- Hello. I'm Dr. Ron Ron MacTaylor,
chair of the department of chemistry and physics
at Salem State University.
We welcome Dr. Kristin Pangallo
who joined the department of chemistry and physics
at Salem State almost 10 years ago now.
First as a full-time temporary faculty member
before coming on board tenure track.
Kristin earned her bachelor's degree in chemistry
from Bates College.
She did her graduate work
at MIT Woods Hole Oceanographic Institute,
earning her PhD in chemical oceanography.
Kristin was a post-doctoral fellow at Rutgers
and was a tenure track faculty member at Colgate University,
before the irresistible pull of Salem, Massachusetts
brought her to us.
Now a tenured associate professor at Salem State,
Kristin responded to another call
to serve on school committee,
at the time of her candidacy a simple time in hindsight,
her focus was on supporting and improving our public schools
for her own children and all of the city's;
students, teachers and families.
Dr. Pangallo has worked tirelessly
to keep up with the current research on virus transmission,
and shares her unique perspective as a scientist, educator,
parent, and school committee member.
Welcome, Kristin, we look forward to your presentation.
- Thank you.
Thank you, Ron for that introduction.
And now it's my turn to share my screen.
So, when I was first approached about doing this webinar
and doing this presentation,
I was really flattered and I wanna thank my department
and thank Ron MacTaylor for requesting, but I also was like,
"Well, what is it that you wanted me to talk about?"
And when he suggested the pandemic response, I thought,
oh yeah, I could probably put together a talk on that.
And they quickly realized
that I had a lot to say (chuckles) on this topic.
And so I appreciate the opportunity for reflection,
which I hadn't yet had and the opportunity to speak today.
I think it's been quite a ride as you'll see.
And I'm just really grateful for this opportunity.
So thank you.
I also wanted to invite everyone to put in this URL.
So https://tinyurl.com/PangalloCovidTalk
and that will bring you to a Google document
that has all of the references that I discuss in this talk,
as well as a whole bunch of other ones.
Because as I said, I had a lot to say,
and I think I ended up,
hiding or deleting more of my slides than I kept.
So let's jump right into it.
Before we get started,
I do wanna say that this talk is given from my perspective
as a school committee member,
but it's really only that role is only one part
of a much larger group that work to make this happen.
And that goes from the city of Salem
and the mayor's administration through the district leaders,
our superintendent, as well as our building leaders,
our unions, our staff, our families,
and of course our students in our entire community.
And I think one of the reasons we've been successful
is that we share a common goal.
We share similar mindset
and we've all really been pulling together.
And that's really allowed us to find success
in our pandemic response.
So I just wanna really make that clear that my role here
has been a small part of a much larger whole.
And as Ron was saying,
when I first ran first school committee,
I did include my perspective as a scientist,
as part of my pitch for why people should vote for me.
But really I emphasized my roles as a parent and an educator
because at the time those seemed much more relevant
to the service that I would provide on the school committee.
Being a scientist kind of helped me stand out.
I do think it gives...
I thought then, I obviously think now,
it gives me a valuable perspective,
but I don't think I realized how integral it would be
and how I would draw on my scientific training
on a day to day basis.
Because of course, I didn't see this pandemic coming.
I don't think any of us really did.
And I got elected in the fall of 2019.
And during that election,
the thing that we were asked a lot about
is what is the most important thing
the schools are going to face over the next few years?
And I think we all said,
we have to hire the right superintendent.
And fortunately we did.
And the first few months that I was in office was focused on
finding and hiring the superintendent who we did hire.
And we did find the right person.
I think Dr. Stevens Zrike has been an incredible leader
and partner in this work
and really grateful that we hired him.
We selected him in mid-February
and we signed his contract on March 6th.
So he has been right in the thick of it,
along with the rest of us.
And that date March 6th sticks out
because I remember after we signed that contract,
we sat around in school committee chambers
with a few other people from the district
and from the school committee saying,
we've gotta be ready because this illness is coming,
this corona virus thing,
and the schools need to be ready to respond.
Like we had the hand sanitizer,
but I don't think we knew quite the impact
it was going to have over the long term.
As a scientist, I had been following the emerging science,
and I'm gonna talk a lot about that.
And I was starting to see,
and it was actually after that weekend
that I really started to realize,
we're gonna have to shut down our schools.
And that was a shock
because I didn't run for school committee
to close down our school buildings, quite the opposite.
But the thing was, is in March, as we all remember,
things changed really fast.
And so I'm showing you Boston globe headlines
from the beginning of March to the end of March.
And you can see at the beginning,
it's like all about politics.
And then it really shifts and we have the pandemic, it hits,
we have the outbreaks, we have the shutdowns,
we have the states of emergency
and it happened really, really fast.
And that's because of exponential growth,
which is the first topic that I'm going to discuss here
because exponential growth
is something that's not particularly intuitive.
We're really used to linear growth in our day to day lives,
where you're just like adding a certain number each time,
maybe it's slow, maybe it's fast, but it's predictable.
Exponential growth is predictable,
but it's just less intuitive
and that's because we're multiplying.
And in this case, I'm forming exponential growth by doubling
by multiplying by two.
But you can obviously do it in other ways.
And because of my comfort,
I think with math and Excel in late February, early March,
I was able to sit down and look at some of the information
coming out about the coronavirus,
about the pandemic and say, okay,
if we had this Biogen event, which you'll all remember,
probably at the end of February,
there was a big conference
and there was a super spreader event.
