Zimplicity!

Last week shook us a bit and, although not unexpected, we all felt like it was a bit early. But, like I wrote last week, we learned much from it and, despite our general success, we can now move to improving our response and solidifying our practices. Middle School returned yesterday and settled back into class without losing a beat. Everything is, thus, generally on track.

Please help us on morning surveys. This is our main issue right now with entry and a critical component of our STOP plan. Daily morning completion of the survey is required and we would like to get our numbers down much lower in order to manage our systems in this regard. This is the reason for the 7:30 a.m. deadline each morning (except Wednesday and weekends). We need the time to check on any issues and we must have this in order to avoid checking children with you based on our lists. There are very few remaining application related issues. The vast majority of our challenge is the 100 -150 entries to the survey that come closer to 7:45 or 8:00. That overwhelms us and is critical to being prepared in the morning and being able to direct our time elsewhere.

To help with this, we are making some changes this coming weekend that we believe will help streamline your survey completion and minimize absences. Mainly, we will be moving to a four symptom focus:

• non-productive dry cough
• serious unusual tiredness
• loss of taste or smell
• serious muscle aches and chills

Please read the attached letter for details on the change and how this will help us focus on the most concerning symptoms and separate them from allergies and common cold symptoms. The link to the document below:

We will also be changing the time period AFTER symptoms and reducing the exclusion to 24 hours, with a requirement for re-test to re-enter. This will minimize absences without adding any risk to our identification as the letter explains.

Attached below is an addendum to our Data Processing declaration that you confirmed in PowerSchool at the beginning of the year. It clarifies the data exchange with EpiXpert and notifies you of the foundation for that exchange. We’ll also post this in PowerSchool and on our FAQ page for reference.

Thanks to those who have sent many messages of thanks and encouragement for our handling of last week’s exposure. You have all been wonderful partners in helping us to achieve our goal of responding to threats and minimizing the time out of school whenever a case emerges. You have all been wonderful.

And, finally, I’m going to change the schedule on Town Halls starting next week. I think we can relax a bit to every other week going forward in hopes of slowing down the communication incrementally. I’ll keep the morning Daily Updates for a bit longer. If we can get a few weeks under our belts without a new case, we’ll look to relax a bit further as we inch our way to the next crisis level. Looking forward to achieving that goal in short order.

Our community was challenged this week with our first COVID-19 infections and we moved right away to put our plans into action in the face of new challenges. As we move through our first day of “no further cases,” it is too early to reflect comprehensively, but the early insights are beginning to crystalize.

Learning #1 – We did well at school. The methods we used at school, both for protection through masks, distance, and hygiene, are limiting the spread of this virus when it intrudes. If that were not the case, we would have seen more cases yesterday. While we hope for no infection, we are also aware that infection will still emerge. Identifying it quickly is the core of our REACT strategy. What we do here limits the impact. It’s too soon to say for sure, but we seem to be on the right track.

Learning #2 – We need to finish fixing our systems to support this. Our app will get increased focus in the coming days and starting on Monday, we will all default to what the app tells us no matter what. Nothing with the app caused the problems, but it confused some of us and we have to regain your trust in it as a key tool. We’ll have to work hard to get there to earn your faith.

It should be noted that the App has been adjusted for exclusion for symptoms and will now flag a student as NOT OK4School if symptoms are reported and, further, will also flag family members for the same. As announced this morning and yesterday, going forward students who experience any of the following symptoms will remain home for 72 hours AFTER symptoms are gone (without medication).

• Temperature greater than 37.8C
• New or worsening cough
• Shortness of breath
• Significant reduction in sense of taste or smell
• sore throat and/or muscle aches
• fever or chills
• diarrhea or vomiting
• tiredness or weakness
• difficulty swallowing, extreme thirst, or loss of appetite

Learning #3 – We have to let this be our wakeup call about what we are doing outside of school. Many of the cases revolved around parties and gatherings during the weekend – birthday and otherwise. We have other students who are self-isolating because they came in contact with our subject or others not at ASW who were positive carriers. I’ve received many reports of this both directly and indirectly.

