Here’s How We Start

Dear Parents,

ASW is about to embark on a course of action gleaned over many months of interaction and discussion with leading experts and wise counsel of the broadest reach possible in and outside our community.  This journey will include significant changes in our routines and habits, and we all need to work together to succeed in this goal, as our core values prescribe.  For sections below, you will find a checklist at the end of procedures you must follow to get ready for your child’s first day.  The rest of the divisional details will come next week, so these steps are a priority for you and your family.

Our health and safety work is based on our core values. There are important rules for us all to know well and follow closely. But for us to ensure everyone’s health and safety, it will take much more than enforcing a series of rules. It will take collaboration and commitment at the highest level, supporting each other, and affirmatively taking all the actions necessary to keep ourselves and our whole community safe. 

Earlier this summer, we received the recommendations of our partner, Epixpert, led by Dr. Jarek Oleszczuk, to assess our readiness and provide clear recommendations for the opening of school.  We have since undertaken the work associated with 23 key recommendations.  Part of this led to contracting Epixpert for further work with us.  Dr. Oleszczuk’s involvement in government sanitary guidelines reassures us that our approach will be consistent with government guidelines, which was confirmed by announcements released yesterday.

We will be implementing a multi-layered approach to the opening of school that will leverage the best options possible. We want to ensure that we prioritize efforts to create the best learning environment possible in each classroom. If you get a chance to watch the videos and review the materials of recent weeks, they will provide deeper insight into the procedures described below.  Two key web locations should provide access to all of these materials:

If you joined us for our summer Town Hall sessions, you should know that our planning is formed around our new key model:

STOP

First, the school will be implementing a broad-based required preventative testing program.  Our contract provider, Epixpert, will institute procedures to assure testing before the start of school and weekly thereafter.  The process will include a simple nasal swab test that eventually will be parent administered at home.  It’s simple, efficient, and will provide us good results for monitoring the overall health of the community.  We intend for this to be non-invasive and easy in order to assure that we offer a key layer of protection for all in this environment.

The testing solutions will be determined by our provider, Epixpert, and they will adjust procedures over time as the local area is assessed for community spread and risk, and should any case be identified through our process.  No one will be exempt from this testing regime and all necessary precautions have been taken to assure confidentiality and protection of data under Epixpert guidelines as the provider.

To serve our purpose, we will be implementing the OK4School application to provide for communication of test results and also implementing daily assessment of risk.  Parents will enter information into the app each day in order for the student to attend school. At the entrance to the school, you’ll find our final boundary protection in the form of ID checking, linked to the results from OK4School.  Next, special overhead cameras will check temperatures as students walk across sanitization mats.  Students will wash their hands for the first time each day at these entrances as well, as the last step of entering school.  Any student that is flagged at the entry for any reason will be further evaluated by our health office staff and you will be contacted for any concern.

Your checklist for STOP:

  • OK4School – you will receive an email within the next week that will invite you to load the app or access the web portal to set up your account.
  • In PowerSchool, choose whether you will attend regular school or select hybrid learning from home by filling out the Consent Form. (See below for more details on hybrid learning)  Also, complete updates to contact information and health/data questions.
  • Login to PowerSchool, click on COVID Testing, and schedule your appointment for any available time beginning August 10th and according to the schedule provided. (You must have returned to Poland for at least 72 hours before testing can be performed.  For selected countries, there is a 7-day requirement).  After August 19, you can be tested at school at any time by calling the health office to schedule a time for that first test. Testing will be in a drive-up format at our main entrance.
  • Get your child’s RFID wristband from the school when they are available and have your child wear it every day. (Wrist bands will be available during the first days of school.)

Your Choice -> In-Class or Hybrid Learning

We want to capitalize on our valuable and highly successful experiences with Virtual School from March through June in order to maximize learning opportunities for all students, whether they are present in the classroom or at home. The data we collected from students and faculty throughout the spring tells us that face-to-face, in-person learning is the most desired teaching and learning option for all. That said, we know there will be times when some in our community will not be able to be present in school, so we need to establish viable options for them.

