The message was clear from UCLA’s Fielding School of Public Health: Getting vaccinated is imperative to fight the virus, as are social distancing, mask wearing and isolation and quarantine of the ill.
The return of students to in-person classes and a highly transmissible variant of the virus have compounded the demand for these measures, UCLA scientists said at a recent webinar on COVID-19.
Dr. Ron Brookmeyer, dean of the UCLA Fielding School of Public Health and distinguished professor, Department of Biostatistics, moderated. He asked what concerns the panelists had about schools re-opening during a pandemic.
“I think the biggest concern is the recognition that the rates of disease in schools is going to mirror the rates of disease in the communities around them,” said Dr. Robert Kim-Farley, professor, departments of Epidemiology and Community Health Sciences, at UCLA Fielding School of Public Health. “And unfortunately, with the Delta variant, we are seeing rising rates in these areas, and this is going to translate into potential outbreaks in schools. So it’s important that school districts try to implement methods to be able to reduce and prevent COVID circulation.”
“We are really at a crossroads here. And the patchwork (to the virus) that we see across the United States, where some school districts have even banned the use of masks, is really problematic for public health,’’ he added.
On the day of the webinar, the Los Angeles Unified School District, the second-largest school district in the country, approved a COVID-19 vaccine mandate for students 12 and older. Vaccines will be mandatory for all eligible students by Thanksgiving if they want to attend in-person classes. The district has more than 600,000 students in more than 1,000 schools. New York City’s school district is the largest in the country.
“As Dr. Kim-Farley just said, we have a variant that is circulating that is so much more contagious than the original variant that we were dealing with last year,” said Dr. Anne Rimoin, professor, Department of Epidemiology, and director, Center for Global and Immigrant Health. “We really have to be putting all of the things that we can into play. So I am very supportive of LA USD’s rules. But that is just one strategy that will be important. It’s going to require vaccination and it will require testing, because we know there are breakthrough cases that occur. And continuing to use social distancing and ventilation.”
Unvaccinated Driving Pandemic
She said that the unvaccinated are driving the pandemic. “They are the most likely to get infected and suffer the consequences of it. We really need to get people vaccinated. We not only have to think about our communities but globally,” Rimoin said.
President Biden has said of the approximate 80 million Americans who have not been vaccinated, “Our patience is wearing thin; your refusal has cost all of us.” He has imposed mandatory vaccine and/or testing rules on federal workers; employers of more than 100 workers, and health care staff. The new requirements could apply to about 100,000 million Americans, nearly two-thirds of the American labor force.
Rimoin, an expert in emerging infections and vaccination, said getting the message out is critical but challenging.
“I’ve been doing a lot of media work for other things previously, such as emerging infections, so I was a little more comfortable talking about these things when we didn’t have more information on what was new in COVID. A lot of people say, ‘Thank you for explaining it to me,’ but I also got a lot of negative comments; and threats to myself and my family.
“Quite frankly, it was scary. That was very, very difficult for me because I am committed to communicating and making sure people know what is going on,’’ Rimoin said.
She suggested that public health officials approach the vaccine-resistant ”with understanding and compassion, which are critical to understanding others’ viewpoints. We need to ask questions and explain why we are willing to get vaccinated.”
Because of breakthrough infections, Kim-Farley said that Los Angeles school district teachers and students, vaccinated and unvaccinated alike, are regularly tested.
For children under 12, who are not yet eligible to receive a vaccine, other measures need to be taken for their protection from COVID, Rimoin said.
“First, vaccination for people who are eligible: who is eligible in elementary schools? All of the teachers, all of the staff members, everybody around them (the children). If we can get as many vaccinated around these kids as possible, we will do a better job of keeping the virus away from them.
“Another thing that we can be doing is that we can be testing, testing frequently. And testing is going to be key to identify cases early on, so pull people out, isolate those who are sick, but also quarantine those in close contact. It’s important to remember that it’s not just about the child but all the contacts the child has — often there are siblings of a variety of ages; it’s very complicated,’’ Rimoin said.
Another measure to protect children from the virus is providing good ventilation; Rimoin said some schools are unable to afford updates and improvements to their ventilation system.