And we had from that conference,
we knew we had a group of people.
We had actual, we knew who was infected.
And so we could kind of predict how many people
that was going to grow to if we used the doubling rate
that the World Health Organization was providing.
And so I just kind of plugged that
into an exponential growth calculation in Excel.
And I wanna be really clear.
This is not a model.
This is just me playing around in Excel
and using exponential growth
and my understanding of Excel and math
to kind of see where things were headed
and like start to understand it and wrap my head around it.
And what this showed me is that although the numbers
were very small in early March,
they were going to grow incredibly rapidly to the point that
they were, we're gonna have to do something
and we're probably not gonna be able
to keep our school buildings open,
that we knew that this was not going to exactly come to pass
because people's behavior would change.
This doubling rate would change,
but it actually mimics it
in the early weeks of the pandemic.
And this was important because
when we shut down the schools, which happened on March 12th,
there was a lot of talk at that time,
about two weeks from now,
this is two weeks, two weeks, two weeks.
And you could see it really clearly,
if you looked at the math that in two weeks,
things were just gonna be worse
and on track to be much worse.
And it was only gonna get worse after that.
So I remember at that meeting on March 12th
saying repeatedly, this is not two weeks,
we need to be thinking over the long term.
And that came from the fact of just looking at the math
and understanding that this was already,
the die was cast and this was going to happen.
So there we go.
Between March 6th and March 11th,
I worked on a summary document
to share with my school committee colleagues
because we had scheduled this meeting for March 12th.
And I initially went into it thinking
that I was gonna have to convince them
that we needed to close our schools,
but by March 10th or 11th, I think everybody was on board.
We all knew by that point
that we would have to close the buildings.
But what I was still able to do with that document
was kind of summarize what we knew about the virus
and what was coming out of the scientific community
and put it into a form
that I hoped was easily accessible for them,
but also had a bunch of references
in case they wanted to explore further.
So here you can see some things that bubbled up
out of that research and these are direct quotes
from that document that I sent my colleagues.
And you can see at this point,
scientists were already trying to get people's attention
that this virus was an aerosolized form,
that there could be asymptomatic transmission,
and that people didn't have fevers.
So temperature checks might not work,
that the fatality rate was obviously higher than flu,
which I think people accepted pretty quickly,
but that people could be infectious
prior to having symptoms, which was really, really important
because that meant that running schools
was gonna be really tricky.
But when I was thinking about this document
that sent out to my colleagues
and trying to remember how it was
that I came up with these points, these key pieces,
it was really because of my scientific training
in grappling with emerging science.
And I wanna spend some time talking about that
'cause that really come into play throughout.
So the thing about emerging science
is that it's really messy,
but that's not how science seems
when you're learning it as a student.
So we're used to things like these big textbooks
that are extremely well organized.
They're highly edited.
Things are put into a very digestible format.
They make sense.
One thing follows another,
and we understand what we're talking about.
And that is great.
And that's also not how
the process of science actually works.
Science is messy and we don't always know
what the end result was going to be.
So I like to think about emerging science as a puzzle,
and it's a puzzle where you don't know
what that final picture is.
So you're just kind of trying to figure it out
as you go, further, you don't have all the pieces yet
because you don't even know
what it is that you're looking for in some cases,
you're just trying to figure out what is missing
and what you might wanna explore next.
But in addition to not having all the pieces,
you have pieces that are raw
mixed in with the pieces that you do have,
because you may have scientific studies that show something,
but maybe you set out to measure X,
but you actually measured Y
because of some confounding variable.
And that happens in science all the time.
And it doesn't mean that people did a bad job
or bad science.
It's just the nature of emerging science.
Further because of how science can be probabilistic,
there can be times when there are certain sets of studies
or individual studies where you get a wrong conclusion
and it's not because it was done poorly,
it's just because of the probabilistic nature of science.
So you've got some wrong pieces
mixed into the incomplete pieces that you do have.
And finally, when you have this puzzle,
the pieces actually fit together in different ways.
And until you have the final puzzle all figured out,
and you understand the system as a whole,
you don't always know
how those pieces are gonna fit together.
So as somebody trained in science,
as somebody who's worked in emerging science,
who has been part of creating knowledge,
as any scientist will tell you, this process can be messy,
but when you've been a part of it,
you are more comfortable with it,
and you're more able to digest it
and kind of keep things in perspective
and understand how that system and how that process works.
And so that was really one of the key things
that I think I was able to provide to my colleagues
during this process.
And what I did is, I would first had questions.
I did what I think most scientists do, most academics do,
I go to the primary literature
and I wanna read the studies and see what is coming out,
what people are finding.
And because when you read the primary literature,
not only do you get to see the data,
you can read the methods
and you can see what the scientist
are saying about their data.
However, when it came to this primary literature,
I was reading things in fields of epidemiology,
infectious disease, virology, areas that I lack expertise.
That means I don't know the context.
I can't always evaluate
whether the method that they chose was appropriate.
I don't always know the limitations
or whether their interpretations always follow precisely
from the past data.
So, because I knew that,
and I knew that I was getting out of my area of expertise.
I really relied on experts in the fields
to help provide that context.
And so expert opinion can be incredibly valuable
because they are going to provide the nuance
and perspective that you need in interpreting these studies
and understanding how they all fit together
and what they're telling us as a whole.
And I was able to find through Twitter feeds
and I provide a lot of different Twitter feeds
on that set of resources.
