Staff shortages riskier than unvaccinated workers, hospital CEOs say

 The CEOs of Cleveland Clinic, Cleveland-based University Hospitals and Johnson City, Tenn.-based Ballad Health said they are concerned that COVID-19 vaccine mandates may lead to an employee exodus that would affect patient care.

Tomislav Mihaljevic, MD, CEO and president of Cleveland Clinic, and Cliff Megerian, MD, CEO of University Hospitals, said Aug. 26 in a virtual forum they are considering a vaccine requirement for employees, but a potential loss of staff is a concern, according to an Aug. 26 cleveland.com report.

The CEOs said they worried that some healthcare workers would rather quit or be fired than get inoculated. Dr. Mihaljevic said hospitals are already understaffed, and losing healthcare employees during a public health crisis would jeopardize the Clinic's ability to provide care. 

"This is something that is on everybody's mind," Dr. Mihaljevic said.

Dr. Megerian said some facilities' COVID-19 vaccine mandates resulted in staff reductions when employees who did not get vaccinated were fired, but didn't provide specific examples, according to the report. 

"It's a cynical question, but what gets us to losing the higher amount of staff?" said Alan Levine, CEO of Ballad Health, Bloomberg reported Aug. 26. 

Ballad Health decided against implementing a vaccine mandate after a model suggested that as many as 15 percent of nurses — or 900 employees — may quit if the system did.

"There are not enough nurses to go around. That is clear," he said, adding that he would hire 600 nurses right now if they were available.

University Hospitals is considering possible consequences for employees who refuse to be vaccinated, such as COVID-19 testing more than once a week, Dr. Megerian said. 

About 80 percent of caregivers at Cleveland Clinic have been vaccinated, and the Clinic continues to strongly encourage its caregivers to get vaccinated, Dr. Mihaljevic said. 

Mr. Levine said 50 percent of Ballad's front-line nurses and 97 percent of its physicians are vaccinated.

Dr. Megerian said about 80 percent of University Hospitals employees have been vaccinated, and he expects that percentage to rise rapidly now that the Pfizer vaccine has received full FDA approval.

"We don't believe that right now, with the minimal amount of [health system employees] who haven't yet decided to pursue the vaccine, that we're putting our patients in danger," Dr. Megerian said. "We just don't want to put our workforce in immediate danger of joblessness."

Ballad is focusing on educating staff about the misinformation surrounding the vaccine. 

"The overwhelming number of our nurses are female and young and in childbearing years," Mr. Levine said, adding that many of his female employees believe the vaccine can negatively affect their fertility. He said educating them has been a priority.

"I can't say that's generated a whole lot of results yet," Mr. Levine said.

https://www.beckershospitalreview.com/hospital-management-administration/staff-shortages-riskier-than-unvaccinated-workers-cleveland-clinic-university-hospitals-ceos-say.html

Physicians prescribing ivermectin for COVID-19 despite FDA warning

 Some physicians continue to prescribe COVID-19 patients ivermectin, a drug most often used to treat parasitic worms in animals, despite warnings from the FDA that the drug should not be used to treat the virus. 

Ivermectin's use in humans is FDA approved only at very specific doses for some parasitic worms, as well as some topical formulations for head lice and skin conditions. It isn't an antiviral. 

Joseph Varon, MD, chief medical officer at United Memorial Medical Center in Houston, told the Houston Chronicle Aug. 26 that he has used ivermectin for COVID-19 patients since the start of the pandemic and since July has used it in all COVID-19 patients in the hospital. 

Dr. Varon gives patients a low dosage of ivermectin based on their weight, along with a cocktail of steroids and vitamins, the Houston Chronicle reported. He said it "makes a difference" in his patients and no one has overdosed or died in the hospital after ingesting it. 

"More importantly, my love for [ivermectin] is based on my personal use and good outcomes my patients have had,” Dr. Varon told the Houston Chronicle. "Once you see it work, it is difficult to deny its usefulness."

