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La Scuola International School

 

Frequently Asked Questions

Added August 27, 2021

How shall we be proceeding with school-organized outdoor sports (require masks while playing? No shared snacks?)

Here is the latest guidance for sports from the SFDPH. Briefly, masks are required for those >24 months old and for indoor sports. For eating, they suggest eating outdoors and spacing but don't require individual plating/bagging, as the risk of surface-based transmission is considered low.

You mentioned that you agree with integrating testing into the prevention approach, including of asymptomatic unvaccinated people, when the disease incidence remains high. How would you quantify high in this case? Can you share La Scuola's proactive plan for asymptomatic testing, especially if/when disease incidence is high? Thank you for your continued expertise.

Though different models differ on the exact thresholds, a general average is to recommend asymptomatic testing above a daily average case rate of >25 per 100,000. At this point, SF County has thankfully fallen below that level, though (many) other parts of the United States are (far) above. La Scuola has maintained its relationship with PMH Labs / Agile Force to potentially offer testing periodically or on-demand when needed and is looking into other options as well.

Given that a lot of the data used to develop guidelines and protocols for this school year is based on last year's pre-delta data, how can we use the preliminary numbers/data coming out of larger school districts (Oakland, Palo Alto) that started school earlier?

We have a consortium of epidemiologists who compare evidence across schools (not only locally, but nationally) and examine best practices to minimize transmission. Some of the results from these analysis can be found here: https://abcsciencecollaborative.org/

Do you think programmatic testing (ie every Tuesday) - if we have the ability to do so - is helpful?

La Scuola is actively considering recurring testing following Health Department recommendations on thresholds and frequency. We will share details as soon as they are available.

Can you share the best data currently available for estimating the percentage of unvaccinated children in schools that may be infected in the near future (symptomatic or asymptomatic), even when indoor masking is in place, prior to widespread vaccination?

Here are the latest model-based estimates: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852255/ (note that while this article is a pre-print, the final version will be coming out in Annals of Internal Medicine within the next two weeks).

In your talk, you mentioned the "compressed spike" being largely a spike in infections of the unvaccinated. Could we see a similar spike in late September or October made up of unvaccinated children attending school?

At this point there is not yet evidence to anticipate a spike among unvaccinated children attending school; naturally we can't predict the future, but the major accelerations seen so far are in high-transmission, low-adult-vaccination locations to a much larger extent than the higher-adult-vaccination locations, particularly where the latter have good mask adherence among both children and adults.

Is any cold symptom worthy or a covid test?

It depends on your specific symptoms and is important to check with a medical provider who knows you and your specific circumstances and conditions. The CDC has a self-checker to help as well: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

Added August 17, 2021

When will the vaccines for children ages 2-12yrs be expected?

September to October timeframe

With the rise in Delta, why are masks optional outside? Smaller kids do not distance and transmission seems much more possible outside than previously.

It is not yet clear whether the Delta variant causes more severe disease in children, but its higher level of infectiousness is thought to apply to both children and adults. The current data on outdoor versus indoor transmission was recently summarized in this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798940/

Overall, while outdoor transmission is not impossible, and has been noted to occur in very crowded/high volume settings, such transmission appears to be responsible for ~1.1% of cases. My understanding is that SFDPH and other public health agencies have faced enormous pressure concerning masking of children during outdoor activities (among other locations), and every set of Covid public health guidance has ultimately been a political compromise among stakeholders, including (in this case) a number of groups advocating for the removal of masks altogether, such that this was posed as a compromise position. I can sympathize with your concern.

If my child has mild symptoms (runny nose, occasional cough) and test negative with a rapid test, can she return to school?

While the COVID-specific guidance requires a negative test for COVID symptoms before going back to school (and FDA-approved rapid antigen or PCR tests would be fine), it's recommended that someone who has symptoms from any infection should remain home since they can still transmit non-COVID infectious diseases (e.g., respiratory synctial virus, or RSV).

What is your opinion on the safety of the vaccine for children?

I am very heartened by the vaccine safety data among children. The rate of pericarditis appears to be around 67 per 1 million (thankfully low), with good recovery among most of those affected, and no further evidence so far of serious side effects. Further data will be soon available as the newer trials among younger children complete. A nice review of the issues is presented here: https://www.nature.com/articles/d41586-021-01898-9

Why should kids wear masks? Chil­dren have been known to trans­mit Covid, but far less of­ten than adults do. A North Car­olina study con­ducted be­fore vac­cines were avail­able found not a sin­gle case of stu­dent-to-teacher trans­mis­sion when 90,000 stu­dents were in school. The faster-spread­ing Delta vari­ant has emerged since—but many teach­ers, par­ents and chil­dren 12 and over have also been vac­ci­nated.

To clarify, the North Carolina study actually indicated the transmission rate was low when masks were in place, not when masks were not in place. See the study and summary here:

The data regarding face mask use has been summarized in a series of recent reviews. Here is one example that includes comment on pediatric effectiveness: https://www.pnas.org/content/118/4/e201456411

The evidence base for pediatric mask use has been mostly made from comparisons of similar schools that did versus did not require masking of children among similar incidence environments, and household studies of mixed-age households, e.g., https://gh.bmj.com/content/5/5/e002794?ijkey=a7af13f90e604c84d0ef561e371e613a6001d83a&keytype2=tf_ipsecsha as one example.

For additional information, see these reviews as well:

Recent data on safety of masks among children is also now available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776928

Is data about in-school transmission being tracked anywhere? The SF dashboard only includes data through July 11 and it says it’s no longer updated.

I've relayed your message to SFDPH and they've indicated that they're working on re-launching for the fall, and anticipate a renewed dashboard over the next few weeks with newer data. In the meantime, they're having regular calls with the school admins to update them and thankfully have no outbreaks to report at this time. The state and national dashboards that were supported by teachers and staff also appear to be defunct after the summer. In contacting them, they also indicate a few renewed efforts will start likely later this month or early September, and I can distribute those links when they are available.