I'm a big fan of podcasts.
Also grand rounds and webinars are excellent sources
in information, and often provided
as a form of ongoing learning, which can be really helpful.
And they're also summaries
and newsletters that people would put out.
So expert opinion was really critical,
but it's important to remember that experts
are going to have different opinions
and they can both be valid.
You can have two different people with valid opinions
that don't agree.
And it's really important to see
a lot of different perspectives and understand
that everybody has their own perspective
based on their training, based on their area of expertise,
based on their life experience.
And so understanding that individual experts can be biased.
It's also important to look for the scientific consensus.
And that means, if you've got a lot of different people
from lots of different perspective,
lots of different fields,
all converging on this general conclusion,
then you can be much more confident that that information
is going to be correct.
You've got multiple studies,
you've got multiple specialties,
that gives you a much stronger faith and knowledge
that that is going to be correct.
The problem here is that scientific consensus
can also get entrenched.
And we've seen this in the journey with COVID
in the form of our understanding
of airborne transmission of viruses.
And I'm gonna talk a little bit about that today.
And that gets me to my final point on this slide,
that individually all of these pieces can be wrong.
And so you have to keep in mind with emerging science
that you might be wrong about something
that seems to be coming up
and if you're wrong, what does that mean?
And I think keeping that in mind at all times
is also really important and helps you sort through
what's most likely to be true.
What's a little bit more tenuous.
So excuse me one minute,
little bit of a runny nose from being out in the cold.
So in the summer of 2020,
we were faced with figuring out how to return to school.
So this was, we had a closed schools
and now we are shifting towards reopening.
And while I was very focused on the scientific part,
I think it's really critical to understand
that this was part of a much larger effort
and that the other aspects of this process,
the logistical aspects, the communication aspects,
these were absolutely crucial
in the success of bringing kids back to school.
And so I want to be really clear on that is that again,
this is one piece of a much larger whole.
All of our work around returning to our school buildings
was guided by our four core values of wellness,
equity, community, and flexibility.
And while all of them are critical and crucial,
I did wanna highlight in terms of this talk,
the one about flexibility,
because the thing that understanding emerging science
brought to this particular discussion was that it was,
the science was going to continuously change
and that it was going to evolve
and we were going to need to be responsive to that.
If we wanted to implement best strategies, we could,
we needed to be responsive to changes
in our understanding of the virus and its transmission.
And so we were able to emphasize
the importance of flexibility from the beginning
and that because science changes over time, it's not a flaw,
it's actually its greatest strength.
So my process through the summer of 2020
and ongoing to today, is to gather all that information
that I talked about
and then to put it into a form that would be accessible.
In March, I did that for my school committee colleagues,
over the summer of 2020,
I did it or my colleagues on Salem returns.
And specifically I had a running annotated bibliography
for myself, which is a strategy I teach my students,
DESE, the department of elementary and secondary education
released guidelines that I read through.
And I wrote a response to them for our team,
because I also read through all of the literature
that they cited in their guidelines.
So I could understand where they were coming from.
And because I was able to do that,
I could then write a response that said,
in addition to this guidance,
I think we should do these things.
And you'll see how our implementation differed
than the DESE recommendations.
And I put it all into a four page summary
to make it more digestible.
That was only a piece again of the puzzle.
From there we had to actually figure out how to implement it
because it's one thing to know what would be ideal to do.
It's quite another to be able to make it happen
and figure out the logistical components there.
And I'll give an example of testing.
In the summer of 2020 I knew testing was important,
but we had no way to put it in place
because testing was not really available.
And it was when you could get it,
it was incredibly expensive and we didn't have any money.
So the thing that we were focused on,
where we could make decisions and really have an effect,
a positive impact, was focused around keeping the air clean.
So this is getting at...
So while I was saying that we were really focused
on getting the air clean,
I have to explain too why this was so important.
And it was because there was some entrenched knowledge
about how viruses were transmitted.
If you remember wiping down surfaces,
washing hands, all the hand sanitizer,
those things are important in terms of disease prevention,
but not necessarily the specific way
that this virus transmits,
this virus seems to primarily transmit through the air
and through aerosols,
which are these tiny little particles
that can stay suspended in air over the long term.
And prior to COVID, I think many people,
most people didn't appreciate the extent
that viruses could transmit via the airborne route.
And there's actually been quite a change
in how we view this as a community.
And within the scientific community
and the medical community,
there's been a change in that too.
And there were a number of specialists in indoor air quality
and aerosol science and viral transmission
who worked diligently through the spring and summer of 2020,
and continue to this day to make sure that people understand
how this virus is actually transmitting.
And it is through the air, COVID is airborne.
And so in order to prevent transmission in a space,
we need to ensure a few things,
ventilation, filtration, and masks.
Obviously we would also ideally like to keep out
anybody who is infected,
but we're recognizing that that might not be possible,
that inevitably there are going to be some people
who are asymptomatic and who are infected and don't know it.
In order to keep the air clean,
we need to work on these three components.
So with ventilation,
you are removing particles from the air,
you're removing dirty air and replacing it with clean air
that can be done through HVAC systems
or even through open windows,
as you'll see, they can make a big difference.
Filtration, you clean the air through filters and masks,
which we've all heard about quite a bit.
And I'll talk even more about
'cause everybody loves masks, I'm sure.
One of the things that I was able to use right off the bat
was this idea that we can use CO2 or carbon dioxide as a way
of assessing ventilation in a space.