Paul Marik, MD, a professor of internal medicine at East Virginia Medical School, told the Houston Chronicle that a number of trials has shown ivermectin is effective against COVID-19, and claimed public health entities are recommending against it because "nobody is making money from it." 

But Dr. A. Clinton White, MD, a professor of infectious disease at University of Texas Medical Branch, told the Houston Chronicle that clinical trials that have suggested benefits from ivermectin were "deeply flawed and likely reflected biases." 

There have been no well-designed clinical trials showing ivermectin is effective at preventing or treating COVID-19 at any stage of the disease, according to the Houston Chronicle. 

In Arkansas, the state's medical board is investigating after a physician said he has prescribed ivermectin thousands of times for COVID-19 patients, CNN reported Aug. 27. 

Robert Karas, MD, a physician that treats inmates at the Washington County Jail in Fayetteville, Ark., defended his use of the drug, telling the Arkansas Democrat-Gazette: "In my medical judgment, weighing the known risks and side effect profile of ivermectin against the potential benefits supports the administration of ivermectin [which we obtained from a licensed pharmacist in dosages and compounds formulated for humans] to COVID-19 patients."

He told the TV station KFSM that he has prescribed the drug to family members and "thousands" of others, according to CNN. 

The FDA posted a warning Aug. 21 advising against the use of ivermectin, which is used most often to treat parasitic infections in animals, tweeting: "You are not a horse. You are not a cow. Seriously, y'all. Stop it."

Calls to poison control centers have been on the rise in recent months as some Americans have been self-administering ivermectin. 

https://www.beckershospitalreview.com/pharmacy/physicians-prescribing-ivermectin-for-covid-19-despite-fda-warning.html

How subtle changes in a microRNA may lead to ALS

When people think about the connection between genes and disease, they often envision something that works like a light switch: When the gene is normal, the person carrying it does not have the disease. If it gets mutated, a switch is flipped, and then they do have it.

But it's not always that simple. Disease-related genes often have different degrees to which they are turned on or off. In these cases, there is a tipping point: With only an incremental biological change around a critical threshold, a person can go from having no symptoms to being very sick. The latest research on this topic from the Salk Institute has implications for studying and treating the underlying causes of amyotrophic lateral sclerosis (ALS) and other neurological and psychiatric disorders. The work, which was published in Neuron on August 26, 2021, could also be applicable to a wide range of diseases involving changes in gene expression levels, like cancer.

"This is increasingly becoming a new and very interesting direction for ALS research," says Salk Professor Samuel Pfaff, the paper's senior author. "Our study is highly revealing in terms of how gene regulation occurs within neurons. While our experiments were done in mice, we believe these findings will also apply to humans."

A handful of genes has been found in patients that are associated with ALS, a disease of the motor neurons that leads to paralysis. What many of these genes have in common is that they are linked to the manufacture of microRNAs (miRNAs) -- regulatory molecules that act like brakes to reduce the production of proteins. In the first part of this research, the team did a systematic review of past studies that profiled microRNA levels in patients with ALS. They found that across all the studies, the same microRNA, called miR-218, kept showing up as being lower, but not completely lost, in people with ALS. They decided to study why particular levels of miR-218 are important for motor neurons to do their job normally.

In a mouse model of ALS, Salk researcher Neal Amin, now a clinical scholar and postdoctoral researcher at Stanford University, devised a strategy to finely lower the levels of miR-218 in a controlled way to study the effects on motor neurons' control of muscle function. Amin found that there's a critical threshold somewhere between 36 percent and 7 percent of normal levels that leads to muscle paralysis and death. Above 36 percent, neuromuscular junctions are normal and healthy; below 7 percent, neuromuscular deficits are lethal. The rest of the study was focused on trying to understand why that was the case.

It turns out that miR-218 regulates the function of about 300 different genes. Many of them encode proteins related to how motor neurons grow axons and send signals to muscle. Once the levels of miR-218 dropped below 36 percent, the way these neurons could signal to muscles dropped off dramatically. The researchers used cutting-edge tools in the lab to determine how miR-218 was influencing various genes.