Let me put it simply: We just CAN’T do this! If we want a safe community and if we want to avoid future closures, we must avoid the things that you all know well. Let me try to list them:

• Do not attend any gatherings with mixed populations
• Do not let your kids play with others outside of the school community
• Do not join large groups in enclosed settings (concert, etc)
• Do not travel (I know – but that’s the way it is – it’s just not safe)
• Do not frequent restaurants and bars (confirmed by multiple studies as high risk)
• Do not have close contact with High-Risk individuals (close contact = no mask, within 1.5 meters for more than 15 minutes)
• Report ALL symptoms (see above) to school when known
• NEW: if one child is sick with the above symptoms, all children in the family stay home. Contact the school for guidance.

Learning #4 – It is good to be back at school. Despite this challenge, good things were already starting to happen. Kids were getting used to masks. They were washing their hands. They were learning and getting back into the swing of school.

So, I’m still convinced we are doing the right thing in the most prudent way possible. We were challenged by this sequence of events, but in the process, we tested and improved systems, confirmed that our tests work (all have been externally validated), and added to our resilience in times of adversity. Continuing our partnership, now and always!

Despite the difficult circumstances, we have begun our extraordinary year with only some general glitches to be resolved. All around the building, I’m hearing the joy in the voices and hearts of children as they reconnect with their friends, their teachers, their learning. As I said to all the Upper School assemblies, I missed you all terribly and it’s so good to have you “home.”

We are doing everything we can to work out the remaining glitches in various systems, but the core is working well and most are finding success with the various controls. From remembering that all temperatures should be in Celsius to the daily routines, I can sense that we are settling into some degree of stride, absorbing new practices as we go. Students are already starting to think creatively about how we can all contribute further to the PROTECT portion of our model and I’ve seen good attention to hand washing and appropriate practices throughout the building. There is a powerful understanding of our limits and the value of taking care of each other.

My thanks to all parents for your patience and I hope that our process has been helpful while making sure it’s not too daunting. It is change after all and change is always hard.

In terms of keeping you further informed, the following is a weekly feature from EpiXpert that will come occasionally and as needed to give you more information on their process.

Testing protocol

We have gone through the first round of testing during which we are using anterior nare swabs and antigen tests. Antigen tests detect the viral protein on the surface of the virus (vs PCR which detects the inside of the virus – its genetic material). As mentioned before, our tests have demonstrated 96+% sensitivity and 99+% specificity, with very narrow 95% confidence intervals (this is the range in which 95% of results fall into, the narrower, the more consistent the performance). These results are on par with PCR tests. The biggest advantage is speed and simplicity. They are also well suited for pooling because their sensitivity and specificity are not affected by pooling (samples are direct swabs so undiluted by transport medium). Antigen tests are being touted as the future of population-based screening – dependent on their availability.

Independently, we are working on validating RT-LAMP tests for use with saliva. RT-LAMP tests are a modern and simpler version of the “dinosaur” PCR method (PCR has been a novelty since the 1980s). We will provide an update on this within the next 2-3 months as this would further simplify the sample collection.

To ensure completeness of the process, if a pool comes out positive, we will isolate and retest each individual in the pool — and whoever tests as positive will be isolated and quarantined.

Swabbing technique

There are now four places accepted as equal for sample collection – nasopharynx, oropharynx, mid-turbinate, and anterior nares. We chose the anterior nares because it is less invasive for children and for more efficient for sample collection in populations. There are studies that actually demonstrated higher sensitivity of anterior nare samples as compared to the nasopharynx. Additionally, children have been shown to have 1000 times higher viral loads as compared to adults when shedding. We have also validated our tests on anterior nare samples. Hence, until we have validation of the RT-LAMP tests on pooled saliva samples, we will continue the current approach.

Even with the anterior nare swabs, there is an odd chance of discomfort or even minor irritation of the nasal mucosa. However, this is the only risk of the testing and is rather transient.