Listen to the most recent episode of Our Body Politic here (May 21, 2021).

Addressing Vaccine Hesitancy Head-On (Medium) May 3, 2021

Updated FAQs, May 26, 2021

March 3, 2021
Dr. Trivedi is recently featured on the New York State of Mindfulness podcast available here.

February 26, 2021
Listen to the most recent Our Body Politic podcast featuring Dr. Trivedi’s thoughts on our current state of the pandemic.

Study of North Carolina Schools Shows Simple Interventions Keep Kids and Staff Members Safe
A study in Pediatrics shows that with consistent adherence to simple, non-pharmaceutical interventions, secondary transmission of SARS-CoV-2 in schools much lower – over 95% lower – than the spread occurring in their surrounding communities. In other words, opening schools may help reduce, not increase, the burden of infection on communities.

The study describes the findings of Duke and UNC researchers, who studied secondary transmission of SARS-CoV-2 in 56 public North Carolina K-12 schools that opened in August 2020 with hybrid schedules (alternating days of virtual and in-person learning to reduce capacity in the schools). These schools implemented public health measures identified by the “ABC Science Collaborative,” a program set up to partner school systems with local physicians and scientists to use data and evidence to reopen during the COVID-19 pandemic. The collaborative focused on 12 principles and a management tool kit to guide schools in reopening, along with a mnemonic called the “3 Ws”: wear a mask, wait 6 feet, wash your hands. The schools also performed daily symptom and temperature monitoring checks. The researchers tracked the schools for 9 weeks.

Based on the spread in the surrounding communities, researchers expected to find more than 900 cases linked to in-school activities. Instead, during that time, they found only 32, with no cases occurring from children to adults. Twenty of the 32 cases were tied to 4 clusters in the 56 ABC Collaborative-affiliated schools, and all were related to absent face coverings. In contrast, among those schools not affiliated with the collaborative during these 9 weeks, 34 case clusters (300 cases) occurred [private schools (19 clusters; 191 cases), charter schools (2 clusters; 10 cases), non-ABC Collaborative affiliated public schools (11 clusters; 89 cases), and those maintaining an all-virtual model (2 clusters; 10 cases)]. Across North Carolina during that time, the SARS-CoV-2 infection rate was 1-2 cases per 1,000. Within the 11 participating school districts of over 90,000 students, the infection rate, in contrast, was 0.04% (32/90,000).

The participating 56 schools implemented additional precautions beyond the 3Ws and symptom screenings if desired; however, none made major changes to their facilities’ ventilation systems, nor did they open windows, with the exception of some special needs classes where masking was not consistently enforceable and windows were opened or outdoor instruction was utilized, when feasible. Instead, these schools optimized what existed. The study does not go into detail regarding cleaning and disinfection methods, other than that cleaning occurred when instruction was all-remote on Wednesdays. 

Published on Medium February 8, 2021

During the Pandemic Children are Better Off in School: They are Likely Safer Than We First Thought
Read More here.
By Brad Hutton, Valerie Deloney, MBA, and Kavita K. Trivedi, MD

Back-to-school 2020 was fueled with concern that it would cause a spike in transmission of COVID-19 in communities. Despite the surging case counts of COVID-19 that have recently affected the nation and much of the globe, there is little evidence of transmission occurring inside K-12 schools that have clear protective measures in place. Some policies and recommendations have changed over the course of the pandemic as our scientific understanding of the virus that causes COVID-19 (SARS-CoV-2) and how it is transmitted has evolved. Now, five months later, it turns out that elementary schools may very well be the safest place for our children during the pandemic. So, what has changed to help explain why schools have proven to be such a safe setting?

Young Children Seem to Play a Minimal Role in Spreading the Virus

While young children may have higher amounts of viral RNA than older children and adults, they still have lower infection rates. One meta-analysisthat reviewed 32 studies found children and adolescents were 44% less likely to be infected than adults if they were a household contact to a known case. Researchers in Germany tested for IgG antibodies against SARS-CoV-2 in children aged 1–10 and their parents. This represents the best evidence of a prior infection. Seroprevalence was three times lower among children compared with their parents (0.6% vs. 1.8%) despite 31% of children in the study attending childcare. One hypothesis is that young children may be more likely to have prior exposure to other coronaviruses that cause common colds and, therefore, have some protective immunity to SARS-CoV-2. Another possible explanation is that young children have fewer ACE2 receptors, which is the route the virus uses to infect cells. So, there is likely a physiologic reason for COVID-19 sparing most children.

Older Children May Be Less Compliant with Recommended Protective Behaviors…But More Compliant While in School.

