An open letter to Texas Center for Arts + Academics
To whom it may concern,
This week we withdrew our daughter from the Fort Worth Academy of Fine Arts. I feel it is important share my reasoning with you and anyone else who will listen.
I know your organization isn't in the business of second guessing government directives, but you are supposed to be in the business of protecting the children entrusted to your care. Unfortunately, the 2021-2022 Health Plan you recently released will do the opposite, exposing students, faculty, and their families to unnecessary risk.
We know now that transmission of SARS-CoV-2 mostly happens when people breathe the air that infectious carriers have exhaled, and that touching contaminated surfaces isn’t a significant risk if hands are washed regularly. Per the CDC:
Current evidence strongly suggests transmission from contaminated surfaces does not contribute substantially to new infections.1
We also know that the virus spreads indoors further than 6 feet; this initial guideline was based on a theory that did not account for aerosolized droplets which can hang in the air for hours. CDC again:
Although infections through inhalation at distances greater than six feet from an infectious source are less likely than at closer distances, the phenomenon has been repeatedly documented under certain preventable circumstances. These transmission events have involved the presence of an infectious person exhaling virus indoors for an extended time (more than 15 minutes and in some cases hours) leading to virus concentrations in the air space sufficient to transmit infections to people more than 6 feet away, and in some cases to people who have passed through that space soon after the infectious person left.2
We also know that:
children under 12 (most students below 7th grade at the start of the year) are not yet approved to be vaccinated for COVID-19
SARS-CoV-2 can be spread by asymptomatic carriers, and indeed that happens more often among children and adolescents3
the delta variant, the current dominant strain responsible for spiking infections in the US, spreads significantly more easily than the strains we encountered last year4
So how did you decide to protect your students and staff? Given that you chose not to mandate masking to comply with GA-36, and that Texas House Bill 1468, providing for remote learning this year, was not passed,5 what are you doing?
(Unless otherwise noted, the rest of the quotes here come from Texas Center for Arts + Academics 2021-2022 Health Plan, August 9, 2021, https://s3.us-west-1.amazonaws.com/post.jupitered.com/v1/p80542713/1/2089696915/2021-2022_TCA_A_Health_Plan_(1).pdf.)
Four Core Practices
Symptom Self-Screening for Students, Staff, and Visitors
Vigilant Hand Washing and Sanitizing
Frequent Disinfection of High Touch Areas
Face coverings highly recommended, but not required
Ok, hand washing is good. Face coverings recommended, good if that’s the best you can do. But these steps are not that useful against SARS-CoV-2.
Remember, it is airborne and spread (especially with children) by asymptomatic carriers. Symptom screening was inadequate with the original iteration of SARS-CoV-2, because infected people were contagious before the onset of symptoms. It’s especially inadequate with young people, who are more likely to exhibit no symptoms, or only mild symptoms which they can easily hide. And with the delta variant the cost of failing to catch and isolate an infection early is greater than before in terms of number of infections.
Based on these practices, you will have outbreaks. So the questions become, how prevalent will they be, and what will you do when they happen?
Individuals Confirmed or Suspected with COVID-19
Any individuals who themselves either: (a) are test-confirmed to have COVID-19; or (b) experience the symptoms of COVID-19 must stay at home throughout the infection period, and cannot return to campus until the conditions for campus re-entry have been met:
[…]
TCA+A Practices to Respond to a Test-Confirmed Case in the School
If an individual who has been on campus is test-confirmed to have COVID-19, the campus will notify the Tarrant County Health department in accordance with applicable federal, state, and local laws and regulations, including confidentiality requirements of the Americans with Disabilities Act (ADA) and Family Educational Rights and Privacy Act (FERPA).
Consistent with school notification requirements for other communicable diseases, and consistent with legal confidentiality requirements, TCA+A will notify all teachers, staff, and families of all students in the school if a test-confirmed COVID-19 case is identified among students, teachers, or staff.
The campus nurse and administrative team will determine all students who have been in close contact with the identified individual and notify all identified families.
Students identified as within close contact may [emphasis added] quarantine until all return to campus protocols are met.
[…]
Additional Procedures
Teachers will maintain a seating chart and track students within six[ ]feet of each other in case of needed quarantine.
TCA+A will provide optional COVID-19 rapid tests for all employees as requested.
Providing tests is great, but the six feet number is meaningless! It seems the answer to the earlier questions is that infections will be quite prevalent, and when they happen you will not do enough to keep them from spreading.