Ultimately, we have learned throughout this pandemic so far that we have to live with uncertainty, and we have to remain as flexible and agile in our approaches to teaching and learning. Thus, establishing a hybrid model is important.

With regard to students who are learning from home, we will develop methods and strategies for teachers and students to connect both synchronously and asynchronously.  What specifically that will look like — from Zooming live into the classroom to following along asynchronously with assignments posted on Google Classroom — will be revealed closer to the opening of school, given that we need to iron out the details of hybrid scenarios with all of our teachers. This planning will constitute the bulk of the work we do together in the coming days. As details of these models are developed, we will publish them to all.

In elementary, for our youngest learners, we fully appreciate that a critical factor in ongoing learning achievement is the relationship between home and school during any learning period away from the school campus. We are committed to a model of frequent communication with families as they support the delivery model from home. Additionally, we will prioritize the need for social/emotional development in the activities that we design for the children as well as exploring ways to maintain the important relationship between the child and their teacher that lets them know they belong and we care about them.

PROTECT

Our protection regime at school will necessarily have the most impact on the way we operate.  Based on the recommendations from EpiXpert, we have made significant changes in the building to support these initiatives.  Handwashing and hygiene will be a focus, with stations throughout the school, along with reducing surface touching where possible.  Water fountains are gone and replaced with no-touch bottle fillers.  Surfaces will be more rigorously cleaned.  Sprayers will use non-toxic misting to disinfect daily and sometimes between uses.

Under this protocol, parents will not be able to access the school with their children.  We will have plenty of support for meeting children each morning as they are dropped off and will work with parents to nurture even our youngest into school in the best way possible. Divisions will provide greater detail on this, but our staff will be visible and present for children in the area just outside each cohort entrance to greet and make sure children are delivered safely to their teachers or first-period class.  Similarly, you’ll be asked about your pickup preferences and we’ll be prepared for kids to ride buses or be picked up in front of school entrances each day.

Another area of significant change is in the Cafeteria.  We will not have an open ala carte environment this year.  Information separately in this message will give you details on the limited food service options and how to order online since we will not be using cash at school.  Students are encouraged to start the year with a packed lunch brought to school.  Elementary students will eat lunch in their classrooms this year.  Middle school and High school students will eat in the cafeteria but in a socially distanced format.

Students will wear masks at school, particularly during movement, and where feasible in their classrooms.  This requirement is based on medical advice and may be relaxed in the future after our testing program demonstrates safety of students.  Staff will be wearing masks, too.  The CDC recommendations are being followed for a cloth or better mask.  Parents will provide this for their students to wear at school, but the school will have backup masks in case they are needed.

Your checklist for PROTECT:

  • Login to PowerSchool and connect with our food service provider through the Cafeteria link on the left menu.  See the information below for more details on setting up your account if you haven’t done this already.
  • Prepare to send your child to school with two masks each day.  One to wear and one as extra in case needed.
  • Fill out the daily questions on the OK4School app and check your child’s status before sending them to school.
  • Children may only enter the school at their cohort entrance.

REACT

In the react section, we prepare ourselves to respond to an infection when it is identified.  This is triggered by a positive result on any of our testing, but may also be initiated by information reported through the OK4School app or that comes from government reporting of exposure.  We are prepared to provide for quick response and action on an identified infection or threat through exposure identification and mitigation and follow-up testing.  This might mean that groups of children are temporarily excluded from school until they can be retested and returned to school.  It may also involve closing a cohort or the whole school until retesting that allows us to reopen.  In a group, cohort, or whole school closure, we will initiate our Virtual School approach and communicate how learning will continue until the threat or exposure is mitigated.  Our goal will be to return to school as soon as possible when medical evidence suggests it is safe.  Our chart for mapping this response is here:

https://zimplicity.org/wp-content/uploads/2020/08/ASW-Testing-Protocol-1.pdf

We will communicate regularly with parents about any concerns and the whole community will be updated whenever there is a positive case identified and the mitigation that was initiated.