Most transmission among school students has occurred outside of school buildings, and on the evenings or weekends. Studies that have associated the spread of the virus with athletics have found it occurs not during competition itself, but during social gatherings associated with teams. What age group is more likely to continue activities, participate in social events, and is less likely to comply with recommendations such as wearing masks and physically distancing — you guessed it…. adolescents!

The incidence of COVID-19 is twice as high among 12–17-year-olds than it is among 5–11-year-olds. Evidence suggests that behaviors explain the difference in rates between younger and older children. In a recent study in the CDC Morbidity and Mortality Weekly Report (MMWR), researchers from Mississippi and CDC compared behaviors among children who tested positive for SARS-CoV-2 at the University of Mississippi Medical Center in September and October 2020 with children who tested negative during the same timeframe. Cases were no more likely than controls to have attended school or childcare in person. Children who tested positive, however, weremore likely in the last 14 days to have attended gatherings outside their household, have activities with other children, and have visitors in their household. The risk of transmission was greater outside school property, reflecting the ongoing challenge that many families face in maintaining vigilance with physical distancing and avoiding gatherings, especially while their schools are not in-person. When schools remain closed, social interactions occur in environments that do not have appropriate infection prevention measures in place, leading to unnecessary infections.

Maybe Schools Are Just Doing a Really Good Job…Prior to Vaccine Availability for Educators

In a study in 17 rural schools in Wisconsin where there was widespread community transmission of SARS-CoV-2, only 7 of 191 cases (3.7%) among students and staff were found to have occurred in school. The schools had high levels of compliance with mask use and physical distancing. Similarly, researchers in North Carolina recently published a study in Pediatrics that reviewed schools that opened for in-person instruction and found extremely low rates of transmission in school despite higher rates of transmission in their surrounding communities. The authors concluded that a strong contributing factor was the schools’ consistent mask use, physical distancing, and compliance with hand hygiene. It is important to note these studies were done prior to vaccine availability and did not implement testing in teachers or students.

These schools also did a good job of contact tracing, issuing public notification to the school community and adapting their normal slate of activities. Ultimately, these studies in two different states demonstrate that transmission in schools is not related to the level of transmission going on in the surrounding communities. It is that the simple recipe of infection prevention measures — masks, physical distancing, hand hygiene — are implemented better by school personnel than most of the public. Educators are in the business of teaching life lessons — how to adapt to a “new normal.” Masks, distancing, and hand hygiene are all protective behaviors educators should discuss, teach, and role model.

Additional Support for Reopening

Thankfully, vaccines are finally available, and educators should qualify to receive them soon in most states, which will protect them from severe illness and hospitalization. However, Pfizer and Moderna have only recently completed enrollment of children aged 12 and older in their clinical trials. We should not expect a vaccine for this age group until late 2021 or early 2022. The studies cited above show success in implementing in-person school with clear protective measures in place. Vaccines will further protect our educators, but we should keep all protective measures in place as we encourage entire communities to receive vaccine. This will keep all of us safe as we move closer to attaining herd immunity. As more people become immune, we can slowly strip away the slices of Swiss cheese — barriers like masking and distancing, which layered together protect us from the COVID-19 virus — and cautiously return to pre-pandemic ways of life. As with healthcare providers, vaccines should make teachers feel even more comfortable interacting with masked, distanced, asymptomatic, unvaccinated children.

Another important change since the fall of 2020 is improved access to testing, and related changes to policy recommendations for screening asymptomatic children and staff. Heading into the 2020–21 academic year, CDC and most states recommended against using diagnostic tests to support reopening efforts of colleges and K-12 schools in part because diminished access to testing at the time made testing students and staff impracticable. Since then, the federal government has provided test kits to states to help support reopening efforts. States like California are providing funding to schools to help them reopen.

Some experts have expressed concerns that low-cost antigen test kits, commonly used for school screenings, have low sensitivity, and may miss cases in children and others who do not have symptoms. However, if antigen tests are used as part of a routine testing protocol to test asymptomatic people, their low cost and quick results add another tool to the tool belt, helping schools detect asymptomatic infections, and facilitating rapid isolation and contact tracing. Still, some school districts may not have resources to implement a rigorous testing protocol; others may opt to test only staff and require students to fill out symptom-based screening tool each day. Others may not test at all, especially if staff are vaccinated. By layering precautions and using testing as an adjunctive option, schools employing any of these configurations can reopen safely if they maintain adherence with essential precautions — masks, physical distancing, and hand hygiene.