The Chronicle reported that on August 7, San Francisco's daily case rate is over 33 new cases per 100,000 people over the last 7 days, taking the average higher than the US case rate, which takes us into the high transmission category. Shouldn't La Scuola be tightening (rather than relaxing) covid policies again, just like last year, considering that none of our children under 12 are vaccinated?

I sympathize with your position. At this point, La Scuola continues to maintain standards above and beyond those of the SFDPH and CDC for this reason. Masking, ventilation devices, and distancing (along with exposure and quarantine rules) remain in place in particular, and staff are required to vaccinate (unless legally exempted, such as due to a medical contraindication). It has been found independently that the screening questionnaires and hand-held temperature checks lacked validity, reliability or benefit, and so could be providing deceptive reassurance.

Given that infections in children and vaccinated adults seem more likely to be asymptomatic, how important is testing as a preventative mechanism? How can we best use it within the context of the Delta Variant?

I agree with integrating testing into the prevention approach, including of asymptomatic unvaccinated people, when the disease incidence remains high. In this circumstance, the testing would need to be at enough frequency to catch asymptomatic or pre-symptomatic folks during their highest period of infectiousness (often before any symptoms), but not be so often as to be dominated by "false positive" results. Once the incidence rate in the county goes down sufficiently, the false positive rate becomes so high that frequent asymptomatic testing can become perverse and can be discontinued at that time.

Breakthrough infections for vaccinated adults and children are now common.

Question: 1. Does that suggest that safety protocols need to be further ramped up from last semester?

Question 2. Does there appear to be any significant risk of long COVID to vaccinated people who get infected?

I would modify the word "common". At present, breakthroughs have occurred among 0.1% of fully vaccinated people in California. Children below vaccination age (less than 12 years) are currently 6% of new infections, 2% of COVID hospitalizations, and 0% of COVID deaths in SF. In the context of the Delta variant in SF however, safety protocols have been revamped, including requiring vaccination of all folks who can be vaccinated (subject to legally-required exemptions), masking indoors and improved ventilation, and cohorting. Only a few, small studies have provided data regarding how common or severe long COVID may be after breakthrough infections. It is likely to be rare because breakthrough infections are themselves rare, and shorter in duration. In one study, 7 of 36 people with breakthrough infections had persistent symptoms for more than six weeks; in a second study, 24 of 44 people with a symptomatic breakthrough infection reported lingering problems.

Runny noses; not on the official list of symptoms from SFDPH (yet?), but increasingly clear that Delta will often present with a runny nose/allergy symptoms - especially in young kids. This is a big difference from last year. What are guidelines re: testing/keeping home with runny noses?

There is quite a conflict between studies on the question of whether COVID symptomatology is truly different among those with the delta variant or if it is incorrect extrapolation from anecdotal reports. The Zoe COVID symptom study derived from app-based reporting suggested the potential for more runny nose, while other assessments that have more rigorous protocols for assessing symptoms and having a more representative patient population have not. That being said, runny nose is now on the SFDPH COVID symptom and exposure checklist for parents, which asks specifically if any symptoms are "new or different from usual", then to contact your child's medical provider for next steps: https://www.sfdph.org/dph/files/ig/Parent-Guardian-Health-Check-Handout.pdf

What classroom air ventilation guidelines is the school implementing?

Windows are kept open and doors ajar, noise permitting in addition to air filters per the below:

Ventilation & Windows
We mitigate the risk of poor ventilation and low room air exchange, and maximize the use of windows and ventilation systems to maximize intake of fresh air and minimize recirculated air, based on Harvard’s “Schools for Health”. We recognize the importance of increasing air circulation indoors and will be keeping windows open and doors ajar as appropriate throughout the day, ensuring outdoor learning is maximized in the daily routine and taking measures to improve our HVAC and forced air systems as follows:

At our Dogpatch campus, we have an HVAC system with Merv 13 filters in place which will be replaced every two months. In addition, each classroom is equipped with an air purifier with HEPA filters changed 1-2 times per month and are efficient for 800 square feet, the maximum size of our classrooms.

At our Fell campus, we rely on a large number of large windows to cool the space / circulate the air and a steam / radiator heating system. There is no forced air in the building. Each classroom is equipped with an air purifier with HEPA filters changed 1-2 times per month and are efficient for 800 square feet, the maximum size of our classrooms.

At our Mission campus, we rely on a large number of large windows to cool the space / circulate the air and a forced-air heating system throughout. The furnaces will be equipped with Merv 13 filters. Each classroom is equipped with an air purifier with HEPA filters changed 1-2 times per month and are efficient for 800 square feet, the maximum size of our classrooms.

What are all the times during the preschool day that students or staff on the Dogpatch campus are allowed to be unmasked? What are the protocols for distancing children during these potential unmasked times?

Will parents be notified if their child ends up within 6 feet of anyone unvaccinated and unmasked (indoors or outdoors)?Adults may be unmasked outdoors.

Children will be encouraged to keep distance between them as much as is feasible.

All adults on campus are vaccinated with very limited exceptions. If a student is a close contact, the family will be notified and a general exposure notice is also shared with all on campus.

If your family was a high-risk family or household (e.g., immunocompromised or multigenerational household), and your child was not yet eligible to be vaccinated, do you imagine you would send your child to school in-person now or wait to see when boosters for high-risk folks or vaccines for <12 will be available or until we know more about how the delta variant is impacting unvaccinated students in schools?

I think it would be best to have a detailed conversation with the medical provider who knows the immunocompromised person best and discuss the level of control of the underlying disease or the level of immunocompromised given the specific condition, and then see how that concords with your level of risk tolerance.

These are still concerning numbers, with 1 in 5 unvaccinated students being infected, but it seems like weekly testing helps stop exposure and outbreaks enough to cut infections in half, which is particularly important if young children are more likely to be asymptomatic. The LA School District and some of the private schools we are familiar with in the Bay Area have already implemented weekly or bi-weekly testing as a policy for this new school year, and some were already testing last year (with saliva tests in some cases for young students to be less invasive and more humane.)