Your checklist for REACT:

  • Fill out the OK4School app each day
  • Be prepared to follow-up on school medical advice
  • Make sure that testing is completed as scheduled

CONCLUSION

We are not done tuning our approach and we will remain agile in our procedures so that we can respond effectively and efficiently when required.  The other questions regarding logistics and in school procedures will come more from divisional offices.

Please review this information and the information that follows.

Thank you for your patience and participation in making it possible for the school to begin despite the challenges.  Be reminded that there is no 100% solution that we can enact.  But, the actions we have taken help us to achieve an acceptable level of risk.

Looking forward to our first day together.

Regards,

Mr. Z

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Making the Case for Preventative Testing at ASW

Also on Medium at: https://medium.com/@jon_zurfluh/making-the-case-for-preventative-testing-at-asw-b5f1f657ec02?source=friends_link&sk=fedc0fb0f04165a3a7c69713ffbd5d20

As part of getting ready to open schools, and understanding the potential that this might not apply in countries where there are limited resources for successful bid process to identify providers, this paper sets out to make the case for a critical safety measure that could allow the return to a more normal approach to schooling and allow for a degree of confidence in practices when this method is also coordinated with access and hygiene-related measures to provide a layered approach to risk reduction.

In coordination with Epixpert.pl, the American School of Warsaw engaged in a full epidemiological audit of our school facility to determine practices and assess components for a multi-layered approach to safe school opening. This work with Epixpert and Dr. Jarek Oleszczuk, MD, Ph.D., a founding partner, has been instrumental in laying the foundation for a safe and successful return to brick and mortar schooling in August.

The three goals of the audit were to 1) prevent the virus from entering the school, 2) ensure that in case the virus enters the school, it does not spread widely, and 3) keep our educational and programme delivery model as unchanged as possible. The audit provided a 14 point comprehensive set of recommendations for mitigation that will reduce the risk for our population and achieve these goals.

In addition to a comprehensive building plan and facility review, the overall audit provided to ASW included an aggressive preventative testing plan for the entire ASW population of students and staff, partnered with in-home risk assessment and facility entry control with temperature checking. The most significant of these proposals is the testing protocol and the following summary, provided by Dr. Oleszczuk, constitutes the structural backdrop to provide for the implementation of practices that being adopted in both the corporate and public service realms around the world, including, as noted below, schools at both the preparatory and post-secondary levels.


SUMMARY

  • 80% of outbreaks are caused by asymptomatic or presymptomatic carriers
  • Frequent testing as a screening tool is the only approach to identify carriers
  • Pooled testing has been validated both scientifically as well as in population settings as a valid approach of screening large populations while preserving resources and financial outlays, offering up to 70–80% savings
  • The FDA has recently acknowledged pooled testing as a screening methodology for asymptomatic individuals
  • Dr. Anthony S. Fauci has publicly announced that a US-wide strategy of pooled testing will be ready by the end of summer
  • Numerous schools and universities in the US are implementing pooled testing as one of the key measures in 2020/21 academic year
  • The FDA accepts nasal swab (both anterior outer nares) as an acceptable alternative to nasopharyngeal swab in SARS-CoV-2 testing
  • On July 18, the Food and Drug Administration issued the first emergency use authorization for a PCR test to be used with pooled samples in the U.S.

In order to contain the spread of any pandemic (including COVID-19) before the broad availability of an effective vaccine, it is imperative to identify all carriers. An alternative is, of course, a broad lockdown that has been shown to have dramatic consequences — not only for businesses but also for schools.

In order to preserve the classroom learning, we need to employ every possible measure to identify all potential SARS-CoV-2 carriers and prevent them from entering the school.

Unfortunately, symptoms of COVID-19 appear many days after inoculation (3–12 days) so identifying ill individuals via body temperature measurements will not identify presymptomatic carriers. Moreover, over 50% of infections are asymptomatic, further confounding the identification of ill individuals. A recent study of more than 60 outbreaks in Japan demonstrated that over 80% of outbreaks have been caused by asymptomatic or presymptomatic carriers.