"Instead of acting like a simple switch, the molecule miR-218 is like an orchestra conductor of 300 musicians playing together," Amin says. "Instead of gradually telling all of the players to dim the volume of their instruments in unison, it's telling some musicians to play more quietly and others to stop completely. It has a much more dynamic and complex control over gene function than we ever previously appreciated."

The researchers say that being able to study this fine-tuning in animal models will allow them to learn much more about how genetic mutations that reduce gene expression put patients at risk for developing brain disorders. This could eventually lead to new treatments that get at the heart of the biological changes that lead to disease. The research not only has implications for ALS, but for other diseases of the nervous system, including schizophrenia, which has also been associated with changes in the expression level of microRNAs.

"We think that these processes may also take place in other diseases related to genes and aging, including cancer," says Pfaff, who holds the Benjamin H. Lewis Chair at Salk. "Having a new way to create animal models of how genetic disease begins and how it progresses will allow us to get at the underlying mechanisms and a deeper understanding of these complex activities."

---

Story Source:

Materials provided by Salk Institute. Note: Content may be edited for style and length.

---

Journal Reference:

1. Neal D. Amin, Gokhan Senturk, Giancarlo Costaguta, Shawn Driscoll, Brendan O’Leary, Dario Bonanomi, Samuel L. Pfaff. A hidden threshold in motor neuron gene networks revealed by modulation of miR-218 dose. Neuron, 2021; DOI: 10.1016/j.neuron.2021.07.028

https://www.sciencedaily.com/releases/2021/08/210826111649.htm

Theranos Founder Claims Abuse by Ex-Boyfriend in Fraud Trial -Court Filings

 Theranos Inc founder Elizabeth Holmes has accused her former boyfriend, who was president of the blood-testing startup, of abusing her, court documents unsealed on Saturday showed, hinting at a possible defense strategy with jury selection in her fraud trial set to start next week.

In court filings submitted more than 18 months ago, Holmes' lawyers said they planned to present evidence that Ramesh "Sunny" Balwani abused her emotionally and psychologically in a relationship that spanned more than a decade. That includes the period when the company claimed its technology could enable a wide array of medical tests with a few drops of blood.

Theranos, which Holmes founded in 2003 at the age of 19, collapsed in March 2018 when she, Balwani and the $9 billion company were charged with fraud by U.S. regulators. Theranos had made Holmes, a Stanford University dropout, a Silicon Valley star.

In the filings Holmes' lawyers argued that the alleged "intimate partner abuse" was relevant to the question of whether she knew that financial information provided to investors and others was false. Holmes intends to blame Balwani, alleging he exerted controlled over her through the abusive relationship, the filings indicate.

Balwani, whose case is being handled separately, has denied the allegations.

"Mr. Balwani unequivocally denies that he engaged in any abuse at any time," his lawyers wrote in a December 2019 filing.

Holmes and Balwani have both pleaded not guilty to charges that they defrauded investors, doctors and patients by falsely claiming Theranos could revolutionize medical lab testing with its technology.

Lawyers at Williams & Connolly for Holmes and attorneys for Balwani at Orrick Herrington & Sutcliffe could not immediately be reached for comment.

Assistant U.S. Attorney Jeff Schenk, the lead prosecutor on the case, did not respond to an email seeking comment.

Holmes' lawyers had previously flagged they would make her mental health an issue in the case. Last year they said Mindy Mechanic, a California State University at Fullerton professor specializing in psychosocial consequences of violence, trauma and victimization, would offer expert testimony at trial.

The case is United States v. Holmes, U.S. District Court, Northern District of California, No. 18-cr-00258.

https://www.usnews.com/news/top-news/articles/2021-08-28/theranos-founder-claims-abuse-by-ex-boyfriend-in-fraud-trial-court-filings

What's next in COVID-19 crisis: FDA approvals, booster shots, new variants

 Between the surging Delta variant, breakthrough infections in vaccinated individuals and evolving guidance around masking and booster shots, the dynamics of the COVID-19 pandemic continue to change 18 months into the crisis.