The statistic that 1 in 5 unvaccinated students are being infected is not correct. Actual infection rates are currently on the order of 0.03%. See above regarding asymptomatic testing.

What will be the protocols for eating snacks/lunch? Will there be additional distancing when masks have to be down?

Snacks and lunch will typically take place outdoors or in the classroom at their desks. Students will always be required to maintain distance when possible.

How reliable are the rapid tests currently found over the counter at the drugstore?

FDA-approved rapid antigen and PCR tests have to date generally have had reasonably high sensitivity and specificity, but note that the actual risk of true versus false positives and negatives depend on your local area's risk of infection. See: https://www.bmj.com/content/373/bmj.n1411/rr

You can lookup specific data on different tests here: https://www.centerforhealthsecurity.org/covid-19TestingToolkit/molecular-based-tests/current-molecular-and-antigen-tests.html

With early research showing the viral load of delta infections could be 1,000 times that of earlier strains, some US scientists have extrapolated that a "close contact" with 15 minutes of exposure with previous strains could now potentially be classified a close contact with just 1 second of exposure to the delta variant. What are your current thoughts on this topic?

The risk of infection does concord with how much infectious material a person is exposed to, times how low they are exposed to it -- but it's not a purely linear relationship. There is a more "S-shaped" curve in which very small amounts of infectious material or very short durations of exposure are not adequate to cause infection, there's a steep gradient in risk at middle ranges of material over long time horizons, and then there's less incremental increase in risk from high to very high levels of material or time. So while this comment--I believe made by a colleague in a NY Times interview--was to impress folks with the risk of delta infectiousness, it's not quite numerically the case that exceedingly small durations of exposure with delta variant virus are as meaningful as longer durations with an alpha/gamma variant.

Have your recommendations and general thinking changed over last year due to the Delta variant, and if so, how?

No, I think our armamentarium remains the same: vaccines, masking, distancing, and being generally cautious.

 

Added March 26, 2021

Is it important that kids in the classroom social distance while eating inside the classroom?

Children eat outdoors and in the classroom at their desks typically distanced with acrylic shields in place. This practice does help reduce the possibility of transmission.

Considering that kids under 2 can not and likely won’t wear a mask is it risky to bring them inside a public space/grocery store/etc?

It is currently considered low risk for young children to enter these spaces despite the difficulties they have wearing masks, due to their generally lower risk of young children parents of young children with heart, lung, or immunocomprising-conditions should take extra precautions

Is it important for teachers to social distance with other teachers/administrators outside their classroom?

Wearing a face covering and maintaining physical distance from others are two of the best ways to prevent the transmission of Covid-19. La Scuola faculty and staff do their best to maintain the 6 feet of distance, both indoors and outdoors. We are happy to share that roughly 95% of La Scuola staff has received their first if not second dose of the vaccine. 

Added Feb. 5, 2021

Are the vaccines safe for nursing mothers?

The CDC, the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine agree that the new mRNA COVID-19 vaccines should be offered to pregnant and breastfeeding individuals who are eligible for vaccination. Although people who were pregnancy or breastfeeding at the beginning of trials were not enrolled, several people became pregnant during the trials and birth defects or other problems were not observed among those vaccinated (by contrast, such congenital and post-natal problems were observed among children whose mothers had Covid, in Wuhan). The mechanism of mRNA vaccines and experience from other vaccines suggest it is most likely safe to get an mRNA COVID-19 vaccine if you’re breastfeeding. There is no virus in the mRNA vaccines. You cannot get Covid, or give your baby Covid, by being vaccinated. The components of the vaccine are not known to harm breastfed infants. When you receive the vaccine, the small mRNA vaccine particles are used up by your muscle cells at the injection site and thus are unlikely to get into breast milk. Any small mRNA particles that reach the breast milk would likely be digested. When a person gets vaccinated while breastfeeding, their immune system develops antibodies that protect against Covid-19. These antibodies can be passed through breast milk to the baby. Newborns of vaccinated mothers who breastfeed can benefit from these antibodies against Covid-19.

How should we think about face coverings for kids now with unofficial recommendations of double masking?

The debate about double masking continues to rage with fairly inconsistent evidence. The evidence base really suggests that ensuring high compliance with any form of mask is most critical, and given the difficulties kids (and adults) seem to have with masking consistently, it is my opinion that we recommend whatever mode of masking is most convenient as to be adhered to most of the time by most people. As it can feel difficult to breathe with double masks, I would hesitate to recommend this widely given the need to focus on widespread adherence.

Added Jan. 22, 2021

Is it important for teachers to social distance with other teachers/administrators outside their classroom?

Yes. While there has been very little in-school transmission in San Francisco, we require all individuals, especially adults on campus, to wear face coverings and maintain physical distance, even if outdoors.

Once parents are vaccinated and we are much closer to herd immunity, do you think it is safe to travel (with masks, etc.)?

SFDPH informs us that even once an individual is vaccinated, they must continue wearing a face covering, maintaining physical distance and washing hands, among other safety measures. Currently available vaccines are about 95% effective, leaving some possibility for continued infection and transmission. We await further word on when herd immunity will be reached and when restrictions can be relaxed, but that point remains unlikely for several more months.

Is there anything else we can do (or should be doing) in addition to what we are already doing to address the new virus strain that apparently spreads easier?

Vaccines being rolled out are showing to be effective against new mutant strains. Maintaining safety (wearing a face covering, maintaining physical distance and washing hands) and signing up to get vaccinated remain the primary protections we have against the new mutant strains.

I'm curious whether you feel the school should be recommending -- in the light of cases numbers still rising in the city, and potential questions re: new variants and children's susceptibility - that parents limit organized out-of-school classes to reduce potential cross-exposure?

