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An epidemiologist’s guide for back-to-school planning

Carrie Dolan (Photo by Lindsay Lyons)As elementary and high school students head back into classrooms, W&M News spoke with Carrie Dolan, an epidemiologist, an assistant professor in health sciences, member of William & Mary’s Public Health Advisory Board and director of the interdisciplinary Ignite global health research lab. She is currently advising the local school district and preparing her own family for going back to school. The most recent health guidelines and protocols are available at the Centers for Disease Control and Prevention’s website. – Ed.

When we last spoke, you gave some excellent advice about how to navigate the holidays in 2020. Since then, so much as changed in the course of this pandemic. Vaccines are widely available, but there is also this new delta variant spreading like wildfire throughout the country. You’ve also taken on a new advisory role for the local school district. Can you talk a bit about what you’ve been doing in that regard?

Of course. I now serve on the Williamsburg James City County Public Schools public health advisory team. That team consists of school administrators, a physician, a clinical director, and me, an epidemiologist. 

And what are some of your responsibilities?

The way that I view my role for the school district is very similar to my role on William & Mary’s Public Health Advisory Team. I see myself kind of like a colander. I take in all of the data and science related to COVID and then sift through it and get all of the relevant facts organized in a way that I can then present them to the policy-makers, so that they can make decisions based on solid evidence. 

There’s so much information out there, and it's really hard for decision-makers to know which piece of guidance they need to look at, and how and why. So, I try to organize it in a way that streamlines the information and then they can use it to plan all of their next steps. So, basically, I do the same thing on both committees.

Of course, that said, the data and the considerations are different. For the school board, we’re talking about a population that, at this point, mostly cannot get vaccinated. Any child under 12 is not eligible for a vaccine. So, in this case, we’re looking to the CDC, the Virginia Department of Health, the Virginia Department of Education and the American Academy of Pediatrics for guidelines. A big part of my role is helping the school system understand the varying types of data that address the challenges that the schools face, and then describing all of the mitigation measures, reviewing the tools that are available, to outline different options for them to consider.

On that topic, Virginia just passed a universal mask mandate for K-12 schools, which kind of makes that no longer an “option” but a “given.” How did that decision impact your recommendations to the school board? 

Right. Well, when the school system first asked for information, the question was mostly about making a recommendation for masking or not. Now, people are going to have to be masked, so it’s not up for debate, which actually allows us to have a more robust conversation about the science behind a whole host of other mitigation measures, like quarantine and isolation. I'm actually hopeful this creates more space to be able to discuss how the masking fits into an overall mitigation approach. There is still a lot to talk about.

You know, I almost didn’t ask you about the mask mandate, because the topic has become so divisive. It tends to make people go into camps and the conversation gets so charged, which I completely understand, because there are always elevated levels of emotion when we’re talking about our children.

Definitely. What you're talking about really resonates with me. My family is in Texas, which is getting hit hard right now, so I’ve been having these discussions with my relatives who are there. My approach to thinking about this is that kids really need five days of in-person school and they need to be in front of the teacher.

We have lots of data and evidence to show that going virtual and being virtual all year is a big challenge to learning. We’re talking about learning loss, but then also there's mental health consequences that are associated with it. So, keeping kids in school is the priority, and what schools are designed to do is to deliver the best education that they can to our kids.

The reason we wear masks is because it limits the spread and keeps kids in front of their teachers five days a week. If we take away the masks, we really do open ourselves up to cases. Then we have kids and teachers going into quarantine, and going back into virtual learning again. It’s incredibly disruptive.

I get that, but I guess part of me is thinking about the fact that this virus is constantly evolving, so disruption is sort built into the context of what we’re dealing with.

Yes. I think that is really important. One of my talking points is that what works today might not work tomorrow – and so school leaders and families really need to be ready to pivot policies and practices. For example, the delta variant has a unique set of conditions that's going to inform our behavior, so we are is in this place of masking as a result.