Thus, the only way, other than a lockdown, to identify SARS-CoV-2 carriers is frequent testing, frequent enough to occur within the window of 3–12 days.

Yet, with current lab fees around $100 per test, repeatedly administering COVID-19 tests to an entire student body will become prohibitively costly for schools. Moreover, no country has the capacity to process tests of every student.

Pooled testing is a well-established approach to track infectious disease, and has already been run successfully on coronavirus samples at labs in Stanford and Israel. In this approach, lab tests are batched in samples of several people and these batches are tested for the presence of active virus. If the test indicates at least one person in that pool is infected, repeat testing of the individuals in the infected pool can reveal the source. This follow-up step does not require a separate round of specimen collection. Rather, each person’s sample is split into two at the beginning of the process — one is subjected to pooled testing, and the other set aside in case individual follow-up testing is required. In contrast, if the pooled sample comes back negative, it could clear all members of the pool for work, at least until the next testing cycle. While there are inherent challenges in this approach, including choosing appropriate pool sizes and factoring in test-reliability concerns, estimates suggest that pooled testing could lower testing costs by up to 70–90% while the prevalence of COVID-19 remains low in the general population.

According to a recently published white paper by researchers at the University of Southern California Schaefer Center for Health Policy & Economics, this strategy can be used with polymerase chain reaction (PCR) testing. The most efficient initial pool size depends on prevalence, with rarer conditions allowing larger pools. Given the current prevalence of COVID19, even five- to 10-person pools of employees or students are likely to test negative, obviating the need for administering tests to each person. A recent study suggests that it is feasible to pool samples on this scale without significantly compromising the integrity of the PCR tests. A simple example illustrates the logic.

Consider an employer with 100 employees in a region of the country believed to suffer from a 5% prevalence of active COVID-19 infection. This employer splits up its workforce into 20 groups of five workers each. For simplicity, suppose that exactly five workers have the disease so that the employer is experiencing the same prevalence as its overall region. Under pooled testing, no more than five pools will return positive tests. The employer then tests the employees in the positive pools individually. In this case, no more than 25 individual tests are run, since there are five pools testing positive, each with five workers. Ultimately, the employer has successfully identified all five of its COVID-19+ employees, but it only needed to run 45 tests — 20 initial pooled tests and 25 individual follow-up tests. The employer saved 55 percent of the cost that would have been incurred via individualized testing.

Pooled testing works best when the employer or school system chooses pool sizes correctly. For instance, if pools are set too large, every pool might test positive. In this case, the organization gains nothing from that round of pooled tests. This issue is particularly salient in high-prevalence regions, where large pools of employees might routinely turn up at least one positive case. By contrast, employers in lower-prevalence regions can afford to use larger pools, because even large pools of employees have a good chance of testing negative in these regions. However, even relatively high-risk regions stand to gain from pooled testing. For example, pool sizes of four to seven employees could help the vast majority of organizations reap most of the gains from pooled testing, even when they are highly uncertain about the prevalence of the illness in their workforce. We estimate that pooled testing could reduce testing costs by 80 percent in low-prevalence regions, and still save 50 percent for higher prevalence (5 percent) locations. Indeed, even if prevalence climbs to 10 percent schools can save as much as 40 percent via pooled testing strategies.

The pooled sampling approach has recently been validated on a population scale during the second wave of infections in Wuhan, China, where more than 11 million inhabitants have been tested in just days.

In a recent interview, Dr. Anthony S. Fauci hailed the approach and stated that “We’re in intensive discussions about how we’re going to do it…. We hope to get this off the ground as soon as possible.”

During a recent visit of Vice President Mike Pence to the University of South Florida, Dr. Deborah Birx announced that the federal government is working to support pooled (i.e., preliminary) testing, where samples from entire families or groups can be tested in a single collection medium and sent to a lab for quick results. In the event that one person in the pooled group tests positive, then individualized testing, using medically certified testing procedures, allows for contact tracing and self-quarantines. She said that, for example, entire classrooms can be tested in this manner, as well as students in a university residence hall.