Texas A&M Today spoke with virologist Benjamin Neuman about some of the latest developments in the pandemic. Neuman is the chief virologist at the Texas A&M University Global Health Research Complex.

What does full FDA approval for COVID-19 vaccines really mean?

On Monday, the Food and Drug Administration gave full approval to the Pfizer/BioNTech COVID-19 vaccine for people 16 and older. Previously, all available versions of the vaccine in the U.S. had been distributed under emergency use authorizations.

Effectively, Neuman said, the full approval functions as a vote of confidence from the FDA in the Pfizer/BioNTech vaccine.

"To their satisfaction, there's enough data to be certain enough about the effectiveness and safety of the vaccines," he said. "In practical terms, it really doesn't make any difference. You'll get the same vaccine now that it's been approved as you would have before."

While the Johnson & Johnson and Moderna vaccines are still awaiting approval, Neuman said it's mostly a matter of how quickly the paperwork can be processed.

The approval from federal regulators could help sway some holdouts toward getting vaccinated, he said. For those who have being waiting for an OK from the FDA before making a decision, "this ought to go some way toward clearing up their hesitancy," Neuman said.

"It would make me so happy to see an increase a demand, and this was the stumbling block that people have been saying was in the way of greater vaccination," he said.

The approval could also lead to vaccine uptake prompted by vaccine requirements from corporations, school boards and other organizations. Neuman said they now have a now have a freer hand to mandate vaccinations, at least in areas where not prohibited from doing so by governor's orders. In Texas, for example, Gov. Greg Abbott announced on Wednesday an executive order banning COVID-19 vaccine mandates regardless of whether they have full FDA approval.

What's the strategy behind booster shots?

U.S. health officials have announced plans to offer COVID-19 booster shots to vaccinated Americans to increase their protection. The doses are recommended eight months after people get their second shot of the Pfizer or Moderna vaccine. People who got the single-dose Johnson & Johnson vaccine will also likely need additional doses, officials say.

Neuman explains that many childhood vaccines, like those for polio, require as many as four doses. With the polio vaccine, a third dose provides 99 percent immunity, and a fourth dose provides immunity for life.

The COVID-19 mRNA vaccines appear to have a similar efficacy per dose, at least for the first two doses, he said.

"So I'm not really thinking of them as boosters—I'm thinking of them as completing the series of what's probably going to be three to five shots," Neuman said. "We're just not sure yet how many it's going to take. The indication is that immunity is a little more durable than we thought previously, which is good news, and that means we may actually be able to get to a point where you are not just vaccinated for now, you're actually vaccinated for good."

While the 90 percent protection provided by two doses is still "really fantastic"—and on par with the most effective vaccines ever produced—Neuman said that still leaves a 10 percent risk for contracting the virus, which is significant considering the tens of millions of people who have been vaccinated, as well as the millions of unvaccinated individuals who are unprotected.

"There are people who are vaccinated who are getting infected, and this third and potentially fourth dose would go a long way toward cleaning up and eliminating that," Neuman said. "It's like a game of Risk we're playing, only it's with peoples' lungs. We're trying to take up as much territory with vaccine as possible so that the virus cannot operate there."

Do booster shots need to be from the same brand as the initial round of vaccines? What could the side effects be?

While it's too early to say with scientific certainty that mixing and matching vaccines is safe—since the data hasn't been gathered—Neuman said it likely won't matter if someone decides to switch brands for their booster shots.

"All of the vaccines that are available in the U.S. use three different ways to make exactly the same version of exactly the same spike protein," he said. "In terms of what your immune system sees, there's no difference. They all produce the same immunity."

In Israel, where third doses have been administered for a little over a month, the side effects have been about the same as those experienced during the second dose. Neuman said that those side effects, which can include fever, chills, tiredness, headache and pain at the injection site, are still "nothing compared to COVID-19."

Why has the head of the World Health Organization called for a moratorium on booster shots?