You will have cases that will never be confirmed by tests (and thus will not trigger your contact tracing protocols) but will spread to others. Even when you do get confirmed-positive cases, your contact tracing will be useless if it only includes students sitting within six feet of that person in class. What about where they eat lunch? What about everyone who has walked through a room or hallway they were in, especially if they weren’t wearing a mask?
CDC:
Per published reports, factors that increase the risk of SARS-CoV-2 infection under these circumstances include:
Enclosed spaces with inadequate ventilation or air handling within which the concentration of exhaled respiratory fluids, especially very fine droplets and aerosol particles, can build-up in the air space.
Increased exhalation of respiratory fluids if the infectious person is engaged in physical exertion or raises their voice (e.g., exercising [such as dance, PE…], shouting [or projecting your voice so an audience can hear you in theatre…], singing [as you do in choir practice…]).
Prolonged exposure to these conditions, typically more than 15 minutes.6
All of these factors will be prevalent throughout your schools, and among students too young to be vaccinated (and likely surrounded by unvaccinated adults in their home life). You teach dance, theatre, and multiple choirs. Every practice session will be a potential super-spreader event. And you are doing effectively nothing to prevent that.
What could you do, though, beyond what you’ve already committed to? Well, we can contrast your approach with an actual successful reopening plan executed in San Diego:
The first couple steps are out because you don’t want to ruffle the feathers of the pro-COVID party in control of this state, but beyond that we have:
3a. Air ventilation-bring in as much outside air as you can thru the HVAC system. Avoid re-circulating air. Important to measure CO2 levels when classes are running-w/ people present. Levels need to be <800 ppm. ARANET4 is a great sensor that can be used to assess.
3b. Fresh outdoor air is 415 ppm so this is as low as possible and suggests one is breathing fresh air. Higher levels mean you are breathing other people's breath which can contain virus. This virus released in the breath of infectious people. 1000x more released w/ Delta
4a. Air filtration: Two types: 1) upgrade HVAC filters to MERV13. Make sure they fit well and there are no gaps/leaks. 2) supplement and add standalone HEPA filters (simple filtration—no ionizers or other bells and whistles) throughout big rooms.
4b. Reduces concentration of all aerosols and provides overall cleaner air (good!). Best to run 2 or 3 on lower speeds so they are more quiet. There are tests for quietness—see Marwa Zaatari on Twitter.
@JollySnowflk @NastyOldWomyn Check the graph below: - Start by the area of the room to be cleaned (y axis) - Consider cost (x axis) and noise (look at color of the dot; <55 db at highest setting is probably a good level) colors = noise level expressed in db (decibel)4c. To build inexpensive air filters-see Rich Corsi @corsiAQ, Jim Rosenthal @jimrosenthal4, David Elfstrom @davidelfstrom—all are on Twitter-great info-some below including cost estimate.
An improvement to the Box Fan and MERV 13 Filter air cleaner. Thoughts and comments welcome: texairfilters.com/how-to-improve… @nikomer75 @clarkvangilder @HuffmanLabDU @neil_comparetto @JohnSemmelhack @energysmartohio @akm5376 @CorsIAQ @jljcoloradoPortable HEPA Filter Systems. 1/ The cost of retrofitting EVERY public school classroom in the entire US w/ a portable HEPA air filter w/ CADR = 300 cfm is approximately $1 billion w/ recurring cost of about $300M/yr for replacement filters. To be clear, EVERY single classroom.5. Wastewater testing. We tested wastewater in all buildings @UCSanDiego—other Universities did this too. This gives you a heads up before big outbreaks occur. When a building tests positive, everyone is alerted in that building and told to be tested.
6. Testing is key—PCR most common. There are really cheap rapid antigen tests that only cost $5 per test and only come up positive when the individual is infectious! Attached is article on the rapid/cheap tests developed by @michaelmina_lab
https://insidemedicine.bulletin.com/378975113857960
7. @UCSanDiego hired student "ambassadors" to help insure people were adhering to "rules"—wearing masks, avoiding crowds, etc. Enlisting a peer cohort (who wore bright yellow T-shirts) to help spread the word helped get important buy-in.
[…]
9. Tracing—when someone tested positive, we did tracing/testing of contacts.
10. Post signs reminding people to wear masks, etc.
11. Here is @UCSanDiego dashboard with lots of info-open and transparent sharing of info as you will see.
https://returntolearn.ucsd.edu
Here is a video you can show them on how aerosols spread and fill a room....