In a call with reporters on Wednesday, July 1, 2020, Adm. Brett Giroir, deputy secretary of health and human services, said he expected the program to be up and running by the end of the summer.

On June 16 the Food and Drug Administration of the United States published an important update to its EUA requirements for test manufacturers as well as laboratories who want to perform pooled sampling. In its press release, the FDA states that “Diagnostic tests are an important tool in anticipating and meeting the continuing and evolving public health needs as we combat COVID-19. Today, the FDA took a meaningful step forward in getting more tests to more Americans more quickly and making that process even easier for developers by posting template updates regarding the validation of molecular diagnostic tests for developers that intend their assay to be used for pooling patient samples or for screening asymptomatic individuals not suspected of having COVID-19.

The FDA recognizes that organizations may want to conduct screening of asymptomatic individuals as part of a broader strategy to help ensure the safety of their employees, patients, students, and others.

This method works well when there is a low prevalence of cases, meaning more negative results are expected.

Oberlin College recently announced its reopening plans and weekly testing using a pooled sampling approach is one of the key measures taken to ensure safety in the College. President Carmen Ambar recently wrote to students and detailed her plans for reopening:

Oberlin is finalizing a contract with Tempus, a private testing firm that guarantees capacity for initial and regularized diagnostic (PCR) COVID-19 testing for students, faculty, and staff who will be on campus. PCR testing provides an indication of the presence of the coronavirus by looking directly for its genetic material. Such tests can determine if someone is carrying the virus, whether or not symptoms are present. We are working with public health experts to determine the parameters and frequency of testing, but our goal is to do surveillance testing for up to 25% of our population each and every week to get a snapshot of our campus.

We are fortunate to have a local hospital almost literally on our campus, Mercy Health-Allen Hospital. We are currently in negotiations with Mercy-Allen to administer a test to our students, faculty and staff, during the move-in period and to support our weekly testing strategy. This means we will test 3,500 or more people in August and then similar numbers each month.

This won’t be easy, as it will require significant logistics and coordination, as well as a substantial financial investment. The College will be fully funding our faculty and staff, and we will be asking for some family support in the form of a testing fee for students. We did not come to this decision lightly, but public health experts say this is the best way to help ensure viral spread does not catch us by surprise.

Similar measures are being introduced by Syracuse University, which recently announced pooled testing will be used to regularly test all of its 20,000 students.

Centogene N.V., a commercial-stage diagnostics, and genetic research company, and the OESIS Network Inc., an innovation network of more than 600 schools across the U.S., have announced a partnership for COVID-19 screening of schools. The partnership will offer RT- PCR testing that can aid schools in their return to campus in the fall and continued screening to prevent a resurgence of COVID-19 over the course of the academic school year. Their approach will incorporate pooled testing, where test samples are batched — potentially reducing analytical costs.

According to the FDA, a nasopharyngeal specimen is a preferred choice for swab-based SARS-CoV-2 testing. If a nasopharyngeal specimen is not available, there are a number of alternatives.

The following specimen types can be obtained with a swab:

  • Nasopharyngeal specimen collected by a healthcare professional (HCP);
  • Oropharyngeal specimen collected by an HCP;
  • Mid-turbinate specimen by onsite self-collection or HCP (using a flocked tapered swab); or
  • Anterior nares specimen by onsite self-collection or HCP (using a round foam or spun fiber swab).

Multiple specimens from the same patient may be taken with a single swab. If a separate swab is used for collecting specimens from two different locations in the same patient, both swabs may be placed in the same vial in order to conserve collection and assay supplies. Other swab specimens (i.e., tongue swabs) may have decreased sensitivity, so caution should be exercised when interpreting negative results. More data are necessary to better understand the validity of buccal swabs, saliva specimens, or other specimen types for COVID-19 testing.