I think that policymakers should build in routine review of their policies to make sure that we're still on track, because we're going to have other variants that are going to bring in their own nuances and we've got to be flexible while we're still in this thing, which we will be for a while. It’s not going to end any time soon.

In light of that depressing revelation, is there a public health measure should we all be adopting even as the landscape changes?

To me, the most important thing we can do is be clear -- with ourselves and each other -- about our comfort levels with risk. That includes the way that kids can express to their peers and their teachers the limits and risks that they're willing to accept.

Earlier on in the pandemic, I developed a framework called Know Your Number. At the most basic level, it’s a number system that categorizes risk from one to five, with one being the most conservative and five being the most lax – but it’s a lot more than that.

It’s a tool to foster acceptance around where we are, and it provides a way for us to quantify and communicate our risk without having to get into all the details about why you came up with that number. So, you can say “I’m a three,” which means you probably avoid large indoor gatherings, but are comfortable interacting outdoors or masked in small-group settings – and there is a shared understanding of what that number means. It creates a new mechanism for starting a conversation without it coming from a place of judgment. It’s just letting somebody know where you’re at and making decisions from that place.

Yeah, because it can get heated really quickly, people bring their own baggage to these conversations.

Correct. And it gets into this place where people feel like they need to justify and explain. We don't have to justify or explain how we come up with our number, we can just say what it is for us and then plan our own next best steps around it.

I think it's especially valuable conversation to insert into the national dialogue right now, as families get ready to head into school. Facilitating that conversation could even be step one for families getting ready to interact with the school environment.

I mean, we're talking a lot about kids and their mental health, and part of your mental health is being able to articulate how you feel in a way that is clear and can be heard. I don't know a single household that isn't discussing back-to-school and what it's going to look like. Kids are picking up on all of that. Having this Know Your Number tool helps them be able to make sense of all that in some way.

You have a kid in elementary school. How are these conversations playing out in your own household? Have you found Know Your Number to be useful right now?

Here’s a great example. We just came back from the Little League World Series tournament in Florida. My son was there with his team – and there were teams from all around the country there. So, we're in this hotbed of COVID, with teams from all around the country, and I hear my son get invited to another team’s ice cream party.

Rather than have it be a whole big conversation among the parents, my son just said, “In my family, we’re a three, which means that I can’t go inside, but if you want to eat ice cream outside we can do that.” And so he went and they had ice cream outside. I didn’t have to go over there and have this big discussion with the parents and make them feel defensive about their own choices. 

If you get invited to somebody's house as a little kid, and then you say their way of doing things in their house isn't right, that creates a lot of animosity. I found that this number system, it fosters a lot more interaction than keeping people apart. Like, they’re kids. They don't care. They just want to eat the ice cream.

I also think the flip side is helpful. Like, it is useful for my family to know how we should interact with other families based on where they fall. This system allows me to accommodate people whose association with risk is totally different from mine, but I can still find a way to build a relationship with them. Regardless of where we stand in terms of our relationship to the pandemic, this makes it so the overruling relationships can be with that person and not with COVID.

That’s it 100%. It's all about building relationships outside of this politically charged environment, finding a way to allow us to coexist and enjoy other people. Some of our closest friends are fives, and they know that we're a three. We've done so many wonderful things and made so many great memories this summer, all outside, all in big open spaces. Whenever we're at the river, everyone's happy. It’s the river.

The last question I have ties in exactly with what you just said. I wanted to ask you about what gives you hope as we head into the fall.

A lot of what gives me hope is what I just articulated. I see a path for us to coexist and live big, full, productive lives this fall. I don't see it as all doom and gloom, like we're going backwards, and that we all are going to be isolated and missing out on life

But I do see that we're going to have to have really effective communication in order for that to happen. I think our kids can be in school for five days a week. I think they can do their afterschool activities. I think that they can continue to see their friends and they can thrive, but it's going to take communication to get there. So, as parents and community members, the more we invest in solid communication efforts, the better off our kids are going to be.