The ethics of administering booster shots in the U.S. while other countries struggle to provide citizens with even a single dose have been called into question. On Monday, WHO Director-General Tedros Adhanom Ghebreyesus called for a two-month moratorium on administering booster shots, citing global vaccine inequality and the need to prevent the emergence of new coronavirus variants.

Neuman explains that vaccine access is a global issue. In addition to the issue of equitable vaccine distribution in developing countries, the virus will continue to change and make new variants anywhere it's able to grow.

"Just as they saw in New Zealand and Australia, as long as there's travel, no matter how limited into or out of a country, eventually the virus is going to work its way in if you give it enough time," he said. "So we've got to knock this thing out everywhere before everybody's really safe. You have to remember not to hold the parade too early."

Should I be wearing a mask around other people, even if I'm vaccinated?

"If there are other people around, I am wearing masks all the time," Neuman said. "There is enough virus circulating in Texas right now that you're essentially not safe anywhere that you would go. It's a very good time to have a mask."

He compares it to putting on a seatbelt when getting into a car with airbags. Even for vaccinated people, Neuman recommends wearing a mask indoors: "they're both going to keep you safe."

Are there any new variants to watch out for?

There are two more variants that will likely be given Greek-letter names soon, Neuman said. He said that when a new variant emerges, it's comparable to the same mutations popping up on a different branch of a family tree.

"The virus is changing on the outside, but it looks as though it may be somewhat limited in the way it can change, because it's not coming up with new solutions," he said. "It is sort of rehashing old solutions, and we know the vaccines work pretty well against all the variants that have come up so far."

While the virus is increasing in efficiency in variants like the highly-contagious Delta, the part that's changing doesn't have anything to do with how it interacts with vaccines, Neuman said. This hopefully means that changes to the virus won't pose new threats to the available vaccines.

"This isn't going to guarantee that the virus is going to stay pending like this forever, but for now it looks as though all the variants that we're seeing, and all the likely variants, are going to be very much able to be stopped by the vaccine," he said.

https://medicalxpress.com/news/2021-08-covid-crisis-fda-booster-shots.html

Contact tracing takes a back seat during latest COVID surge

 Health investigators across the U.S. are finding it nearly impossible to keep up with the deluge of new COVID-19 infections and carry out contact tracing efforts that were once seen as a pillar of the nation's pandemic response.

States are hiring new staff and seeking out volunteers to bolster the ranks of contact tracers that have been overwhelmed by surging coronavirus cases.

Some states trimmed their contact tracing teams this spring and summer when virus numbers were dropping and are now scrambling to train new investigators. Others have triaged their teams to focus on the most vulnerable, such as cases involving schools or children too young to be vaccinated.

Texas got out of the business entirely, with the new two-year state budget that takes effect Sept. 1 explicitly prohibiting funds being used for contact tracing. That left it up to local health officials, but they can't keep up at a time when Texas is averaging more than 16,000 new cases a day.

Mississippi has 150 staff working full time to identify people who have had close contact with an infected person, but they are swamped, too.

"A lot of times by the time of cases are reported, transmission has already occurred by the time we reach that person," state epidemiologist Dr. Paul Byers said.

Since the pandemic began, states have been relying on the practice of contact tracing to track down, notify and monitor those who were exposed to someone who tested positive for the coronavirus.

Dr. Yvonne Maldonado, a professor of global health and infectious diseases at the Stanford University School of Medicine, said that while contact tracing can be time-intensive, especially if one person potentially exposed a lot of people, "it does in the end prevent additional cases."

Maldonado said it's a "staple of public health" and can be the only way someone can find out a stranger may have potentially exposed them to the disease.

The contact tracing response has varied from state to state throughout the pandemic.

New York, which has had a robust team, has adjusted its contract tracing staff with the pandemic's waves. The state had more than 8,000 contract tracers in February and March of this year but now has 3,860 staff working on contract tracing. That does not include New York City, which has its own $600 million tracing initiative with thousands of staff.

Arkansas has hired two outside firms, General Dynamics Information Technology and Arkansas Foundation for Medical Care, to handle the investigations for the state. The firms have about 257 people working right now and are each trying to add about 100 more.