On July 18, the Food and Drug Administration issued the first emergency use authorization for a PCR test to be used with pooled samples paving the way for broader use of this approach:

This EUA for sample pooling is an important step forward in getting more COVID-19 tests to more Americans more quickly while preserving testing supplies,” said FDA Commissioner Stephen M. Hahn, M.D. “Sample pooling becomes especially important as infection rates decline and we begin testing larger portions of the population.

References

1. Furuse Y, Sando E, Tsuchiya N, Miyahara R, Yasuda I, Ko YK, et al. Clusters of coronavirus disease in communities, Japan, January–April 2020. Emerg Infect Dis. 2020 Sep [date cited]. https://doi.org/10.3201/eid2609.202272;

2. Hogan CA, Sahoo MK, Pinsky BA. Sample Pooling as a Strategy to Detect Community Transmission of SARS-CoV-2. JAMA. 2020;323(19):1967–1969. doi:10.1001/jama.2020.5445

3. Idan Yelin, Noga Aharony, Einat Shaer Tamar, Amir Argoetti, Esther Messer, Dina Berenbaum, Einat Shafran, Areen Kuzli, Nagham Gandali, Omer Shkedi, Tamar Hashimshony, Yael Mandel-Gutfreund, Michael Halberthal, Yuval Geffen, Moran Szwarcwort-Cohen, Roy Kishony, Evaluation of COVID-19 RT-qPCR test in multi-sample pools, Clinical Infectious Diseaseshttps://doi.org/10.1093/cid/ciaa531

4. https://healthpolicy.usc.edu/wp- content/uploads/2020/05/USC_Schaeffer_PooledTesting_WhitePaper_FINAL-1.pdf

5. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19- update-facilitating-diagnostic-test-availability-asymptomatic-testing-and

6. https://www.nytimes.com/2020/07/01/health/coronavirus-pooled-testing.html

7. https://www.usf.edu/news/2020/white-house-coronavirus-task-force-visits-usf-to- address-floridas-spike-in-covid19.aspx

8. https://www.oberlin.edu/campus-resources/bulletins/covid-19-planning-2020-21- oberlin-college

9. https://www.syracuse.com/coronavirus/2020/07/how-will-syracuse-university-test- 20000-students-for-coronavirus-by-pooling-their-saliva.html

10. https://www.technologynetworks.com/diagnostics/product-news/centogene-and- oesis-network-partner-up-for-covid-19-testing-for-us-schools-337103

11. https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs- testing-sars-cov-2#troubleobtainingviraltransport

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The End of Year is Upon Us

A year comes to a conclusion, but not as we planned. We’ve done everything in our power to bring this year to a close in the best and most engaging way possible under the circumstances. Every ounce of energy has been expended and I’m well aware that we will all collapse from exhaustion on Friday, ready for some time to contemplate and understand what comes next.

We should all enter into the summer with hope in our hearts. The most important thing we may have learned from #lifesolation is the importance of our sense of community. It has both informed and sustained us. We now have proof of the old adage that absence makes the heart grow fonder. Forged by our absence, the longing for a return to our relationships has been profound, particularly in recent days. And, I know for some, this is almost overwhelming. We have learned how precious that opportunity to connect is for all of us. In education, we live in a kind of place where people are valued over product, where possibility and accomplishment flow from relationship and collaboration. We live to be together and the punishing separation of our weeks at home have taught us what we must now cherish and renew.

We wish you well for your summer sojourn, wherever it may or may not take you. We hope for peace, health, and safety despite an increasingly complex world.

This is your last eNotes for this year. We’ll be back again in early August to get us ready for the new school year. Other communication will come directly in the meantime. Throughout the summer, look for opportunities to continue Town Hall meetings and less frequent Updates from the Director for the latest information on planning.

Please plan on joining us on Friday, first for our online closing assembly with some wonderful surprises. Link is here to get ready and also in the Daily Updates. I highly recommend gathering around a big screen if you can set it up and watching this together as a family. It’s packed with important messages and special messages from our students. Please join us for this most important Livestream:

https://www.aswarsaw.org/about-us/livestream

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