And that's because carbon dioxide can be a proxy
or a standing for aerosolized particles.
This proxy relies on mass balance equations
to make some calculations around
what the final concentration would be.
I'm not gonna get into all those details.
But my training in chemical oceanography
actually prepared me really well for this particular area
because I'm very accustomed to using proxies
and also very accustomed to using mass balance calculations.
So all of this made a lot of sense to me
and I could see its power immediately,
as soon as I first read about it.
And here's how it works, in our exhaled breath,
when we breathe out,
there's about 35 to 50,000 thousand parts per million
of carbon dioxide in our breath.
There's also the aerosols
that if we're infected can contain the virus.
So in a closed space over time,
when you have more people in a space
and over a longer period of time,
the amount of carbon dioxide in that space will rise
as will the amount of aerosols.
And so carbon dioxide is telling us
when we have a lot of aerosols around
because the physics is kind of similar of the two.
And when you ventilate that room or you remove the old air
and replace it with fresh air,
the carbon dioxide concentration will fall
and the aerosols will also be removed.
And so we can ventilate our rooms with HVAC systems
or by opening windows to replace that re breathed air
with fresh air and lower those carbon dioxide concentrations
which tells us at the aerosol concentrations are also lower.
And so a good rule of thumb that I like comes from a webinar
given last summer from an expert in indoor air quality,
and aerosols is that if you can keep that CO2
under 900 parts per million, that's great.
It should not exceed 1200 parts per million.
And there's a lot of research showing
that classrooms can have CO2 concentrations
of 2,000, 4,000 parts per million,
which is really very high
and explains a lot of respiratory virus transmission.
So we wanna keep it under 900 parts per million,
but closer to four parts per million
or outside air is better here.
Here you can see, this is my trustee CO2 monitor.
It's an Aranet4, I really like it.
It's small and easy to use.
But you can see that the values I have here
that I'm registering in classrooms are relatively low.
Well under 900 parts per million,
and this is what we found
in most of our classrooms with windows.
So you get a classroom, the windows open,
the carbon dioxide is usually fine,
showing absolutely great ventilation.
There were some classrooms,
especially if the windows were closed,
where we saw that they were had higher concentrations of CO2
indicating that there could be more aerosols.
And so when I opened one of those windows
and came back 10 minutes later, I was able to see that yep,
that concentration fell and was into a better range,
but you can also see that that range is still
kind of on the high side, closer to 900.
And that's probably because we were using
some amount of recirculated air in our buildings,
meaning the air was not replaced with fresh air,
but was passing through filters and being reclaimed.
And those filters were not MERV 13, which is the threshold
that we really want to see for viruses.
But that was because of the systems that we had in place.
So in addition to opening windows,
which aren't always is an option in every room,
you can clean the air with filters.
And so what we are looking for in filters,
you wanna have a HEPA-based air purifier,
a HEPA filter is the kind of filter that you want to have
and you wanna have it as part of an air purifier.
So what you're looking for is something
with a high clean air delivery rate,
that's size appropriate,
and they're all rated for a certain square footage
and also something that's quiet.
'Cause we're talking about classrooms.
You don't want the teacher having to compete
with the air purifier.
You want to avoid things that have ionizers
and ozone and other bells and whistles.
For one thing, they're more expensive.
You don't want to have to pay for that.
But also those are putting things into the air
and we don't wanna have to think about the safety
of the ions or the ozone, that that could be a problem.
So we really wanna focus on HEPA-based air purifiers.
And if you can't get commercially available ones,
you can actually make your own.
These DIY HEPA purifiers are incredibly, incredibly good.
In fact, in preparing for this talk,
I was seeing some research showing that these have better
clean air delivery rates than many commercial devices.
So I'm actually thinking that we need to install
some of these in our cafeterias
to are really help clean the air in the cafeterias,
especially in these cold winter months,
when we do have kids eating indoors,
which is the most risky time,
because that is of course, when they take off their masks.
And I don't wanna spend too much time talking about masks.
I am keeping my eye on the time,
we have already talked about them a lot,
but I do wanna talk a little bit about filtration with masks
and why melt blown materials are so helpful.
Oops.
So melt blow, these surgical masks and N95, KN95s.
They are made out of material that's not a woven material,
but it's actually this thing called melt blown.
And it results in these layers of fibers
that are interlocking and intersecting,
making up kind of like a funnel web of these fibers.
And they don't work just by sieving out for particles.
They actually are sticky.
And so when the particles hit the fibers,
they're going to stick to it.
And it's from dispersion forces
or Van der Waals forces.
They're also electrostatically charged.
And so as the particle is moving through the mask,
it's gonna get attracted to the fibers that are charged.
And then of course they'll stick.
And so these type of material is much more effective
than any cloth mask.
However, N95, KN95s are disposable masks
that even though they're disposable, they can be reused.
What you wanna, you wanna let them dry.
You can hang them or place them in a paper bag
and you can use them until they're soiled or they break.
So this is kind of the setup that we have in my house,
my children, however, this was a Wednesday
when I took the picture
and you can see they took from the Monday hook.
So we're getting there, but we're not quite there yet.
So coming back in the fall of 2020,
DESE guidance was kind of, it was based on these myths
of airborne transmission that we now know,
aren't really true,
that we hadn't really grappled with this idea
of aerosolized virus yet.
And so they said consider different ways
to increase ventilation.
They didn't really talk about filtration.
And for masking, they recommended second grade and up.