Fortunately, elementary, and secondary schools have been diligent and cautious, and have reopened successfully in many parts of the country — without vaccines. K-12 schools should strive to implement science-based best practices to re-open. There is risk to interacting with one another during a pandemic. But as we are seeing, we can provide the enormous benefits of in-person school with appropriate protective measures in place — and even have children and staff be safer for opening school doors. Districts in parts of the country that have yet to reopen would do well to follow the lead of their colleagues and get back to educating American youth.

If you need expert assistance with your school reopening efforts, you can contact us at: https://www.trivediconsults.com/contact .

December 7, 2020
PODCAST UPDATE
Listen to the most recent Our Body Politic podcast featuring Dr. Kavita Trivedi.

What to do about pandemic fatigue?

Published on Medium on November 25, 2020

The past ten months have been a barrage of advice about what we should or should not do to protect ourselves and our communities from SARS-CoV-2.

Distill it down to what we can do individually, today, and four simple, evidence-based practices emerge: wearing face coverings, physically distancing while avoiding enclosed spaces, staying home when sick or exposed, and keeping our hands clean.

By now, we do the last three of them reasonably well. But face coverings are our Achilles heel. Meanwhile, studies suggest that when more than 80% of members of a community consistently wear face coverings in public, it is even more effective than lockdowns.

Many of us have pandemic fatigue after months of restrictions. Let’s try to work through some of the reasons we avoid face coverings to overcome our resistance to them, cut transmission, and start to resume the activities and interactions we miss so much.

1. They’re uncomfortable.

After repeated uses, our bodies stop noticing face coverings, like when we get used to wearing a watch, glasses, gloves, or a bike helmet. But, when we’re inconsistent about wearing face coverings, or when we fidget with them or wear them incorrectly, we undermine the ability for our bodies to get used to them.

2. They’re not totally effective.

Numerous case studies from airplanes, hair salons, and gatheringsdemonstrate that people who wear face coverings are protected from symptomatic and asymptomatic carriers. If worn properly, they work.

3. I know these people.

When we’re among those in our households, as long as no one is infectedwith COVID-19, we are in our “bubble” and can interact in pre-pandemic ways. A “bubble” is a group of people who, because they live together, share a microbial environment.

Think of growing your “bubble” like you’re proposing pandemic marriage. It is a commitment. Are you ready to share your microbial life, for better or worse, with your co-worker? Your neighbor? A close friend? A bubble offers safe exemption from pandemic precautions, but only if it fits this definition of exclusivity. Otherwise, the four simple practices still apply.

4. Wearing a face covering makes me feel self-conscious.

Face coverings have become politicized, meaning some people are making a statement by not wearing them, or trying not to make a statement, also by not wearing them. We can excise the politics with simple participation. Social pressure gently turns new activities into norms and we hasten the tipping point by leading by example.

Choice helps too. You don’t have to put on the same style of face covering every time. The best face covering is one you’ll wear. Represent you, but cover your nose and your mouth. We applaud the designers who are offering clothes with coordinating face coverings to help make them a social norm.

5. Face coverings weren’t recommended at first.

SARS-CoV-2 is a highly-contagious virus. None of us had existing immunity. When it was brand new, the scientific community started from what it understood of similar viruses — SARS, MERS, influenza, and other coronaviruses. We did not need the public to use face coverings to control them.

Because there are no tiny Go-Pros on each virus giving researchers moment-by-moment views of how it spreads, we have had front row seats to the twists and turns of real-time science. In April, accumulated evidence showed that a large portion of people were spreading SARS-CoV-2 while asymptomatic, pre-symptomatic, or unusually symptomatic. At that point, CDC recommended face coverings for the public in order to control the pandemic and has never turned back. Let’s keep looking forward.

6. What about [testing, vaccines, therapeutics]?

These scientific and public health interventions will help bring about an end to the pandemic, but none are “one-shot” solutions. Tests are not prevention strategies on their own. None of them are sensitive enough, yet, to assure that a negative test means we can interact without precautions. The recent news of the leading vaccines’ Phase 3 trials is thrilling, but for various reasons we’re at least a year from enjoying herd immunity. Face coverings will be present in our lives for a while. And in terms of therapeutics, the old adage applies — “An ounce of prevention is worth a pound of cure.”

7. …or [the economy, small businesses, schools, holidays]?

We agree, 100%. These put food on the table, bolster health and happiness, and help us thrive. Face coverings and physical distancing protect them. We fully believe if organizations (from mom-and-pop shops to large institutions to community services) embrace these four simple strategies, most can re-open and thrive, albeit appearing different from pre-pandemic business as usual.

8. …or [the risk of oxygen deprivation, or the benefits of vitamins, salt lamps, oils]?