In Louisiana, another virus hotspot, state officials have added 130 people in recent weeks to their staff working on contact tracing. They now have more than 560 people working on tracing efforts.

In Idaho, a new public health website, VolunteerIdaho.com, encourages people with health care skills or a simple willingness to volunteer for Idaho's Medical Reserve Corps. Among the volunteers they are seeking are people who can with contact tracing and data entry

Health officials say with the overwhelming number of new cases, they're not able to track every case and instead try to focus on infections that could have exposed large numbers of people or vulnerable groups.

That's the case in Alabama. Dr. Karen Landers with the Alabama Department of Health said her agency encourages anyone who tests positive or is exposed to follow isolation and quarantine guidelines and notify anyone they had close contact with, but the health department is focusing its resources on bigger outbreaks, clusters and group settings.

In Nevada, the investigators are prioritizing their efforts around cases involving children or schools, according to Julia Peek, Deputy Administrator of Community Health Services at Nevada's health department.

In Texas, Gov. Greg Abbott last year approved a $295 million contract with a firm to run contact tracing for the state, but the deal drew conservative backlash and a lawsuit from lawmakers who said the governor overstepped his authority by approving the deal with the Legislature was not in session.

Abbott eventually won the lawsuit, but contact tracing funds were stripped from the new budget.

Local governments say they're continuing the effort and trying to ramp up staffing as cases climb. In Austin, for example, the local health department had about 50 investigators working on contact tracing at the peak of the pandemic. But when cases dropped, they reduced their staff to 12, according to Austin Public Health spokesman to Matt Lara.

In California, state workers have been dispatched to help county health department teams working on contract tracing. At the peak of the pandemic, Los Angeles County had about 2,800 people working on the effort until this spring, when cases began falling, said True Beck, a public health worker who manages a team of contract tracers for the county.

Beck said some staff in the spring were reassigned to make calls encouraging people to get vaccines and others were sent back to their regular jobs at other county departments, but lately they've been bringing people back and have about 1,000 working.

She said the work is relentless and the calls, which can last an hour, can be emotional. Workers making contract tracing calls not only help people learn about what they should do to keep themselves and others safe, but they can hear from people who are scared, lonely or grieving or in need of assistance, such as with paying rent or getting food. Beck said the staff on her team try to help and connect people with other resources.

"It's hard to do this day in and day out calling perfect strangers," she said.

She said people are not as eager to talk or do interviews as they were earlier in the pandemic, when there was a lot more fear and unknowns about the virus.

"Now I think people are a little tired of COVID. I think we all are, frankly."

https://medicalxpress.com/news/2021-08-contact-seat-latest-covid-surge.html

Let virus run its course: Seattle-area school district official

 A top administrator at the Issaquah School District took to Facebook last week to rant against the state mask and vaccine orders, arguing that the virus should be allowed to “become endemic and run its course.” 

“What’s the end game with all this? Masks, vaccines and limiting freedoms for how long? My family has been in Washington for seven generations and this is the first time in my life that I despise this state.

“It only took 200 years to get rid of small pox. Let the virus become endemic and run its course, it’s here to stay,” the district’s chief financial officer, Jake Kuper, wrote in response to a public service post about masking from the state health department. “So happy for the strictest Covid-19 mandates in the US. I thought liberals loved freedom…and pro choice…oh wait.” 

The comments alarmed a group of Issaquah parents, who said Kuper’s statements made them question how well the district will implement protections against COVID-19. Kuper, who said in another comment on the post that he is fully vaccinated, is involved in labor bargaining on behalf of the school district, including an agreement that covers health and safety conditions for the upcoming school year. Sept. 1 is the first day of school for Issaquah and many other Seattle-area districts. 

“Everyone is entitled to their opinion, but that’s a very misinformed opinion and dangerous opinion to share with others,” said Dr. Jeff Duchin, health officer for Public Health – Seattle & King County during a Friday news briefing. “… Letting the virus run its course will result in an unacceptable number of people becoming ill, developing long COVID, being hospitalized and dying.”