We in Salem, however, we made sure
that all of our HVAC systems were repaired and upgraded.
We made sure that all of our classrooms
where we had students had HEPA air purifiers
and we had universal masking from the get go.
So, as I said earlier in the talk,
one thing that I wanted to put in place
right away was testing.
I teach analytical chemistry.
I love testing.
I think it's really critical,
but it was really hard to put in place.
And that's probably why DESE didn't recommend it.
It's guidance actually said testing is not recommended.
However, based on what I know about testing
and what we were reading from epidemiologists
and other experts,
is that testing was a really important part
of bringing students back into classrooms
and that you could use different strategies
and different techniques to make it happen.
But first let's talk about why testing was so necessary.
And this gets into the dynamics of this virus.
So when you are infected with a virus,
it goes into your cells and it replicates.
And it takes a while this incubation time
between when you're infected or exposed
and when you actually become infectious to others.
So you have to reach some point
of having enough virus in you
that you can start to give it to somebody else.
And so then you have this infectious period
where your virus overload goes up
and your immune system kicks in and then gets rid of it.
But you have an infectious period
and that doesn't necessarily overlap
with the symptomatic period.
And we know that we have this window
where you are infectious, but you're not yet symptomatic.
And further we know that some people never are symptomatic.
And so if you don't have testing, that's a problem.
However, testing and at the time,
all that we really had access to is PCR testing,
requires trained analysts, expensive instrumentation,
multiple reagents, and a lot of time.
And so that's a bit of a conundrum
because as trying to provide testing for public schools,
we don't have a lot of time, we don't have a lot of money.
It was a bit of a problem, but again, without it,
we don't know who's infected and who's not.
So what we did is we joined up with a collaborative
that was working on implementing testing in the schools.
And this originally formed from parent scientists
in Wellesley and Newton, and some of those other districts
in the Metro west part of the state.
But they very quickly started reaching to other districts.
And we worked up with them in October of 2020.
And we modeled our initial program on that of Wellesley.
And Wellesley was incredibly generous in helping us
get that initial program off the ground.
So that by November, we were offering testing for our staff
and then our high school students.
And we used pooled testing to do this.
So pool testing works by having multiple people
all take their sample.
And then for example, here it's swabs.
So nasal swabs, putting the swabs into one tube,
that tube is the pool and you test the pool for the virus.
If the pool is negative, that means that those people
don't have the virus in their nose.
And then you know.
If the pool is positive, then you say, ah,
at least one of those people who put their swab in there,
at least one of them must be positive.
So then you have to use reflex testing.
You go back and you find that positive case.
And we often use rapid tests for reflex testing.
So pool testing allows us to test a lot of people
in a short amount of time with a lot less money.
Further, it allowed, at the time testing
was kind of a limited resource
and it allowed us to use those resources
much more efficiently.
So we started off with that saliva based testing program
in November for staff and then our high school.
We also used it when we returned from winter break,
that first week after break, we kept everybody remote
and made testing available.
And we made it available to our staff,
our students and their families.
We did over 2000 tests and caught 30 cases
that we were able to keep out of our school buildings,
just in that one week.
We also had a citizen science program, which was awesome,
where our middle school students worked with Gingko Bioworks
on their pool testing program before they rolled it out.
It's now a national program.
And there's a video in my Google Doc
with a link that they made,
link to the video that Gingko Bioworks made,
that's really cool.
And we also put in place testing in our elementary
and middle schools.
So this pool testing, initially independent.
And then when the state decided
to put in place their own testing program, which was great,
we started to do the state program
because they provided resources to do that.
Our initial investments here came from the city of Salem
and so big shout out to Mayor Driscoll
and her administration for helping to fund this
and make this happen.
The past school year,
we've had an increasing reliance on rapid antigen tests.
And I'm gonna talk about those
'cause they're really important.
We have continued to do pooled PCR testing,
and now we're doing once a week rapid tests
where students get them to do at home.
We also used rapid test as part of our test
and stay program in the fall.
So that was a great program that allowed students
to avoid quarantining.
So if you were exposed to somebody with COVID,
but you didn't have COVID,
you did a rapid test each morning
for your quarantine period.
And if your rapid test was negative,
you could just go about your school day as normal.
Obviously if positive, you went home,
but this allowed students to be in school
rather than in quarantine,
which got us back so many in person days.
It was wonderful.
Thousands of days.
Finally, in January of 2022,
we implemented a test to return program.
And I'm gonna talk about that in a little bit,
but first I want to talk about rapid tests.
Rapid tests are amazing tools in our COVID toolbox.
I think they're a little bit maligned though.
So I wanna make sure that everybody understands
why rapid tests are incredibly useful and powerful tools.
So this article that I have an image from
and I'm studying here is by Michael Minna,
who is probably the person who's done the most
to get the word out about the power of rapid tests.
He published this in the summer of 2020,
and it's continues to be really helpful.
So what we have to think about with rapid tests is that
we think about PCR as the gold standard,
but we know that with PCR, it takes you a while.
If you're not gonna probably go and get a PCR all the time,
if you start to feel sick,
then you'll schedule your PCR and then you go to your PCR
and then you get your PCR data back.
It could be a week between
when you first start to feel a little off
and when you finally learn if you have the virus or not.
Rapid antigen tests allow us to make decisions in real time
and are incredibly powerful for that.
They also are able to be,
they turn positive in that infectious window
that I talked about before.
Now that overlap isn't perfect but it's really, really good.
