someone you know develops a pox, please seek medical care immediately.
The scabs that form over the pox marks are infectious. Scabs that are left behind on clothing, bedding, towels, or shared sports equipment/uniforms can transmit the disease from person to person. Please be mindful of who you share your clothing with; who you allow to lay down in your bed; and what you use to wipe off or dry off your body in a locker room or shared bathroom.
As we head back to school, we must all seek to—
Listen well.
Make beautiful things.
Practice civility.
Be healthy.
And work hard every day.