“It’s under-discussed in these scenarios. A lot of schools have trouble updating their buildings. But we can use air scrubbers, opening windows and reduced occupancy wherever possible. Here in L.A., one of my former students in the Epi department, told me that during the 1918 pandemic, they held school outside. I think we under use the outdoors here in L.A.; we should really be thinking about that.’’
Developing and distributing a vaccine for children under 12 is urgent, Kim-Farley said. “It’s really going to be important for us because we won’t reach levels of immunity until we get children under 12 vaccinated.”
Brookmeyer asked what are best practices for dealing with children with COVID-19 symptoms.
“If the child has symptoms of COVID, they should be kept at home, until either they have been cleared or it’s confirmed that it is COVID-19,” Rimoin said. “That child should be isolated at home and should be tested. If they test positive, they should follow the guidelines: 10 days of isolation until symptoms start to resolve; take medications and follow CDC guidelines.”
“If there are other children in the household, it’s wise to test all in the household,” she added. ”Whether you can hold all at home, is a question of logistics and their risk threshold. But if a child tests positive, all in the house are exposed. I recommend that they quarantine appropriately. They are still at risk for getting this, whether you are vaccinated or not.”
How Variants Work
Kim-Farley said variants of a virus fall into three groups: of interest, of concern, and of high consequence.
“The Delta variant is considered a variant of concern. We know it is more transmissible because there have been more breakthrough infections; that it why it is of concern. It’s much more easy to be transmitted. I think prior to Delta, we felt our vaccine was very good for prevention of severe disease or death, or very effective in stopping or curbing transmission. But, it isn’t a brick wall to stop transmission,’’ Kim-Farley said.
Kim-Farley said that the current vaccines are holding up well for protection from severe disease and death and that those who are vaccinated and have breakthrough cases are “very asymptomatic or having mild symptoms.
“Those in hospitals and dying are primarily unvaccinated people. It’s much more a pandemic among the unvaccinated,’’ he said.
Informing the Public
Brookmeyer suggested that there is an aspect of good citizenship in getting vaccinated.
“How do we convince people to get vaccinated? How do we put this out there and explain the issues?’’
Kim-Farley said the public health sector has done a good job of informing the public. “We do a pretty decent job in public health in putting out statistics, showing rates among the vaccinated and unvaccinated, but the anti-vaccine movement often appeals a lot more to the non-linear (thinking) than the scientific.
“Its appeal is much more on the emotional level. We need to fight fire with fire. There are those people who did not get vaccinated and who have either gotten seriously ill or a family member did, or they died. They expressed the regret of not having been vaccinated, of not having taken this seriously. The more stories we can get out will help our public health approach. We need to appeal to the emotional side of why we need to be vaccinated,’’ he said.
Kim-Farley said that a formulation of the booster vaccine will “have taken into account the new Delta variant; so not only will it be a booster, but a tweaked booster. At the moment, it looks like the vaccine does well against the variant, and boosted, even better. We will see in the future, with more variants that outweigh the vaccine, a change in the formulation of boosters.’’
With the arrival of colder weather and the flu season, Kim-Farley said it is safe to get both a shot for the flu and the COVID-19 vaccine at the same time.
Anticipating the holiday season, with its high travel and contact among family and friends, Kim-Farley said getting vaccinated is a priority, as well as other following other measures.
“We encourage people to try to be somewhat vigilant, to avoid highly dense indoor crowds, and, social distancing and mask wearing are also important.’’
Confusion because of new and changing information about COVID-19, Rimoin said, does not alter the need for caution.
“Scientists have become very defensive, so they’re less likely to talk about issues that are not completely supported yet. One thing that I can say: it’s easier to stay out of trouble than to get out of trouble.’’
Kim-Farley said that despite the confusion, there is an unchanging reality.
“As much as we are hearing noise out there regarding the vaccine, that it’s not effective, the bottom line message is: These vaccines are highly effective for severe disease and death. That is what we want a vaccine to do — to protect us against these events. So, it’s important to get vaccinated,’’ Kim-Farley said.
In a four-decade career in journalism, Eleanor O’Sullivan has reviewed many books on best practices for financial advisors, has written for Financial Advisor and the USA Today network, and was movie critic for the Asbury Park Press.