SFDPH has guidelines that allow one OST activity, and obviously for some families that may be an essential form of childcare, but when classes are optional enrichment, should the school be asking parents to consider dropping these? Otherwise, if every kid in a class is attending an OST activity as well, the number of potential contacts adds up quickly...Given the data available from the city to date, there have not been potential infections among children in one OST activity. Hence, while every parent has a different threshold for risk and benefit, maintaining a single OST activity and consistent cohorts seems to be producing a safe cohort environment when other protections are in place (masks, distancing, etc.).

With the vaccine now rolling out, what are your thoughts on visits from people who have received the vaccine and the concept of airline travel in the future for those who have received the vaccine?

Currently available vaccines are about 95% effective, leaving some possibility for continued transmission. We await further word on when herd immunity will be reached and when restrictions can be relaxed, but this remains unlikely for several more months. Until that level of herd immunity is reached and transmission wains significantly, it is safest to continue distancing and minimize travel.

What if my child has symptoms and our doctor won't refer for a test?

When parents share that their child has symptoms in line with Covid (see link), they will be asked to stay home, along with any siblings, contact their healthcare provider and get tested for Covid-19. If the healthcare provider does not advise that the child get tested, La Scuola will ask for a doctor's note clearing the child to return to school. If the sibling has no symptoms, the sibling would also be able to return to campus.

Could you share your thoughts around the India study that found children were big drivers of transmission?

The India study showed that children could be involved in transmission, but with two caveats: most transmission to children was parent-to-child transmission or adult-to-adult transmission within the same age groups among extremely high-risk environments with a very high incidence rate and without masks; and secondly, that child transmission was not a major portion of overall transmission, contrary to (mis-)representation in some media outlets. The key figure is below, which shows how many people were infected (bottom axis) by people of each age group who were infectious (left axis), revealing the most transmission again was among adults infecting other adults of the same age or parents infecting children, and that infectiousness was particularly among those above age 18 years old.

Are rapid tests acceptable or does La Scuola require PCR tests in order for a student to return to school after illness?

La Scuola will welcome back students on campus with negative test results from either the rapid test or the PCR test. While, if a student tests positive from the rapid antigen, we would work with the SFDPH and ask the child to take a PCR test before determining next steps.

Dr. Basu shares that the negative predictive value is very good for both sets of tests, rapid and PCR. If the rapid test is negative, that’s great news and it is fairly safe for the child to return to school. The positive rate is the problem for the rapid tests. The rapid tests often have false positives, and so a person may be kept out of school while the PCR test will often be negative despite the positive rapid antigen. 

After flying, what is the right amount of time to wait before getting a Covid test?

Generally 4-7 days from the day of potential exposure are recommended for testing.

Have you seen a higher level of effectiveness of keeping COVID numbers down with the use of the tracing app. In the United States, rather than creating a single contact tracing app, the decision to support Exposure Notifications is made by each state’s public health authority. The Google/Apple COVID-19 exposure notification feature has not currently been turned on for California, and is currently being used in only 11 of 57 states and US territories. The slow uptake may cast doubt on the viability of containing COVID-19 in the near-term with contact-tracing apps, which would likely require the majority of people (about 60% or more) to participate. Further discussion of digital contact tracing can be found in a research article in the journal Science: http://dx.doi.org/10.1126/science.abb6936

We are considering forming a pod with a local family. We would like to get tested before entering the pod and before socializing with others once we have formed the pod. Can you advise on timing related to when we should take the pre-pod test?

Generally, you want to submit your test about 72-96 hours before starting the pod interaction to permit time to have negative results in hand before getting together.

If a family is visiting from outside CA and wants to get tested shortly after arrival (e.g. 4-7 days), what is the best testing option for them (in terms of location, timing, and accuracy)?

The best options in my opinion include a home-based PCR testing kit (e.g., Labcorp Pixel if adult, Picture Fulgent Genetics if child), or an in-person rapid antigen or PCR test such as those offered by Carbon Health or Dignity Health/Go Health Urgent Care clinics.

At what point do you get concerned about having kids in school, given community rates (is that new cases rate? incidence rate?)?

Typically we would want to see the test positivity rate maintained <5%. Currently it is 2.5% in San Francisco county.

What are your opinions on the new reports of the efficacy of the vaccines? Do you have any apprehension or concerns of the "new technology"? Are you recommending it to your patients and will you take it yourself?

I am heartened by the evidence of effectiveness of the vaccines, and will be taking a vaccine myself when it is my turn in line. I would suggest adults get the vaccine when it is available, and am recommending it to patients. The safety profile of the vaccines are very good so far, with some exceptions for people with severe allergic reactions to vaccines or Guillain-Barre Syndrome, which is thankfully rare. The evidence for effectiveness in children remains pending at this time; the Pfizer vaccine will start enrolling kids this month, and Moderna will do a separate pediatric trial shortly thereafter. Once we have results from those trials, we can speak in a more data-driven way about the safety and benefits to children. Requiring vaccination is a matter of state laws, which La Scuola is required to follow; at present, the COVID vaccine is not on the required vaccination state list for childcare or schools. I recommend reading a summary of current evidence from the vaccine studies from The New England Journal, available here: http://dx.doi.org/10.1056/NEJMe2034717

With the surge in Covid cases in SF it is sometimes difficult to book a test and get test results in a timely manner. If a member of the household starts experiencing any of the symptoms associated with Covid (such as cough, fever, etc.), what is the recommendation regarding sending a child to school if they are asymptomatic, but the symptomatic member of the household hasn't received a negative test result yet?

This is a scenario in our draft communication for next week. The answer I have put in there is here below, but please feel free to change:

Someone is sick in my household, can my child come to school?

According to SFDPH guidelines, yes, a child may come to school unless they have tested positive, were identified as a close contact or are exhibiting illness symptoms themselves. We rely on our families to use their best judgement and strongly encourage anyone showing illness symptoms to get tested immediately. If the sick individual is a student that attends La Scuola, we ask that families keep any other siblings at home until the sick individual is tested.