And it can tell you if you are infectious with the virus.
And the thing is,
is that the rapid antigen test are incredibly accurate
at these high viral loads when you are most infectious.
Another piece that's really helpful
with the rapid antigen tests
is that they stop being positive
at the end of that infectious window.
And that's really important for this idea behind tests
to return, because with the DESE guidance,
which is based on the CDC, it said to isolate for five days,
and then you can return as long as your symptoms are absent
or resolving and you mask.
Well coming in a school situation,
saying, symptoms are resolving, that's really nebulous.
How do we determine that?
How do we know if students symptoms are better
or resolving or not.
Also trying to guarantee a student using a mask
consistently through that period is really difficult
because our littlest students,
they do a great job with the masks but they're not perfect.
Further they can't wear N95 masks
because N95 masks don't exist for students,
KN95s do, but not N95s.
Finally, this was in January
and we knew that students would be needing to eat indoors,
meaning they would have to take their masks off indoors.
So this was gonna be a problem for us.
And so we were able to use tests to return
and what we is asked our students
that if they were going to return prior to day 10
of their isolation period,
they needed to test out using a rapid antigen test.
So if you took a test and it was negative, you could return.
And here you can see why, how this is so powerful.
So these are from my own daughter.
Unfortunately, Lucy contracted COVID in January,
she's doing great.
She's totally fine.
She's vaccinated.
But you can see on day six,
when DESE guidelines said she could go back,
she was still positive, still infectious.
Same on day seven.
Day eight and nine you can barely make out that test line,
but it is there.
And then finally on day 10, that was a clear day.
That was a day where she passed the test.
The test was negative.
And so she was able to return to school.
And so the power of these antigen tests is excellent.
So just in January, this data is from Collins Middle School.
You can see that we had 39 students
who were able to return to school
and get back some of those in person days,
they were feeling fine, they tested negative.
They were able to go back to school.
We had other students who either decided not to return
to the buildings
because maybe they weren't feeling better yet,
or perhaps they were still testing positive.
So we had 24 students who didn't come in early
and then 10 students who thought that they were good to go,
but they actually were positive when they tested
and they went home
and we were able to keep people out of the building
who were still infectious.
So I wanna talk a little bit about variance and vaccination,
but I'm very aware of my time.
So I'm gonna go a little quickly here.
And the thing that I really wanna emphasize here
is that with the variance of Delta and Omicron
or Alpha two to some degree, but they were more contagious.
And that means that there was less room for error.
So the '21, '22 school year looked a little bit different.
We had these more contagious variants, but at the same time,
we also had more normal school and more normal lives.
And there were more cases of COVID
because they were more contagious.
However, we also had more immunity
because thankfully we had a lot of our population vaccinated
very high vaccination rates among our staff,
and we have vaccination requirements.
And unfortunately we do also have prior infection.
So we have a bunch of different things
that made the '21, '22 school year look a little different
than that first school year.
Additionally, we were able to have
vaccine requirements put in place, including a vax or test
at the beginning of the year for our staff.
And now that's turning into a mandate for staff.
We have vaccine requirements for our students.
If they want to do extracurriculars,
high respiratory extracurriculars.
We also put in place more HEPA units
because these variants were contagious.
And we had a strong emphasis on masking
and we're on can KN95s to our kids.
The other things that we were emphasizing,
I forgot to write it down here,
but really stressing the importance
of keeping those windows open.
And that CO2 monitor was I was able to show teachers
in real time how important that was,
and also emphasizing the importance of outdoor lunch
and eating outside that when we have those masks down
in order to keep the air clean, which is really the goal,
it's still really all about clean air.
We wanna eat lunch outdoors as much as we can.
Vaccines too.
These are my daughters.
They both got vaccinated in November
and I was so, so grateful
and continue to be a big proponent of vaccines.
And it is one of my favorite cartoons where,
the ideal scientific experiment
is one where you don't need the statistics
to prove that it works.
But when we're thinking about vaccines,
a lot of stuff comes up.
People get very nervous.
And I think it's mirrored in any sort of intervention,
whenever we're thinking about the risks that we're facing
and we're trying to make decisions,
we have to think about the risks of COVID
as well as the risks of the response.
And they're pushing against each other.
And we have to consider both.
And with vaccines,
what we need to remember is that vaccines prevent infection.
I know that we hear that, you can still get it.
And like my daughter did get COVID,
but the thing is it prevents infections.
It doesn't prevent it entirely.
They're not magic.
But they do prevent a lot of infection.
And we can see this here where people who are unvaccinated
had a far higher predominance of infection
than people who are partially vaccinated
or fully vaccinated.
Vaccines also prevent severe illness,
as we know, they're incredibly effective.
And of course, they also prevent people from dying of COVID.
And so when we're thinking about vaccines,
we have to remember how incredibly powerful they are,
but also how safe they are.
Vaccines are remarkably safe.
And this slide is focused on the five to 11 demographic.
This is where we are really now trying to increase
our rates of vaccination.
And this slide is made in December.
So the not 8.7 million is probably closer to 9 million
at this point, might be over 9 million,
but millions and millions
of these vaccines have been provided
and they are incredibly safe.
There really are not some of the side effects
that people were worried about, like myocarditis.
They're incredibly rare.
And vaccines are incredibly safe for our kids.
They're also in effective.
When I think about the risks of COVID
versus the risk of vaccination,
the risks of kids getting COVID is not zero.