12. Note the riskiest places to be are crowded indoor locations with poor ventilation and people talking/yelling without masks.
FAQs on protecting yourself that we created:
https://tinyurl.com/FAQ-aerosols
13. I also attached a list of items for protecting yourself from 1918—Do's and Don'ts showing we have known what to do for a very long time!
14a. Final points-Also, please share the Greenhalgh paper I co-authored-this provides evidence for how we know the main mode of transmission is in aerosols through the air—sharing air needs to be avoided.
14b. If you can't, then masks and cleaning the air are critical. People say ventilation and filtration are expensive—they don't have to be. Can simply open the windows and doors (for free).
15. Multiple layers of protection are critical especially to protect those that are unvaccinated still.
With more contagious variants, the Swiss cheese model is more important than ever. Vaccines are one (important) slice but until everyone has access, we must use the other slices. Ventilation, filtration, and masks are essential protection against an airborne virus.A new version with colour & division inspiration from @uq_news and strict mouse design oversight by @kat_arden (ver3.0). It reorganises slices into personal & shared responsibilities (think of this in terms of all the slices rather than any single layer being most important) https://t.co/nNwLWZTWOLɪᴀɴ ᴍ. ᴍᴀᴄᴋᴀʏ, ᴘʜᴅ 🦠🤧🧬🥼🦟🧻🧙♂️ @MackayIM
And the thread continues. Opening windows in the Texas summer isn’t very feasible but much of the rest could be done here. These are the kinds of protocols that are created when people actually care about protecting people from this pandemic. On the other hand, stories of the predictable outcomes of failing to take proper precautions when reopening are already starting to come in.
The 69 outbreaks reported between Aug. 2 to Aug. 6, which was the second week of school for some districts, resulted in nearly 1,000 children and 300 teachers and staff testing positive for COVID-19, according to a weekly report from Mississippi's Department of Health.7
School hasn’t started yet in the Fort Worth ISD and ICU beds in our county are already more than 90% full.8
Withdrawing my daughter was the only remaining option I had to protect my family. And writing this is all I can do to protect yours. I hope it makes a difference.
Thanks,
Ethan Elias Johnson
Update: actually all staffed pediatric ICU beds are full: https://dfw.cbslocal.com/2021/08/12/no-staffed-pediatric-icu-beds-north-texas/
Scientific Brief: SARS-CoV-2 Transmission, cdc.gov, May 7, 2021, https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html#anchor_1619805200745
Scientific Brief: SARS-CoV-2 Transmission, cdc.gov, May 7, 2021, https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html#anchor_1619805184733
Studies that have systematically tested children and adolescents, irrespective of symptoms, for acute SARS-CoV-2 infection (using antigen or RT-PCR assays) or prior infection (through antibody testing) have found their rates of infection can be comparable, and in some settings higher, than in adults.
[…] Compared with adults, children and adolescents who are infected with SARS-CoV-2 are more commonly asymptomatic (never develop symptoms) or have mild, non-specific symptoms (e.g. headache, sore throat). Similar to adults with SARS-CoV-2 infections, children and adolescents can spread SARS-CoV-2 to others when they do not have symptoms or have mild, non-specific symptoms and thus might not know that they are infected and infectious.
— Science Brief: Transmission of SARS-CoV-2 in K-12 Schools and Early Care and Education Programs – Updated, cdc.gov, July 9 2021, https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/transmission_k_12_schools.html#covid-19-children-adolescents
What's This About Delta Being 1,000 Times More Infectious?, MedPage Today, July 23, 2021, https://www.medpagetoday.com/special-reports/exclusives/93717
Back-to-School Plan, artsacademics.org, June 17, 2021, https://www.artsacademics.org/2021/06/17/back-to-school-plan/
Scientific Brief: SARS-CoV-2 Transmission, cdc.gov, May 7, 2021, https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html#anchor_1619805184733
1,000 Kids in Mississippi Test Positive for COVID-19 After School Reopens, US News & World Report, August 11, 2021, https://www.usnews.com/news/education-news/articles/2021-08-11/1-000-kids-in-mississippi-test-positive-for-covid-19-after-school-reopens
Tarrant County, Texas COVID-19 Information, tarrantcounty.com, fetched August 12, 2021 https://www.tarrantcounty.com/en/public-health/disease-control---prevention/COVID-19.html