Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid.

(And it’s okay with me if you want to share.)

Today I’m talking about the importance of testing at colleges and what we know about kids and how science builds on science (and not on headlines).

Massachusetts remains steady with a 1.2% positive test rate. We test a lot (>20,000 tests/day) as there’s so much demand.  Everybody wants a test these days —  for travel, for curiosity, for work, for recent exposures (don’t forget to quarantine while waiting for results!).

So with all that demand you will want to call ahead to make an appointment and maybe plan on driving a distance to get to a center with a good turn-around time. 

But the good news is there’s a LOT of testing places — including the eight centers run by the state doing free testing for asymptomatic people (google “Massachusetts” and “stop-the-spread” to find them) —  and they’re staying open til Sept 30, yay!

Also some of the Boston colleges have started testing their students and staff.  So far, so good. BU tested >13,000 people and has a 0.18% positive rate. Northeastern tested >6500 staff and students and had ONE person with a positive test. (These both have public testing dashboards with daily updates.) 

Most of these schools are also planning regular re-testing of the kids and staff (“interval testing”) which is absolutely key — we need to catch cases as early as possible and quarantine people right away.  Hopefully that will help prevent big spread here in Boston. 

This is very different from UNC-Chapel Hill and a bunch of other colleges who only tested kids once upon arrival (or not at all), and then only tested kids thereafter if they became symptomatic.  These other schools also put the kids two to a dorm and let them go out and party without masks and then of course had a zillion cases so of course they had to switch to remote learning after the kids had already moved in.  What a mess, and how predictable —it’s science, people!

On the other hand, if Boston colleges test regularly, and have enough “wellness wings” for quarantining kids, and enforce masking, we may not end up with that kind of a calamity.  But if you leave out any one of those steps (particularly regular interval testing), well, that school may well end up being another headline. 

Speaking of headlines, lately there have been some really misleading ones including all that scary “The Kids Are Doomed and Are Going to Kill Us All” clickbait. 

But if you look beyond the headlines, most studies about kids are much more rosy.  Recent research seems to be confirming early reports from China and Europe.  Looking at the big picture it appears that:

— kids do get Covid but they don’t get it much

— kids usually don’t get very sick

— kids rarely end up in the hospital

— kids die very very rarely and almost always with pre-existing severe medical problems (a hideous horrible tragedy so we’re thankful it’s so rare)

— even the scary condition of MISC (Multisystem Inflammatory Syndrome in Children) happens only to the tiniest of fractions of kids (2/100,000) 

But do kids spread it?  Oh, no doubt they do, the question is how much?  We don’t really know yet. Some studies show more, some show less, some show transmission from older kids, some rushed studies have turned out to be flawed.

And some research has gotten lots of publicity but about the wrong angle, like this week when MGH’s awesome research on kids’ viral loads ended up twisted in headlines like: “Kids play a larger role in spread than previously thought, researchers find.”

Wait a minute.  What did the researchers actually find?  They found that kids had a lot of virus RNA pieces in their noses.  (And some cool stuff about ACE receptors and antibodies but I digress.)

My conclusions about this study:

  • What did the study mean?  It means infected kids can have high levels of viral RNA in their nose. 
  • Does it mean kids are more contagious than previously thought?  No, that wasn’t studied.
  • Does it mean asymptomatic kids are spreading Covid? No.  Asymptomatic kids can have high levels of viral RNA but again, transmission wasn’t studied.

So if the whole question of how much kids spread Covid is not yet answered, how will we get a definitive answer? Via more science that builds on these kinds of studies.

How do these kinds of studies happen?  Like this:

You’re a physician/scientist working all day in a clinic, sweating through your PPE, seeing one sick kid after another. Some have Covid.  You wonder: how contagious are they?

You go home, strip off your clothes in the garage, drop them in the washer, grab a towel and go straight into the shower, shouting hi to the kids on your way up the stairs.

Once you’re good and squeaky clean, you go hug your kids, make dinner, do good-night stories with your children. 

Then you lay in bed, unable to sleep, wondering: how contagious were those sick kids? Could I have brought it home?

You say to yourself: I can’t know yet how contagious these kids are, but maybe I can get an answer to a fundamental question:  Do these sick kids have many viral particles in their noses?

You figure out a population to study

You figure out the right test

You write a study protocol

You discuss the study protocol with your colleagues, statisticians, ethicists, your partner at home, immunologists, testing companies, patients, lab workers

You rewrite the protocol

You present the protocol to your colleagues, your boss, your lab, the hospital’s Institutional Review Board

You rewrite the protocol per their suggestions and make their changes and get approved

And then,

You work all day in a clinic, sweating through your PPE, seeing one sick kid after another, and some of their (saintly) parents read about your study and volunteer to advance the frontiers of science and consent to let their sick kids get tested by having a swab go up their nose to measure the number of viral particles.

The number of viral particles turns out to be high.

You write up the results of this unexpected finding. 

And so that’s what we’ve learned from this study: kids have viral particles in their noses. 

But,oh dear. We still don’t know if those kids are spreading those viruses (no matter what the headline says).

But, never fear. On the strength of those findings other physician/scientists start a study where — for instance — they get whole (saintly!) families of Covid-positive kids to get a nose sample every day for three weeks and they follow the family and see whether that little kid infects anybody else. 

And one of these days they’ll publish that. And we’ll learn more about whether kids are spreaders, big or little.

This is how science progresses.  One question at a time.  One study at a time.  One physician/scientist willing to put in the work. 

And then eventually — since All Epidemics Always End – we will get to talk about this in the past tense.  “Remember when we didn’t even know how Covid spread?  Remember those endless debates about kids and aerosols and droplets and what kind of mask did what?  So glad they figured that all out — that was the beginning of the end of our nightmare.” 

And all because a physician/scientist lay in bed unable to sleep.