Lucia Bisceglia is the president of the Italian Association of Epidemiology. On Thursday, the IAE held a virtual conference on “Covid & Schools,” a hot topic that has returned to the spotlight. The conference, attended by epidemiologists from all over Italy, has reviewed the data collected so far and the list of things to do to reopen schools safely in September, avoiding the use of distance learning as far as possible.
Dr. Bisceglia, have we figured out if reopening schools is dangerous?
There is still an issue with the lack of data. But the evidence we have accumulated tells us that the epidemic in the schools is a mirror of the epidemic in the community, and there is no evidence that schools trigger chains of contagion. The schools have worked so much on prevention measures. On the other hand, we can recall the large school outbreaks, and this is because they have not been as frequent. The real problem is the involvement of health services when there is a positive case at a school: we need teams dedicated to testing and contact tracing, because each individual case brings the need to trace and isolate contacts.
How can we improve infection prevention at school?
Some data is of great value. For example, the data from the Piedmont region, which implemented a screening strategy with its “Scuola sicura” project. However, we have seen very different measures from one region to another, and similar epidemic trends: this also supports the idea that schools reflect what is happening in the community. The whole effort must now be aimed at equipping prevention departments and public health and hygiene services with tools to facilitate testing and isolation. However, those who participate in a screening program run a greater risk of isolation, and that is a deterrent. So a compromise must be found that ensures adherence to these programs.
Eight-five percent of school staff have been vaccinated: is that enough?
If we compare this average with the one for influenza vaccination, we find that this is a very high percentage. But this is an average number for highly heterogeneous situations. There are regions where this percentage is 30 points lower. School personnel were among the priority categories in the vaccination plan. It was important to protect a professionally exposed community in a context where a single positive case can lead to the isolation of entire classrooms or even the closure of schools. Working on the issue of school staff is essential to a safe return to school for all.
Has there been skepticism about vaccines, or disorganization in the vaccination campaign?
That data is very difficult to find. The commission authority is highly focused on this issue. In my opinion—but this is just an opinion—the fact that the vaccine of choice was AstraZeneca, the most-debated one, also played a role. This may have reduced uptake. In any case, it’s worth trying to increase the vaccination coverage.
So is that the priority heading into September?
That’s not the priority. We should not run the risk of shifting the focus to the issue of vaccinations alone. In reality, the problems of the schools have remained the same: we are still discussing the number of students per class and spacing. The emergency can be an opportunity to rethink school spaces and how students are transported. These were hot topics last year and they are hot topics again this year. It is a priority to think about structural measures that would intervene on these aspects as well. The priority of the vaccination campaign now is to maximize the completion of the vaccination cycle in people over 50 years of age or who are vulnerable. Estimates tell us that there will be an increase in the Delta variant, and we cannot leave the over-50s exposed to the effects of the virus.
We’ve been discussing contact tracing for a year, and it has often been insufficient. Can it be done or should we resign ourselves that it’s impossible?
We have learned that there are different correct responses to the epidemic depending on the phase it is in. In a substantially calm phase such as this one, contact tracing plays a critical role. Early identification and isolation of close contacts and early testing of close contacts are activities that make it easier to break the chains of infection. The other crucial element is the isolation of outbreaks and review of the circumstances of exposure, which helps target contact tracing to priority situations and suggest targeted, not generalized, restriction measures. As epidemiologists, we are all convinced that contact tracing should be improved and made consistent and useful as a knowledge tool. But there is a problem with the time available. We thought we would have some more days, but it’s time to invest all available resources.