CDC and other public health groups recommend breathable cloth coverings and other styles that do not to cause oxygen deprivation. Air molecules get through, but the virus is too big. It is true that a small number of people cannot wear face coverings for medical reasons or because they’re under age 2. If you’re not among them, it rests on your shoulders to wear your face covering to help stop transmission in your community.

If salt lamps or other self-treatments are your thing, go for it, but remember they do not, in any way, supplant wearing face coverings, physically distancing, staying home when sick or exposed, and keeping your hands clean.

Advising many businesses and organizations through the pandemic, we have been humbled by how the face covering, a low-burden intervention, can protect the wearer and people around them. An individual choice that can have community-wide impacts. What better way to show you are thankful for your community this holiday season?

There are multiple COVID-19 vaccines. What’s next?

Kavita K. Trivedi, MD
Valerie Deloney, MBA

Posted on Medium on November 24, 2020

News of the successful COVID-19 vaccines’ Phase 3 trials has us seeing a light at the end of the tunnel. We’ll need to handle this last leg better if we are to reach the brighter future of herd immunity, though. Packing ourselves some Swiss cheese will help us get there.

Swiss cheese as a metaphor for layered defenses against a threat is popular in many fields, including infection prevention. Each slice of cheese has holes — vulnerabilities and imperfections — but when stacked together, the holes don’t line up and the slices become a solid barrier.

We have a ways to go. Experts estimate 50–75% of the population needs to be immune to SARS-CoV-2 to achieve herd immunity, and we’re at least a year away from that. Why? These vaccines have only been tested on adults; additional trials will need to occur before children get vaccinated. Some people with early access to a vaccine will decline it (as a point of reference, fewer than 50% of people in the US get the annual flu shot). The leading COVID-19 vaccines require two doses, four weeks apart. A percentage of people inevitably won’t show up for the second dose. The logistics for these vaccines are their own complicated puzzle. Last but not least, we’re still learning how long immunity lasts. Fatigued as we are, there’s a journey ahead of us.

There are four evidence-based practices — slices of Swiss cheese — that we individually have the power to implement now, without waiting on new developments or counting on as-yet unavailable supplies. We can implement them today and every day until we emerge on the other side of the pandemic:

a. Face coverings: they protect others by trapping our own germs — and they reduce the amount of virus we inhale if someone else exposes us;

b. Physical distancing while avoiding enclosed spaces (think of spaces where, if a person in it is smoking, the smoke lingers): with 6 feet of distancing and fresh air, if the virus gets around a face covering, it has a hard time reaching a potential host;

c. Staying home when sick or exposed: basic to infection prevention, as well as;

d. Keeping hands clean with soap and water or sanitizer: we touch our faces when we don’t realize it. If our hands are clean, we don’t accidentally deposit the virus there and make ourselves sick.

Together these four simple practices form a nearly solid barrier between us and SARS-CoV-2. Conversely, when we remove slices — for example, when we forgo wearing face coverings — we open up pathways for the virus to spread.

Think of a vaccine as a fifth slice of Swiss cheese. It will fortify our defenses, but collectively we need the other slices to finish the journey.

We’re pretty good at three-quarters of these slices. Most of us have become more diligent about washing our hands. Showing up somewhere sick was iffy pre-pandemic, and now is unthinkable (few will accept exposure to cold-like symptoms because it’s “just allergies”). We used to interact a few feet apart and have become accustomed to judging 6 feet of distance. But when it comes to face coverings, we’ve stumbled.

Every day we’re greeted with an avalanche of information on COVID-19 from experts and non-experts alike. We get it — it’s too much. But turn down the noise, and focus on these four simple practices until we reach the end: using face coverings, physically distancing, staying home when sick or exposed, and cleaning your hands.

We’ll be in line for the first of likely two vaccine injections — standing 6 feet apart with a face covering — but until then, we all need more than hopes, prayers, or excuses. We need actions from many more Americans to stop COVID-19 and get our lives and our economy thriving again.

November 16, 2020

Listen to Dr. Kavita Trivedi on Strategy Simplified here.

Jenny Rae sits down with Kristy Weinshel (Executive Director at The Society for Healthcare Epidemiology of America) and Dr. Kavita Trivedi (Managing Director of Trivedi Consults) for an engaging conversation around independent consulting. The interview covers a lot of ground, including: How do you start a consulting practice from a specific expertise? How do you know where the line is between giving away information for free vs charging for your expertise?What do you expect to change in the healthcare consulting industry in the next 5 years? West Coast or East Coast: which is better? And more! Enjoy this fantastic conversation with two of the foremost subject matter experts in the healthcare consulting industry.