Many safety provisions in schools, including mask orders and mandatory vaccines for all K-12 school workers, are not up to the discretion of school district administrators. They are state mandates.

Through a district spokesperson, Kuper said the comments were made from his personal account, and reflect his personal opinion and not those of his employer.

District Superintendent Ron Thiele wrote in an email to parents this week that “all operational decisions are ultimately approved by me” and that the district plans to follow all health and safety guidance from the state’s Department of Health. Asked if the district would take any disciplinary action based on Kuper’s remarks, spokesperson Lesha Engels said Kuper was exercising his First Amendment rights. 

“It just casts doubt on everything,” said Tiffany Smith-Fleischman, who has three kids in the school district. “I trust my principal, I trust our custodians, but they can only do as much as the district allows.” She and other parents say they’ve been frustrated with the way the school district has responded to their safety concerns, and with the district’s decision to not offer an option for remote learning.

Smith-Fleischman said she was also concerned about the “cavalier” way Kuper spoke at a recent School Board meeting, after a teacher testified she was concerned about how the district was calculating the distance between desks. Kuper said the district was going to do “much less measuring” to enforce distancing, saying that using exact measurements is “so last year.” (He also said there will still be reminders to keep physical distance in schools.) 

The state Department of Health guidelines leave this somewhat flexible: they advise schools to maintain 3 feet of distance when possible, and when not feasible, to use other approaches including adjusting ventilation to improve airflow.

At the same School Board meeting, a few parents testified against requiring masks in schools.

As the new school year begins, parents’ anxieties about their children’s health have collided with pushback against mask mandates and other safety provisions. School Board meetings have been a stage for these debates, which have spilled into the late-night hours and attracted protesters. 

The rate of infection among kids has increased in a short amount of time because of the highly transmissible delta variant, according to an American Academy of Pediatrics report released earlier this month.

Cases of hospitalization and deaths due to disease caused by the coronavirus are still very low among kids, Duchin said Friday. But, he said, he’s still “very worried about what may happen when our children come back to school for in-person learning.”

In this state, the fiercest debates over prevention measures have mostly taken place in Eastern and Central Washington. On Aug. 24, several audience members at an in-person Wenatchee School Board meeting flouted Gov. Jay Inslee’s indoor mask order, appearing maskless a day after the mandate took effect. The board moved its meeting online after 25 minutes. Groups of protesters have also argued against the mask mandate in front of the Kennewick and Richland school district headquarters. 

On Wednesday, the superintendent of the Kittitas School District in Central Washington said that she wouldn’t exclude students from the classroom for not wearing masks, according to the Ellensburg Daily Record newspaper.

Public employees have more freedom to express their opinions than those working in the private sector. But there are some cases in which courts have ruled in favor of public agencies disciplining employees for speech. One local example: the 9th U.S. Circuit Court of Appeals sided with the Bremerton School District for its decision to prohibit a football coach from praying at the 50-yard line at the end of games.

He acted in a public capacity, and in a way that adversely affected the religious rights, and was contrary to the district policy,” said Hugh Spitzer, a law professor at the University of Washington.

In assessing whether an employee’s words should result in discipline, the government has to weigh how much consequence the speech has for the work the employee or employer does, Spitzer said. The consequences in Kuper’s case would have been greater had he been a superintendent or a nurse, or posted the comments from the school district’s Facebook account.

“But I will say that this particular CFO has probably reduced his effectiveness and value to the district by using pretty bad judgment,” said Spitzer. 

Washington state’s top education official, Chris Reykdal, warned this month that school districts will risk losing their funding if they don’t enforce the mask and vaccine orders. 

Washington is one of 16 states that have required masks in schools, according to Education Week. Several other states have done the opposite, prohibiting school districts from requiring masks, though in some places, including Texas and Arkansas, enforcement of these bans are on pause while they are reviewed by courts.

https://www.seattletimes.com/seattle-news/education/let-the-virus-run-its-course-a-seattle-area-school-district-official-said-on-facebook/