Page 33 - Campus Security & Life Safety, November/December 2020

19, some schools eliminated mandatory physicians’ notes for absenc- es and perfect attendance awards. Most schools negotiated with their teachers to avoid the practice of decreased reimbursement for those declaring sick days.
Schools with bigger budgets used next-generation cleaning and hygiene products mainly implemented by other industries. Sophisti- cated products have been used to decrease COVID-19-laden aero- sols, including vaporized hydrogen peroxide, ultraviolet-based disin- fectants, new HEPA filters and autonomous floor scrubbing robots.
Perhaps the most important advance has been the creation of novel electronic products that schools can use for symptom monitoring and health management. Symptom monitoring has been universally acknowledged to be a mandatory part of any reopening program. On the surface, symptom checks screen for people with possible COVID-19. However, they also educate everyone on the disease of COVID-19, allow early detection, and may even indirectly promote safer behavior. Generally, symptom monitoring has been incorporated into a questionnaire that can ask about the presence of COVID-19 symptoms. More sophisticated questionnaires can also ask about symptomatic contacts or concerning travel histories.
Monitoring Symptons
Schools have been using a wide gamut of products for monitoring symptoms since reopening began. These products have included simple paper forms, online products related to Survey Monkey or a Google Doc, and more complex electronic software platforms. The type of product that is chosen by each institution depends on multi- ple factors including cost, willingness of parental involvement, fac- ulty buy-in, and local necessity based on COVID-19 rates.
The perfect symptom monitoring tool possesses multiple features. First and foremost, the product has to capture accurately the symp- toms of COVID-19 to meet state and national requirements. Accord- ing to the CDC, COVID-19 has more than 15 possible symptoms associated with COVID-19 and five of these symptoms warrant immediate attention. Logically, all of these should be queried in some form. Better products also have varying weight given to the presence of more severe symptoms. Other important features of a useful prod- uct would include the capacity for report generation and the ability to glean information on possible outbreaks.
However, the most important aspect of a school’s symptom moni- toring system is that it is easy to use, and inspires 100% adoption with accurate, timely information.
Unfortunately, most of the symptom monitoring products fail in this regard. Many schools use paper or online products where insuf- ficient information is given. Other products require app download and password where compliance can be poor. Some products ask for temperature checks without the ability for a temperature to be recorded. Some inferior methods allow no data to be entered and do not prevent the people from going on campus where they can expose others to possible infection. Accuracy is another issue. In many cases the students, even young children and not parents, are the ones put- ting in the information into the system regarding the presence of potential symptoms.
Generating Reports
The best symptom monitors are electronic solutions that ensure 100% adoption. These innovative products would also generate reports while potentially yielding and storing much more information. The most logical ones would not need a log-in or password or an app to download. All these steps would hinder full compliance. The top solutions would automate many of the features and respond smartly to the answers. They could then send messages to symptomatic indi- viduals and provide immediate contact tracing support to protect exposed contacts. Some of these products could be extremely sophis- ticated and even store links to test and vaccine data.
Another immensely valuable feature of the best symptom monitors would be the incorporation of an access control program. With this
feature, persons with worrisome symptoms or exposures, or someone who did not provide adequate survey questionnaire information would not be allowed into school. This safety step could mean the difference between an outbreak occurring in a school or not.
People with symptoms or noncompliance would be the ones who would be most likely to spread infection into the schools. Messaging for severe symptoms could even provide guidance on where to gain testing, see a physician or give alerts for a period of quarantining. Conversely, with proper access control, people who satisfy the requirements of the questionnaire will have an access pass or “smart card” that allow entry.
Despite these strategies, some people in schools could still statisti- cally become ill with COVID-19. The main determinant of whether schools could stay open after this event will be how quickly and effi- ciently the schools respond to this situation. The best prepared schools will have plans in place to manage this inevitable scenario. The challenges for this event will be to identify the ill individuals, determine who the additional exposed people were and prevent fur- ther infections from occurring while of course managing the sick person. Additionally, every community is different. In some places, the messaging around the event and the ability to demonstrate confi- dence that everyone else’s children are being appropriately managed may also prevent a school closure.
Contain the Infection
After ensuring the safety of the afflicted person, the most important immediate consideration is containment of the infection. To borrow some terminology from the disaster management and fire commu- nity, the containment needs to prevent both “horizontal” and “verti- cal” disease transmission.
In this analogy, horizontal transmission would be transmission between individuals of a similar grade and vertical transmission would be the transmission of the infection to other grades, parents, siblings and faculty. The prevention of major vertical transmission is crucial in that this event could open up exponentially far more indi- viduals who could become at risk and infected.
As the number of exposed people increases, far more need to be tested, quarantined and closely monitored and the success rate dete- riorates. Containing the infection to the immediate horizontal cohort and a “bridge” exposure like a sibling, parent or teacher whom can all be immediately quarantined can prevent a potentially calamitous spread. So early containment without vertical transmission and only controllable horizontal transmission of disease could mean the differ- ence between a school sending a classroom home for a short quaran- tine and an entire school shutting down indefinitely.
The best electronic products, like Cleared4Class, will be able to facilitate this process. Immediate messages can be sent to affected people. A strategic understanding of the most likely exposed contacts of each individual who becomes sick will help predict which people might be harboring asymptomatic infections. The particular under- standing and resources of each situation might lead to surveillance testing for the most likely contacts of a sick person. A strong elec- tronic symptom monitor platform could automate this process and save crucial time with expedient testing and tracing.
Understanding the concepts about transmission and monitoring individuals with an eye to minimizing risk of exposure will be immensely valuable to keeping schools open. The most successful international communities where schools have been able to be kept open, such as Denmark, have completely bought into this and created strict “pods” where children learn, play and recess together. The American school system can study this model and use electronic tools and other technologies to combat the vital task of keeping schools open during the next phase of the Covid-19 pandemic.
Soumi Eachempati, MD, FACS, FCCM is the CEO and co-founder of Chelsea Health Solutions.
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