Yes, the risks are lower, but it's not zero.
We know that kids can get acutely ill.
We also know that kids can have long term complications
from COVID, including MIS-C
and the pediatric vaccines has been shown
to reduce MIS-C remarkably.
And they're incredibly effective at that as well.
So we're now moving towards a new equilibrium
and I'm choosing that word very specifically.
We're looking at,
this is a slide that I just changed yesterday
because Massachusetts decided to remove
its statewide mask mandate for schools.
And we're looking at this happening throughout the country.
People easing mask rules and wanting to move on
because people are tired
and they want to just get back to normal.
And I think that's really understandable.
I'm tired of COVID.
And I would love to get back to something
that resembled normal in the year 2019.
The thing is though, is that right now,
this pandemic is not over. (chuckles)
We want it to be, but it's not.
And although our case counts are far lower
than they were just a few weeks ago,
they're still pretty similar
to what they were at their highest a year ago.
And that's the same with deaths and hospitalizations.
Despite that, I think it's also critical
that we re the pandemic is now different.
We have incredibly safe and effective vaccines.
We have access to testing both PCR and home-based tests
that are excellent.
We also have new pharmaceuticals that are being developed,
access to these is a little iffy right now,
but we have them, we will have them very soon.
So I think saying when can we get back to normal
is a reasonable question to ask,
but working on this presentation
has also prompted me to ask a few more.
And one of them is, can we get back to normal?
And the reason why,
we have to think back to what our normal was.
This is the flu burden by season.
So by year, for the past 10 years,
we had millions of cases of flu each year
resulting in hundreds of thousands of hospitalizations,
which is in blue and tens of thousands of deaths,
which is in red.
On top of that every year, there's an RSV epidemic
that blows through resulting in
over 10,000 deaths each year,
and hundreds of thousands of hospitalizations,
and those who are most vulnerable to RSV and to flu
are often also the most vulnerable to COVID.
So when we're thinking about getting back to normal,
we need to reckon with what normal was.
I think most of us didn't realize quite how bad
this annual epidemic of flu in RSV was.
And even if we did know how that it was a problem,
and it was important to get those flu shots,
I don't think we thought there was much more
that we could do about it.
And now we're looking at, on top of that,
putting on top of that, all of these hospitalizations
and death and illness from COVID,
and I don't think that's acceptable.
I'm not not ready to accept that
as the price of getting back to normal.
I also don't think it's going to be manageable
because one of the things that we found in January
with our schools was one major challenge was staffing.
We had so many staff out sick that it became difficult
in some cases to run schools, we were able to do it,
but it was a real challenge.
We also had so many students out sick
that it became difficult to run schools
because how do you have a curriculum
that's flowing from day to day
when you have a different batch of students
in class each day?
So I think we need to find this new equilibrium.
And I choose this word very carefully because in equilibrium
is a dynamic state that's predictable and stable,
but it's constantly balancing opposing forces.
And the thing about equilibrium and that I teach my students
all the time is that it changes as conditions change.
So new conditions result in a new equilibrium.
Our choices are going to determine the new state
that we find ourselves in.
It's not inevitable.
We have a say in that.
And as we're thinking through what our goal should be,
I go back to the equity statement that we've written
over the past year as part of the work with the district.
And as I read through this, looking at each bullet,
each one of these bullets gets back
at to why we need to create a school environment
that can be safe and accessible to all of our community.
Whether you are immunocompromised
or you have a family member who's ill,
you have a newborn brother at home,
or you live with an older relative,
that everybody has access to school,
that's not going to make them sick.
So I think we need to think about
a new equilibrium for schools.
We have new tools in our tool box
that we now know can work.
Before, we didn't realize what we could do.
And now we know we can do things.
So as we have these pathogens that circulate,
we know we'll have waves of infection,
we'll know we'll have new variants.
We also will probably have new spillover events
and new pathogens,
but we have things that we can do
to help keep the air clean.
And I am quickly running out of time.
So I'm not gonna go into detail here,
but I think we can divide them up to things
that are always in place
and then things that we can apply as necessary
and deciding when we put in place, which mitigation effort,
I think depends.
And that's a discussion that we need to have.
When I started this,
I talked about being an elected official and as a scientist,
and I wanna end there too.
This was something I actually said on election night, 2019,
and I believe it more than ever
and it's not that I was always right, I wasn't
and it's not that science is the only thing
that can give you insight.
It definitely doesn't, as I've said throughout,
there are other factors that you need,
we always need to be working on too,
but scientists are incredibly underrepresented
among our elected officials.
And science has given me so much help in grappling
with very difficult decisions that I've had to make.
And I think that we need more scientists in office.
So if anybody out there who wants to run for office,
I really encourage you to do so.
And finally, I wanna thank everybody on this slide.
And particularly I wanna highlight Chelsea Banks,
who is the chief of Opportunity and Response
and headed up our Salem returns efforts.
She's been an incredible partner to work with,
and I feel fortunate to count her as a friend.
I don't have time, I wanna take questions.
So I'm just gonna move on and just thank my family.
And also just leave you on this slide.
So I am going to leave to slide up for a second,
urge people to become vaccine ambassadors.
And I'm happy to take some questions.
- Thank you so much, Dr. Pangallo.
That was a wonderful talk.
And I'm sorry for your loss.
I'd like to ask you a question from a student
to start us off.
The student says, I'd like to pursue involvement
with helping schools with clean air
is their contact information?
That's one part.
