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Testing, Surveillance Strategies, Social Distancing, & Community Spread Are The Key Requirements for Students and Families to Feel Safe in Returning the Campus This Fall According to Top COVID-19 Officials

Yesterday, May 12 th , the U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) held a virtual hearing entitled, “COVID-19: Safely Getting Back to Work and Back to School”.

The hearing brought together top officials from within the U.S. Department of Health and Human
Services including representatives from:

  • The Office of the Assistant Secretary for Health;
  • National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIAID);
  • Centers for Disease Control and Prevention (CDC); and
  • Food and Drug Administration (FDA).

Each witness was asked to provide testimony regarding:

o The current status of the fight against the disease;
o Their assessment of when it will be safe for the nation to return to a more regular schedule/routine; and
o What protections and requirements should be put in place to assist in controlling/preventing future outbreaks of the virus.

During what was often times a particularly partisan discussion, the two key times in which the Senators and the panel of experts discussed Education policy came first with the opening questions by Senate HELP Committee Chairman Lamar Alexander (R-TN) and later in the hearing as part of a series of questions and observations presented by Senator Rand Paul (R-KY).

Chairman Alexander, hoping for reassurances that both elementary and secondary institutions and
institutions of higher education can look to open in the fall, asked the panel what they would say to
persuade parents and students to return to school in August (and September).

Several panelists attempted to answer the Chairman’s question, providing more than a few key
takeaways worthy of summation:

1. It IS realistic to believe that institutions can open in the fall. However, to do so will depend considerably on:

a. Access to Testing – By September 2020, HHS expects to be able to produce and distribute approximately 25-30 million point-of-care tests per month. Such tests would provide institutions with the capability to test their student populations using the Surveillance Strategies developed by the state/institution/feds.

b. Implementation of Surveillance Strategies – Multiple strategies could be developed and implemented to ensure regular testing of students (e.g. tests upon start of term, testing rotations, pooling tests, and possibly new emerging tests such as wastewater assessment).

c. Maintaining Social Distancing – The panelists were united in their beliefs that social distancing is a key factor in controlling the spread and potential for recurrence of the disease.

d. Tracking Community Spread – The location of the institution and its proximity within the state, regional, or local community to outbreaks of the virus that are going to occur.

2. It IS NOT realistic to believe that there will be a proven treatment to halt the spread of the disease or a vaccine to protect individuals from contracting the disease by this fall. There may be some breakthroughs throughout the coming months, but the efficacy of those new treatments/vaccines will take time to assess before their effectiveness can be truly determined.

3. There IS NOT an easy answer to when states, employers, academic institutions, or other economic and workforce engines should reopen and there IS NOT any way to determine where, when, and/or to what degree future outbreaks will occur.

4. There ARE serious concerns that reopening too soon could have “really serious” consequences, including potentially setting the area back further than the original novel coronavirus outbreak.

Senator Paul later expressed his frustration with the inability to more accurately predict the viruses spread and the negative effects that also arise when the shelter in place and limitations are prescribed unilaterally. He explained that in his home state of Kentucky there are larger regions of the state that have not, thus far, experienced the levels of disruption and adversity experienced in other places. His observation, frustration, and concerns centered around the adverse impact further limits on reopening areas of the country will have on individuals education – noting that an extended period of time out of the elementary and secondary school system, especially without adequate support during the hiatus, could have a devastating – and long lasting effect – on various groups of students. Impacts that they may not be able to overcome.
To that end, he urged consideration of the counter argument to re-opening too soon, the opportunity
cost of not opening soon enough.

Complete Reprint of Senate HELP Committee Chairman Lamar Alexander’s Q&A

Senator Lamar Alexander, Chairman

Senate Health, Education, Labor and Pension Committee

Let’s look down the road three months, there will be about five thousand campuses across the country trying to welcome twenty million college students and one-hundred thousand public schools welcoming fifty million students (at the K-12 level).

What would you say to the Chancellor of the University of Tennessee (Knoxville), or the principal of a public school, about how to persuade parents and students to return to school in August?
Let’s start with treatments and vaccines first, Dr. Fauci?

Dr. Anthony Fauci, Director
National Institute of Allergy and Infectious Diseases, National Institutes of Health

Well I would be very realistic with the Chancellor and tell her that when we are thinking in terms…in this case, the idea of having treatments available, or a vaccine, to facilitate the reentry of students into the Fall term, would be something that would be a bridge too far.
As I mentioned the drug that has shown some degree of efficacy was modest and it was in hospitalized patients. Not yet, or maybe ever, to be used either as prophylaxis or treatment.
So if the issue is that young individuals who will be going back to school would like some comfort that there is a treatment, probably the thing that would be closest to utilization then would be passive transfer of convalescent serum.
But we are really not talking about necessarily treating a student who gets ill, but how a student will feel safe in going back to school.
If this were a situation where we had a vaccine, that would really be the end of that issue in a positive way. But as I mentioned in my opening remarks, even at the top speed we are going, we don’t see a vaccine playing in the ability of individuals to get back to school this term.
What they really want is to know if they are safe. And that is the question about what do we have to do with testing.

Chairman Alexander

Admiral Giroir, you said that we are doing about ten million tests this month, that we might be as high as forty or fifty million a month by September, which is a significant increase.
So, if I am the Chancellor of the University of Tennessee could I develop a strategy where I say to all my students that we have for example antigen tests, which are quick and easy. We want everybody on campus to come by and take it once before you begin school. That will, at least, let everybody know that day we have isolated anybody that might test positive. And that then we can continue to monitor. Is that strategy possible in August and September?

Admiral Brett Giroir, Assistant Secretary for Health
United States Department of Health and Human Services

The strategy that is going to be employed really relies heavily on the community spread at that time. If
there is almost no community spread your strategy will be different. If there is high community spread it
will also be different.

But yes technically we will have the ability, and your Chancellor will have the ability (to enroll in the fall).
We expect there to be about twenty-five to thirty million point-of-care tests per month available. And it is certainly possible to test all of the students. Or, it is much more likely that there would be a surveillance strategy done where you would test some of the students at different times, given assurance that there is no circulation. That would be done with the CDC and the local health department. 
There are also strategies that are still needing to be validated (i.e. pooling samples). We know that some  experimental labs, as many as ten or twenty samples can be pooled, so that one test could test twenty
And finally, there are some experimental approaches that look interesting, if not promising. That for example wastewater from a dorm or an entire segment of campus could be tested to determine if there are coronavirus in that sewage, the wastewater. So there are other strategies being developed.
I’d like to give at least twenty second to Dr. Redfield who will be working on the strategies to teach us how to deploy the strategies in different communities.

Dr. Robert Redfield, Director, United States Centers for Disease Control

First, I think it is really important to evaluate critically the changes in the roles of social distancing on college campuses and the schools in these situations and not to forget the experiences from what we have learned (when individuals fail to social distance).
Clearly also addressing a plan for wellness education. Making sure that people understand when they are symptomatic and need to seek evaluation. I mean you are going to have to take a look at the important role of testing in these circumstances. I think it will be individualized based on where these various schools are and how much infection is in the immediate area.

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