My child has a sibling not at La Scuola that is sick, can my La Scuola student still come to school?

Yes. We strongly encourage anyone showing illness symptoms to get tested immediately. SFDPH has no requirement to keep the healthy La Scuola student at home unless they test positive for Covid, are identified as a close contact or are exhibiting illness symptoms.

Our nanny is the only person who we’ve had in our home or seen in person since March. She lives alone and follows all CDC guidelines, but she lives in a neighborhood in which COVID cases have spiked. How can we best mitigate the risk to her and to our family?

The best way to mitigate the risk to her and to your family is to continue to maintain a tight pod, mask and physically distance, avoid breaking the pod with new entrants, and isolate and test if symptoms develop among anyone in the pod.

What are your thoughts on the vaccine? How do we know that they are safe and free of long-term side effects? Will you vaccinate your child and, if yes, with which vaccine? Should a vaccine be mandatory to enroll at the school?

I am heartened by the evidence of effectiveness of the vaccines, and will be taking a vaccine myself when it is my turn in line. I would suggest adults get the vaccine when it is available, and am recommending it to patients. The safety profile of the vaccines are very good so far, with some exceptions for people with severe allergic reactions to vaccines or Guillain-Barre Syndrome, which is thankfully rare. The evidence for effectiveness in children remains pending at this time; the Pfizer vaccine will start enrolling kids this month, and Moderna will do a separate pediatric trial shortly thereafter. Once we have results from those trials, we can speak in a more data-driven way about the safety and benefits to children. Requiring vaccination is a matter of state laws, which La Scuola is required to follow; at present, the COVID vaccine is not on the required vaccination state list for childcare or schools. I recommend reading a summary of current evidence from the vaccine studies from The New England Journal, available here: http://dx.doi.org/10.1056/NEJMe2034717

Other private schools have opted to close given the recent rise in cases. Why has La Scuola opted to remain open, given the increased risk?

La Scuola continues to follow the scientific evidence and guidelines from federal, state, and county departments of public health. The data continues to show low risk among K-8 populations despite higher risk among high school populations, and current models indicate schools can remain a priority as other activities are reduced during the new shelter-in-place, to balance the risks of long-term detriment to educationagainst the risks of in-person schooling responsibly.

Would Sanjay be willing to host another session and take us through the latest data, including the new vaccine results?

Yes, perhaps waiting until the results of pediatric vaccine trials are available.

Many parents are choosing to participate in activities such as air travel, play dates, sleepovers, gatherings, holiday celebrations, outdoor dining (when it was open) and team sports. Given that our family is not participating in activities like these, how can we best protect ourselves and the school community?

We plan to reiterate guidelines for safety among the community, continue to have the longer winter break period to enable isolation of families before returning to in-person school, and offer testing opportunities.

Is it important that kids in the classroom social distance while eating inside the classroom?

Yes, children do currently eat in the classroom at their desks typically distanced with acrylic shields in place. This practice does help reduce the possibility of transmission.

Considering that kids under 2 can not and likely won’t wear a mask is it risky to bring them inside a public space/grocery store/etc?Thankfully there is limited transmission to young children due to their receptors and immune system. We would encourage hand washing and distancing, but there are far fewer cases among the very young than among older persons to date.

Schools in the UK have closed due to the new, more contagious COVID strain, and capacity at SF hospitals is as high as it’s ever been, with hospitals moving to emergency levels of patients that they say are not sustainable if they continue to increase. At what point do you recommend moving back to distance learning?

While the choice of in-person versus distant learning is different for every parent based on their personal risk and benefit judgements, there is some good news emerging. COVID-19 incidence in the US has declined steadily since January 11, down from 248,367 new cases per day to 221,692, a decrease of nearly 11%. In addition to decreasing daily incidence and initial indications that mortality could be leveling off, current COVID-19 hospitalizations in the US appear to have passed a peak. As we have covered previously, current hospitalizations tend to be more resilient to holiday-related reporting delays than incidence and mortality, so a decreasing trend can provide additional confidence that the US could be passing its third peak. In San Francisco, disease incidence has dropped from 41 to 29 cases per 100,000 per day, with the positive case rate below the threshold of 5% typically viewed as safe for in-person schooling.

 

Added Dec. 11, 2020

We are considering forming a pod with a local family for the Christmas and new year holiday. We would like to get tested before entering the pod and before socializing with others once we have formed the pod. Can you advise on timing related to when we should take the pre-pod test?

Generally, you want to submit your test about 72-96 hours before starting the pod interaction to permit time to have negative results in hand before getting together.

If family is visiting from outside CA and wants to get tested shortly after arrival (e.g. 4-7 days), what is the best testing option for them (in terms of location, timing, and accuracy)?The best options in my opinion include a home-based PCR testing kit (e.g., Labcorp Pixel if adult, Picture Fulgent Genetics if child), or an in-person rapid antigen or PCR test such as those offered by Carbon Health or Dignity Health/Go Health Urgent Care clinics.

At what point do you get concerned about having kids in school, given community rates (is that new cases rate? incidence rate?)?

Typically we would want to see the test positivity rate maintained <5%. Currently, it is 2.5% in San Francisco county.

Someone is sick in my household, can my child come to school?
According to SFDPH guidelines, yes, a child may come to school unless they have tested positive, were identified as a close contact or are exhibiting illness symptoms themselves. We rely on our families to use their best judgement and strongly encourage anyone showing illness symptoms to get tested immediately. If the sick individual is a student that attends La Scuola, we ask that families keep any other siblings at home until the sick individual is tested.

My child has a sibling not at La Scuola that is sick, can my La Scuola student still come to school?
Yes. We strongly encourage anyone showing illness symptoms to get tested immediately. SFDPH has no requirement to keep the healthy La Scuola student at home unless they test positive for Covid, are identified as a close contact or are exhibiting illness symptoms.

