BACK TO SCHOOL AUTUMN 2021

Dear Member,

 As we start school amid a Delta variant surge, we wanted to give you some tips for you and your child to stay safe while in school. 

Studies have shown that distance, masking, and good ventilation help prevent the spread of COVID-19 in schools. Delta is much more contagious and more aerosolized than Alpha so we need effective measures to keep it at bay. Last year's recommendations did not have Delta in mind and the classes are more crowded this year. Here are a few tips:

Ventilation is one of the best ways to stop transmission. Recently the New York times showed that one window open in a classroom (all day) has a 14% reduction in transmission of COVID-19. 

As well, a HEPA filter in the classroom can be immensely helpful with a 69% reduction in COVID-19 transmission. What if your school doesn’t have this in place? The incoming dean of engineering at UC Davis, Richard Corsi, had the idea for a DIY HEPA filter that can be made. Then a colleague of his, Jim Rosenthal figured out how to do it inexpensively and the Corsi-Rosenthal box was born. You can make it as a class project. Speak to the teacher or the parent teacher assocation about it.

The instructions are here: Corsi-Rosenthal DIY HEPA Filter Box



Masks - With Delta we recommend that masks need to be better fitting than they were with Alpha. This school year classes are fuller and there is less space between students. Delta is also much more contagious. In a recent study from Finland, health care workers with surgical masks (the paper kind) were infected despite wearing protective gear when it came to Delta. They then switched to higher grade masks and were almost 100% protected. The higher-grade masks in their cases were N95/KN95/N99. However, N95 masks are not good for kids as they don’t fit properly so we do not suggest you buy these. You are better off with a KN95 or KF94. Fit is key. A well fit mask should fit snugly over the nose and there should not be any gaps on the sides and it should extend to below the chin. Disposable masks can be reused if not visibly soiled or torn by placing it in a paper bag after use for 3 days. Eva Enns at the University of Minnesota, made a list of good mask brands: 

www.behealthyusa.net carry 4 brands of K94 masks that are great: Blue, bluna, both and posh. The latter 3 have adjustable ear loops as well. 

https://4cair.com/product/4cair-nano-mask-for-kids/ This brand was also tested by the NY Times.

https://enro.com/collections/kids this mask is washable. Also tested by the NY Times. They run large though - may not fit those under 4.

https://www.happymasks.com/ once again a brand that is washable and reviewed by the NY Times.

There have been quite a few cases of counterfeit KN95s so best to go with a brand that’s been vetted.

As well, Aaron Collins (@masknerd on twitter) has a 20-minute video regarding masks for kids. Here it is here: 

Now that Pfizer is FDA approved, can’t we get it for kids under 12 now as an off-label use? In short, no. Multiple reasons, but the two most important are that the dosing is very different for kids under 12 and the American Academy of Pediatrics issued a stern warning not to administer it to those under 12 until it is authorized by the FDA.

When will vaccines be available for those under 12? Although it’s hard to pinpoint an actual time, the latest news is that Pfizer will ask for EUA (emergency use authorization) for children between the ages of 5-11 at the end of September. We are hoping the FDA is then quick to approve the vaccine. Kids 2 years old to 5 will be next to be approved (anticipated to be early 2022) followed shortly by children 6 months to 2 years. 

My friend/relative is vaccinated, is it safe to see them indoors and unmasked? The risk of being infected by Delta by someone who is vaccinated is much greater than it was for that time earlier this summer when Alpha was the main variant circulating. So, unless they quarantine prior to seeing you, the risk is there. We are seeing quite a few breakthrough infections of vaccinated people - most are quite mild. Vaccines do work, but they work at keeping you out of the hospital and alive, not necessarily from being infected. And the jury is still out regarding who will get long covid. As you see by the graph below, the infection rates are slightly raised for vaccinated people but the hospitalization rate remains flat.

I already had COVID-19, do I still need to vaccinate? Given the variability of how one's immune system responds to varying degrees of COVID-19 infections, it is highly recommended that you vaccinate. Some people have protection for months and months, some for a short time and some not at all. Harvard is currently working on a predictive model to determine one's immune reaction to the disease. Vaccines on the other hand produce a more or less similar response in people (unless you are immunocompromised). There is a new study out of Israel showing that natural immunity (ie getting infected) is much more protective than the vaccine, however, this is just a preprint which means it hasn't been vetted yet and/or published and usually the preprint and the final product are quite different in their claims and have qualifiers. Also, obtaining "natural immunity" means another 300,000 Americans will die (on top of the 630,000 already lost to COVID-19)and that doesn't take into account all the morbidity that can come with a COVID-19 infection. As well, being unvaccinated was associated with 2.34 times the odds of reinfection compared with being fully vaccinated. So, for those who have been infected, natural immunity is to be looked as like a third dose of the mRNA vaccines. You should still get both doses as that gives you the highest immunity available and the most protection from Delta.

Is the Delta variant more severe than the Alpha? A new study out of The Lancet looked at closer to 45,000 COVID-19 positive patients. They found that those infected with Delta were young (median age of 29), and that Delta patients had twice the risk of hospitalization than Alpha and used the emergency room more than Alpha patients as well. This is compatible with an earlier study in Scotland and Singapore where Delta infection was associated with higher risk of oxygen use, ICU admission and death - all adding to the growing evidence that it is in fact more severe than Alpha.

Do I need a booster? Data from Israel has shown that booster shots give added protection against Delta viral infection. The CDC currently recommends those who are immunocompromised to receive a booster vaccine if you had the mRNA vaccines. The general public will start being given boosters as of September 20th. There is no booster vaccine for the J and J vaccine as of yet but they are presumably submitting data to the FDA shortly. As mentioned in our previous newsletter, we have been giving mRNA boosters to those who wish to get one who had J and J previously.

We hope this information has been useful and wish you a safe entry back to school and work.