And then the second is what are the next steps
that will be taken as of yesterday?
Charlie Baker announced K-12 will not have to wear masks.
What do we do?
- I had no idea that question would come up,
that's a real topic.
(Ron and Kristin laughing)
So the first one, in Salem,
we have functioning ventilation systems.
We have filtration, we have carbon dioxide monitors,
so we're in good shape.
But if you wanna help out other districts,
I don't think at other districts all have the same access
to the same information.
I mean, we've been trying to,
I try to share it with as many people as I can,
but get the word out,
explain what a CO2 monitor is is and how it can help.
Do some DIY Corsi-Rosenthal boxes.
And I think that's a great thing
that we can do with students.
And I think that that's something
I'd like to see us do in Salem.
As for the mask mandates,
that's a discussion that we will be having
on the school committee.
I don't think that we can remove masks yet.
Given our current vaccination rates,
given the amount of COVID that we have in our community,
the fact we have preschool classrooms
and not all of our preschoolers are eligible for vaccines.
So in my opinion,
I don't think we're ready to remove masks yet.
However, as I said,
I think we do need to have a very in depth discussion about
when we apply these mitigation measures
and when we relax them.
And that conversation needs to occur in concert.
- Cool.
Dr. (indistinct).
While she's getting ready, I'm gonna ask another question.
There was a question, from your research,
how effective do you think that aerosol disinfectants are?
- Oh, like the Lysol that you spray?
- I guess that's what they're talking about.
I don't know.
- Yeah, I have not looked into those.
So I can't give you like lots of evidence on that,
but my gut instinct on that
is that when you're adding more things to the air,
that's more stuff you are going to breathe in.
And I usually air on the side
of not breathing excess material.
(Ron and Kristin laughing)
It doesn't tend to go well.
So I mean, I don't know for sure,
but I certainly would have lots of questions
about the health implications
of spraying disinfect into the air.
Especially at scale,
applying that to lots of classrooms with little kids
that doesn't seem like maybe the best strategy.
- Dr. (indistinct) are you...
Another question.
Can you talk about the need to tie
as needed mitigations strategies to clear metrics,
especially institutional vaccination rates?
- Yeah, I mean, I think that's critical.
We know that these vaccines work
and something that I didn't have time to talk about,
I've said a lot about,
going forward, what does this look like?
Because although there are risks with COVID,
it's also, so while we can reduce our risk on a day to day
over the course of our lifetime,
that risk builds up to some degree
and we're going to be exposed,
and most of us will at some point be infected.
So we do need to be cognizant of that.
However, we can also by having vaccination rates
that actually helps to keep COVID out of the schools
and out of an institution.
So I think it makes a lot of sense to tie it to case counts,
vaccination rates, and as case counts fall,
I actually think wastewater surveillance
would be an excellent tool
because case counts might end up falling
because we have more people using rapid tests at home.
Rapid tests are great, but they aren't as easy to count.
So wastewater surveillance allows us to understand
what the burden of infectious diseases in the community.
- Another question,
and I think this is gonna have to be our last one,
understanding your desire for more scientists in office,
is Salem has one health idea of being able to put together
various field positions in a single committee
to overlap scientists, politicians, doctors, vets,
and social workers?
So trying to melt everybody together, I think.
- I mean, I really love that idea.
Having lots of different scientific perspectives
in a community, and in fact,
I'm participating in something like that this afternoon.
In Salem, we have a medical advisory committee
for the public schools for the past two years,
and we have a public health specialist.
We have area doctors.
I contribute from my perspective,
we have somebody from the schools
contributing their perspective
and that has helped give us a variety of perspectives
on these issues.
And I do think that that's useful.
We're doing that with our schools
and I think it can be useful in other areas.
And I know that the city already does that
in areas of like climate and sustainability,
stuff like that.
And on the board of health.
- I shouldn't, but I there's one more question,
somebody just asks and I think it's worth you
getting your perspective and then we'll have to say goodbye.
What do you think about people refusing to get vaccines
and wear masks?
- Another thing that I was unable to fit in in,
maybe another talk,
we need to approach all of these conversations
with compassion and empathy,
because that's the only way to successfully communicate
for one thing.
But also, I think you have to assume best intentions
in most of your conversation partners.
Nobody will wants to get sick.
Nobody wants to die from COVID and everybody,
even scientists, we choose who we trust,
we choose to trust other scientists.
And I mean, we even choose to trust
that these textbooks are correct.
They might not be, right?
- Right, they may not be.
- So we're all making choices and about who we trust.
And what you would find on the COVID ambassador training
is that the most important thing
about changing somebody's mind
is listening to what they have to say.
It's not giving them new information.
It can be answering their questions,
but it's listening to people.
And this is not to say that some of the political
and media leaders who are exposed
and espousing anti-vaccination positions
are to be assumed that they have the best intentions.
I don't think that they do.
And I think that I hold them to a different,
they're in a different category,
but the people around you,
I think everyone's making the best decisions
with the information that they have.
And we have to be really cognizant of that
as we enter these conversations.
And as someone who's had a few of these conversations,
I think the goal,
a good goal for a conversation like that can be
to strengthen the relationship.
It's not to change their mind.
Hopefully over time you will,
but strengthen the relationship,
give people a chance to be heard
and then help, you'll understand them better.
And hopefully they'll understand you better.
And hopefully we'll all get to a better place
because of that.
- Thank you so much.
We have definitely run out time.
We very much appreciate your talk and your expertise.