Our nanny is the only person who we’ve had in our home or seen in person since March. She lives alone and follows all CDC guidelines, but she lives in a neighborhood in which COVID cases have spiked. How can we best mitigate the risk to her and to our family?

The best way to mitigate the risk to her and to your family is to continue to maintain a tight pod, mask and physically distance, avoid breaking the pod with new entrants, and isolate and test if symptoms develop among anyone in the pod.

What are your thoughts on the vaccine? How do we know that they are safe and free of long-term side effects? Will you vaccinate your child and, if yes, with which vaccine? Should a vaccine be mandatory to enroll at the school?

I am heartened by the evidence of effectiveness of the vaccines, and will be taking a vaccine myself when it is my turn in line. I would suggest adults get the vaccine when it is available, and am recommending it to patients. The safety profile of the vaccines are very good so far, with some exceptions for people with severe allergic reactions to vaccines or Guillain-Barre Syndrome, which is thankfully rare. The evidence for effectiveness in children remains pending at this time; the Pfizer vaccine will start enrolling kids this month, and Moderna will do a separate pediatric trial shortly thereafter. Once we have results from those trials, we can speak in a more data-driven way about the safety and benefits to children. Requiring vaccination is a matter of state laws, which La Scuola is required to follow; at present, the COVID vaccine is not on the required vaccination state list for childcare or schools. I recommend reading a summary of current evidence from the vaccine studies from The New England Journal, available here: http://dx.doi.org/10.1056/NEJMe2034717

Can you recommend a protocol for seeing family members? Like for Christmas, we have a week before Christmas - if we all isolate + get COVID tests, can we see elderly grandparents?

While the recommendations are to avoid such activities as much as possible, for people who will definitely participate in such activities, it is better to continue masking especially indoors, isolate, and get COVID PCR or rapid antigen testing beforehand, though that is still not an absolute guarantee of safety.

Other private schools have opted to close given the recent rise in cases. Why has La Scuola opted to remain open, given the increased risk?

La Scuola continues to follow the scientific evidence and guidelines from federal, state, and county departments of public health. The data continues to show low risk among K-8 populations despite higher risk among high school populations, and current models indicate schools can remain a priority as other activities are reduced during the new shelter-in-place, to balance the risks of long-term detriment to educationagainst the risks of in-person schooling responsibly.

Would Sanjay be willing to host another session and take us through the latest data, including the new vaccine results?

Yes, perhaps waiting until the results of pediatric vaccine trials are available.

Many parents are choosing to participate in activities such as air travel, play dates, sleepovers, gatherings, holiday celebrations, outdoor dining (when it was open) and team sports. Given that our family is not participating in activities like these, how can we best protect ourselves and the school community?

We plan to reiterate guidelines for safety among the community, continue to have the longer winter break period to enable isolation of families before returning to in-person school, and offer testing opportunities.

Added Nov. 13, 2020

Are rapid tests acceptable or does La Scuola require PCR tests in order for a student to return to school after illness?

La Scuola will welcome back students on campus with negative test results from either the rapid test or the PCR test. While, if a student tests positive from the rapid antigen, we would work with the SFDPH and ask the child to take a PCR test before determining next steps.

Dr. Basu shares that the negative predictive value is very good for both sets of tests, rapid and PCR. If the rapid test is negative, that’s great news and it is fairly safe for the child to return to school. The positive rate is the problem for the rapid tests. The rapid tests often have false positives, and so a person may be kept out of school while the PCR test will often be negative despite the positive rapid antigen. 

After flying, what is the right amount of time to wait before getting a Covid test?

Generally 4-7 days from the day of potential exposure are recommended for testing.

Have you seen a higher level of effectiveness of keeping COVID numbers down with the use of the tracing app?

In the United States, rather than creating a single contact tracing app, the decision to support Exposure Notifications is made by each state’s public health authority. The Google/Apple COVID-19 exposure notification feature has not currently been turned on for California, and is currently being used in only 11 of 57 states and US territories. The slow uptake may cast doubt on the viability of containing COVID-19 in the near-term with contact-tracing apps, which would likely require the majority of people (about 60% or more) to participate. Further discussion of digital contact tracing can be found in a research article in the journal Science: http://dx.doi.org/10.1126/science.abb6936

Which Covid test is most recommended for children?

PCR testing is more recommended than antigen tests. Antibody tests are not recommended.

Which Covid test is most recommended for adults?

PCR testing is more recommended than antigen tests. Antibody tests are not recommended.

 

Added Nov. 6, 2020

Could you share your thoughts on the India study that found children were big drivers of transmission (https://science.sciencemag.org/content/early/2020/09/29/science.abd7672)? It seems like the largest study in terms of the number of people and given the high #s of asymptomatic cases (maybe more in kids?), I'm wondering if we're collectively underestimating this risk. I am currently pregnant and are worried about exposure now and during newborn months to the rest of the family.

The India study showed that children could be involved in the transmission, but with two caveats: most transmissions to children was parent-to-child transmission or adult-to-adult transmission within the same age groups among extremely high-risk environments with a very high incidence rate and without masks; and secondly, that child transmission was not a major portion of the overall transmission, contrary to (mis-)representation in some media outlets. The key figure is below, which shows how many people were infected (bottom axis) by people of each age group who were infectious (left axis), revealing the most transmission again was among adults infecting other adults of the same age or parents infecting children, and that infectiousness was particularly among those above age 18 years old.

 

Added Oct. 29, 2020

With the new CDC report on the definition of close contact does that change the school's approach and communication of close contact?

The Centers for Disease Control and Prevention released new guidelines regarding what counts as “close contact” with someone who has COVID-19. The expanded definition includes brief but repeated exposure to others with the virus that adds up to 15 minutes over a 24-hour period. SFDPH is currently evaluating their position and will be advising La Scuola on any change to how the school defines Close Contact.

