School Days

Dear Members of the Baylor College of Medicine Community,

I could not be sorrier to be back writing about another difficult week of our seemingly never-ending COVID-19 saga.  Sadly, once again we are on the wrong side of a developing wave.  Although we have not yet reached the peaks of prior waves, it is clear at this point that we – along with other regions of the country with low vaccine uptake – will reach, and probably exceed the peak incidence of new cases and hospitalizations seen in prior waves.  What are you feeling?  Discouraged? Exhausted?  Hopeless? Angry? Frightened?  I have heard these all.  The unfortunate reality is things will almost certainly get worse before they get better.  But we have been here before, we know what to do, we will get through this.  Although it appears SARS-CoV-2 will with us for the foreseeable future, hopefully this is our last major wave.

Clearly, we are collectively frustrated.  Today I want to focus on the positive things we can all do to help get through the next few weeks. 

• I will start with the "you sound like a broken record" part of the message.  Get vaccinated. Today.  Strongly encourage those around you to get vaccinated. Today.  Have a difficult conversation with someone you care about.  This is the single most important thing we can do. 
• If you are unvaccinated, you should be exceedingly cautious, and your risk is greater than ever.  The overwhelming majority of patients admitted to Texas Medical Center facilities are now unvaccinated.  Prior surges in hospital admissions were driven by people aged 60 and above.  This surge is led by people in their 20s, 30s and 40s.  Get vaccinated, mask, stay out of crowded indoor environments.
• If you are vaccinated, do not over-react to media reports on the Delta variant.  You are actually very safe.  We are certainly seeing "breakthrough" infections, and we will see more as our community disease prevalence rises.  But you still have extremely strong protection against getting seriously ill from SARS-CoV-2.  As long as we are in a high prevalence environment, be aware of your surroundings and use common sense.  Avoid overly crowded settings, especially indoors.  Assume everyone you meet is potentially infectious.  Mask indoors.  High situational awareness will limit your chance of catching or spreading the disease.
• Stop calling this the "pandemic of the unvaccinated."  True, the unvaccinated are driving hospitalizations.  But this is still the pandemic of those who for medical reasons cannot be vaccinated.  It is the pandemic of the frail elderly and immunosuppressed who wonder when their vaccine-induced immunity will start to wane.  It is the pandemic of hospitals and healthcare workers who have had no break since the Spring of 2020 and are now facing yet another wave of disease.  It is the pandemic of small business owners who, after a year of dealing with an existential threat to their livelihood, need a stable and predictable environment to lick their wounds and begin the process of real recovery.  Importantly, it is the pandemic of our children, especially those under twelve, who have no approved vaccine option. 

Regarding children, they really present a special and difficult case.  While true that statistically children are at much lower risk from COVID-19 than adults, statistics are of little comfort if your child draws the short epidemiologic straw.  In addition, the Delta variant may be driving more infections in children.  As the new school year rapidly approaches, parents are again faced with a difficult choice.  More accurately, parents are faced with accepting that they have virtually no choice.  Remote learning opportunities are far fewer than a year ago, and a poor option for many students.  A limited few will have the choice of private education or home schooling, but the vast majority of caregivers will – with a fair amount of trepidation – drop their children off at classrooms without required vaccinations or masking. Remember, in most cases, transmission of COVID-19 among students in school is relatively rare, especially when prevention strategies, such as physical distancing, cleaning and masks, are followed.  Still, this will be emotionally difficult for many.

What can you do to make this transition a little less anxiety provoking?  Here are some suggestions:

• Ensure everyone in your immediate family – those in regular contract with your child – is vaccinated.
• If your child is twelve years old or older, get them vaccinated.   Do it now.  If you start today, remember for the Pfizer vaccine you need to get a second dose 21 days later, and immunity does not peak for another two weeks.  Start today, and your child is about 5 weeks from reaching maximal immunity.  A single dose provides very poor protection against the Delta variant.  Make sure they get the second one.
• If you are able to choose a school/daycare center/afterschool program, ask some questions.  I am considering sending my child to your program.  What will you do to keep my child safe?  Do you enforce/encourage masking?  How do you promote/enforce distancing?  What percentage of your staff is vaccinated?  Do you require vaccination of your staff?  Over the past couple of weeks, members of my team did some "secret shopper calls" to ten daycare programs in the Houston area and asked these questions.  Gratifyingly, most – but not all – were well prepared to answer.  Most – but not all – seemed to have thoughtful plans in place.  One was clearly annoyed to be asked.  It was a useful exercise.
• Consider writing a letter to your child's teacher, or join with other parents in your classroom to write a joint letter.  A suggested sample:

Dear Mr/Ms XXXXXX,

First of all, I want to start by thanking you.  Teaching in the best of times is a noble and challenging profession, and these are not the best of times.  I am sure the past year has not been an easy one, and I am personally grateful that you are there to teach my child.

As I am sure you appreciate, it has also been a terrible time to be a school-aged child, or parent of a child.  I will acknowledge I am anxious about returning to face-to-face learning.  I know there is great benefit.  I know the risk to children is lower than that of adults, but I am still worried.   Respectfully, I make the following requests.  I do not feel I would be doing my job as a parent if I did not raise these issues.

• Please strongly encourage masking in the classroom.
• To the greatest extent practical, encourage physical distancing of at least three feet, and preferably six feet when the viral presence in our community is high. I recognize there are challenges to achieving this – all I ask is you do the best you can.
• Limit or eliminate outside visitors to the classroom.
• If you see children in your classroom who are symptomatic – including my own child – please remove them until they can be evaluated medically and deemed safe to return.
• I am not asking you to declare your vaccination status to me, but if you happen to be unvaccinated, and do not have a sincerely held religious belief that prohibits immunization or true medical contraindication, please get vaccinated.  This is the single most important thing you can do to keep my child safe. 

I do not necessarily expect an answer to this letter.  It is not my intention to make your professional life any more difficult than it must already be.  However, I am compelled to say: you are caring for the most precious part of my life.  I implore you to do all that you can reasonably do to keep my child safe during these difficult times.

Again, thank you for all you do.

I will finish with a word of advice as you interact with school administrators and teachers.  Parents are in a difficult place.  So are schools.  A respectful dialog may enhance communication and promote a safer environment.  A confrontation risks pouring kerosene on our ever-present embers of stress.  Working together, we can get through this.

Hang in there.  Better days are coming.

James T. McDeavitt, M.D.
Executive Vice President and Dean of Clinical Affairs

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