Previously, the CDC defined close contact as spending 15 consecutive minutes or more within six feet of someone with COVID-19. The new CDC guideline does not change the communications text or instructions around close contact when such contact happens, but does change how the school will keep track of close contact, in that cumulative exposure within 24 hours will be taken into account, potentially broadening the number of people who will be communicated with to quarantine and follow standard subsequent steps if a positive case occurs.

Shouldn’t all children be required to have a flu shot to minimize unneeded absences?

It is highly recommended for all children over the age of 6 months to receive a flu vaccine; however, there are some conditions that may prevent a person from safely receiving a flu vaccine (e.g., Guillain-Barre syndrome). La Scuola is bound by local, state, and federal regulations and laws regarding how they can phrase a recommendation versus a requirement to vaccinate; at present, the California and SF vaccine requirement laws do not apply to the flu vaccine. Nevertheless, based on publicly-reported data, La Scuola is in the highest tier for vaccine compliance among schools (95-100% of students fully vaccinated in the latest dataset, covering the 2018-2019 school year).

Where can we get a rapid 15-minute kids turnaround test in San Francisco?

PCR antigen tests are recommended. Rapid antigen tests are discouraged due to increasing reports of false positive and false negative results.

What if my child has symptoms and our doctor won't refer for a test?

When parents share that their child has symptoms in line with Covid-19, they will be:

  1. Asked to stay home, along with any siblings,
  2. Contact their healthcare provider, 
  3. Get tested for Covid-19

If the healthcare provider does not advise that the child get tested, La Scuola will ask for a doctor's note clearing the child to return to school. If the sibling has no symptoms, the sibling would also be able to return to campus.

I am curious for more detail on the SFDPH guidance that influenced the sibling policy for an impacted cohort and why the potential for infection isn't a concern?

The SFDPH and CDC have no quarantine requirements for any siblings or family members that have been close contacts of an individual that has tested positive (what is referred to as a “contact of a contact”) unless they also test positive. The quarantine requirement only applies to those that have had close contact with an individual that has tested positive (what is referred to as a “close contact”). The La Scuola policy is one step more cautious than the SFDPH and CDC, however, in that it requests that household members get tested if in contact with the person who has tested positive, to minimize the risk of infection before the non-positive sibling can return to in-person school. Please refer to www.lascuolasf.org/reopening for more details.

Could you talk a little about the risks of carpooling within classes, plus siblings that are in other grades? What’s the level of additional risk or how should we approach it?

Carpooling within classes/pods with masks on is considered a low risk activity, essentially adding no further risk beyond that of typically being within a pod for regular school activities. Being with siblings of other grades/ages is unlikely to meaningfully increase risk given that the full household is likely already exposed to that sibling, and others in the pod are likely effectively exposed to that sibling as well, such that the circle of exposure is essentially extended to include that person. Yet this does not appear that such extended pods have elevated risk meaningfully in prior studies including differently-aged siblings crossing pods in communities with low incidence rates (<10 cases per 100,000 people per day), as evidenced in particular by results from New York City's school reopening [NYC is at 7.9 and SF is at 4.9 cases per 100,000 people per day]. The risk may be more in communities with substantially higher incidence rates [such as in Boston, at 16.7 cases per 100,000, though even in this setting the carpooling itself or the cross-aged sibling aspect was not noted to increase the risk; rather, the overall community rate was amplifying risk for adults transmitting to other adults].

Why is travel by air even just by a family member deemed to be so dangerous that it requires a 14-day quarantine? Large family gatherings for the holidays, indoor activities nearby seem to pose much larger risk?

Large family gatherings or indoor activities in which people are unmasked and in close contact for prolonged periods are certainly of high concern. Travel by air has recently been reviewed by the Journal of the American Medical Association and you can find the summary here: https://jamanetwork.com/journals/jama/fullarticle/2771435

The bottom line is that infection within the airplane is considered unlikely, particularly with masking and ventilation systems on commercial airliners, but due to the much higher rate of COVID in communities outside of the Bay Area in the US, the risk of being in those other locations outside of the airplane [the destination trip itself] greatly heightens the risk of transporting COVID back to the Bay Area. For that reason, SFDPH currently advises: "you quarantine for 14 days upon return to San Francisco if during your travels you interacted within 6 feet of individuals outside your household when you or those around you are not wearing face coverings at all times. The more interactions that were indoors, the larger the number of people involved, and the longer the duration of such interactions, the greater the risk. In addition, DPH recommends that you quarantine for 14 days upon return if you traveled on planes, buses, trains, or other forms of group/public transportation where face coverings were not worn at all times by you and those around you while in these enclosed spaces."

La Scuola does not currently anticipate any changes to the travel quarantine policy, but will be working closely with SFDPH on when will be appropriate to update.


 

Added Oct. 13, 2020

What happens when a family has more than one child at La Scuola and one child is symptomatic?

In the case where a family has more than one child at La Scuola and siblings are in other cohorts, whether on the same campus or a different campus, if a child is symptomatic, the symptomatic child will be isolated in a designated location until a parent or caregiver can pick them up. The student will be sent home with instructions to isolate for 10 days and a negative COVID-19 test result will be required prior to returning to campus. The school must be notified of the results and will work with the individual on a campus return date in conjunction with SFDPH. The cohort will remain open and no specific communication with the health department is required.

We require any asymptomatic sibling to quarantine at home until the symptomatic child’s Covid-19 test results are back. 

If the symptomatic child’s test results are negative, the symptomatic student would follow standard handbook protocol on when they can return and the asymptomatic child may return to campus assuming they are also symptom-free. From our handbook: Children may return to school after they have been symptom-free for a minimum of 24 hours and/or are accompanied by a doctor’s note. For example, if the child leaves the school on Monday with a fever over 101, she/he should not return until at least Wednesday. 

If the symptomatic student tests positive for Covid-19, SFDPH will be notified immediately to facilitate contact tracing.  The student must isolate at home for at least 10 days after first symptoms occurred.  

A symptomatic student may return 10 days after testing positive AND symptoms have improved and if it has been at least 24 hours since the last fever without the use of fever-reducing medications.  

In this case, the sibling may be considered an individual who cannot avoid having close contact (for instance a caregiver or someone who cannot maintain any distance at home) and would be required to quarantine for 24 days (quarantine for 14 full days after the day that person completed their 10-day self-isolation). SFDPH quarantine and isolation guidance details can be found here.

This same protocol would apply in the case of any two family members or more that are at La Scuola.

Do you have any data on COVID cases in daycares and preschools in San Francisco?

The California Department of Social Services regularly updates Covid-19 Positive Cases in Child Care Facilities.

My young children are going crazy and they need to have a play date. How can we do one safely?

Making decisions about risk can be complicated. If you decide to have social interactions outside your household, please see these tips from the CDC

  • Clean hands often using soap and water or alcohol-based hand sanitizer.
  • Avoid people who are sick (coughing and sneezing).
  • Put distance between your children and other people outside of your home. Keep children at least 6 feet from other people.
  • Children 2 years and older should wear a mask over their nose and mouth when in public settings where it’s difficult to practice social distancing. This is an additional public health measure people should take to reduce the spread of COVID-19 in addition to (not instead of) the other everyday preventive actions listed above.
  • Clean and disinfect high-touch surfaces daily in household common areas (like tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, and sinks).
  • Launder items including washable plush toys as needed. Follow the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.
  • Make sure your children are up to date on well-child visits and immunizations.
  • Although most children get no or mild symptoms when they have COVID-19, some children are at higher risk. For some families, children with health conditions or disabilities may be feeling an intense need for social interactions. If you are feeling overwhelmed, reach out to La Scuola or others and let them know. The San Francisco Human Services Agency also has a 24-hour Crisis Line For Parents at (415) 441-5437. Source: SFDPH.

What does ventilation look like at each campus?

At our Dogpatch campus, we have an HVAC system with Merv 13 filters in place which will be replaced every two months (typically replaced every 6 months).  In addition, each classroom is equipped with an air purifier with HEPA filters changed 1-2 times per month and is efficient for 800 square feet, the maximum size of our classrooms. 

At our Fell campus, we rely on a large number of windows to cool the space / circulate the air and a steam / radiator heating system. Three is no forced air in the building.  Each classroom is equipped with an air purifier with HEPA filters changed 1-2 times per month and is efficient for 800 square feet, the maximum size of our classrooms. 

At our Mission campus, we rely on a large number of windows to cool the space / circulate the air and a forced-air heating system throughout.  The furnaces will be equipped with Merv 13 filters.  Each classroom is equipped with an air purifier with HEPA filters changed 1-2 times per month and is efficient for 800 square feet, the maximum size of our classrooms.

What are we using to clean on campus? How did we change our cleaning procedures?

Across all three campuses, our facilities team cleans throughout the day and we have a janitorial crew that comes each evening. They both use Quat20 at the recommended dilution. 

At our preschool campus and for grades Kindergarten and 1, where there are more manipulative toys or sleep mats available for children, a diluted chlorine solution is used regularly, as recommended by the Department of Social Service and the SFDPH.  We continue to wipe down common areas and high touch surfaces throughout the day.

Are face shields considered face coverings? 

When we refer to face coverings, we are referring to cloth face coverings (defined below). Face shields may be worn in addition (and will be provided to our teachers that are more comfortable wearing them) but they are not required. Only cloth face coverings are currently required for our teachers and anyone over two. 

What is a cloth face covering? A cloth face covering is a material that covers the nose and mouth. It can be secured to the head with ties or straps or simply wrapped around the lower face. It can be made of a variety of materials, such as cotton, silk, or linen. A cloth face covering may be factory-made or sewn by hand or can be improvised from household items such as scarfs, T-shirts, sweatshirts, or towels.

Someone I met up with tested positive for COVID-19. We haven’t touched and have only met outdoors, what is the risk and what should I do next?

We are learning more about COVID-19 each week. At the current time, there is minimal risk to outdoor, no-contact interactions where people are six feet apart at all times with their faces covered, and no food or objects are shared. If you think you spent more than 10 minutes within 6 feet of that person while THEY were not masked, then you should quarantine for 14 days. See Guidance for Isolation & Quarantine. If you develop any symptoms of illness, call your healthcare provider, get tested and isolate according to the instructions in Guidance for Isolation & Quarantine. Source: SFDPH

How will the school support students whose parents make the hard choice to keep them home, or who have to stay home for quarantine?

We are activating all of our resources to support our students and families during our return to campus. While we cannot predict the future, we know that some families may choose not to attend in-person classes. Should students not be able to attend in-person classes, Distance Learning will be available for our K-8 students. In a Distance Learning setting, students will receive a blend of synchronous and asynchronous learning.  

What will happen if someone tests positive?

SFDPH is finalizing its protocols for this, and we will follow these. We will share more information when we have it from SFDPH, but families can be certain that we will scrupulously implement all the steps required for our community’s safety.

What can students, families, and staff do?

If a case is detected that impacts a school, what are some possible steps we might take?

  • Work with the San Francisco Department of Public Health to evaluate exposure risk and make decisions regarding quarantine. 
  • The decision to close a school would be made on a case-by-case basis in collaboration with the Department of Public Health, and would take into account the general safety of all students and staff.

Will we have extended care at Elementary and Middle School?

We are actively working on what that may look like and will keep you updated on any news.  Extended Care will be highly dependent on SFDPH regulations for mixing of student cohorts. Our traditional Extended Care would remix groups of students; if we are allowed to remix groups to some degree, we may have some flexibility to offer the Extended Care program. If SFDPH regulations are such that we are able to offer Extended Care, we will plan to start the program as soon as we can while ensuring our regular school day is operating effectively