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Provided by Tom Ulmet on April 16, 2020.

Welcome back from what would have been spring holiday! You have by now been able to assess how many teachers are restricted from entering China and may also be able to anticipate how many families cannot return. Another headache to deal with! Many new headaches will now arise as you and your Board/Owner decide how to resolve some of the following problems. The chances are increasing that foreigners will be unable to return to China by the end of May, in which case, should they remain where they are until August? While you will, no doubt, be fully engaged with restarting classes and preparing your hygiene and cleaning regimen, here are some questions that require reflection.

  • With intensified cleaning in place, which parts of the buildings can be closed off to save on people power?
  • How can we combine classes for students unable to return because of entry restrictions?
  • How will those staff who could not return be dealt with? Fully paid, half paid, released?
  • If some decide not to return at all next year, how will their possessions and accommodations be dealt with?
  • How do we handle staff who want additional pay for covering for staff not there?
  • How can staff who are still abroad carry on with online learning for students remaining abroad?
  • What happens if families and staff still abroad decide not to return for the next school year?

Re-opening Coming Soon! 
Some campuses have already reopened for some grade/year levels. You may have already received notice from the provincial or city government about your reopening date. Jiangsu Province reopened first. Most provinces should be able to reopen schools at some point in April with at least a two-week advanced warning. A small percentage of Chinese students returning from abroad reimported the virus with them so additional time will be needed to get them through the quarantine period. Hong Kong was aiming for April 21, but that has now been extended indefinitely. Schools in Hong Kong will be given three weeks advanced notice for reopening. To fight the virus, “Continue to achieve, “suspending classes without suspending learning.” Macao has also not yet set a date for reopening.
https://www.edb.gov.hk/attachment/en/sch-admin/admin/about-sch/diseases- prevention/edb_20200331_eng.pdf

It is possible that students/teachers in state schools will be required to wear face masks all day which could initially apply also to private schools. If you can demonstrate your intense cleaning and hygiene regimen, you may be able to obtain an exemption, especially as there will be no foreigners returning from abroad for some time to come. Even though reopening carries big additional responsibilities, it will be good to have students return to school. But remember, it only takes one person, one case to change that.

Containment Works!
The good news is that China has shown the world that strong, timely measures can contain the spread of the coronavirus very well in contrast to how an uncontained spread has affected other areas of the world, especially Europe and the USA. China moved through the three stages of containment, prevention and reduction very effectively through preparedness and fast action. The greatest danger to China now comes from the neighbor in the north, Russia. Because few cases were appearing in WHO Situation Reports, it was assumed that Russia was not affected. Now however, they have awakened and discovered a situation nearly out of control with similarities to the rapid spread in some other countries. There were no flight bans from Russia until last Saturday when a flight of largely Chinese citizens arrived in Shanghai from Russia. Due to stringent controls, passengers were quickly tested and 51 tested positive. This means that as Chinese abroad continue to enter, all efforts and facilities will be needed to process their return. https://www.bloomberg.com/news/articles/2020-04-12/russian-flight-had-half-of-infections- found-in-china-on-saturday

It is hard to imagine how foreigners will be able to reenter China any time soon. And what does this say about other countries whose airport and border screenings and tracking lag far behind China? The prospect of a long recycling of COVID-19 appears increasingly likely.

Unfortunately, the rest of the world was not prepared and did not heed the warnings from the previous coronaviruses, SARS, H1N1 (Swine Flu), H7N9 (Avian Flu) and MERS. Hopefully, this hard-learned lesson will bring needed global awareness and global cooperation before another virus appears as it surely will in a heavily populated, well-traveled world. These same coronaviruses are still active around the world. The seasonal influenza that ravaged the US from November through February without much publicity (because it is just the flu) is our old nemesis, Influenza A H1N1. 
https://www.cdc.gov/flu/weekly/#PublicHealthLaboratories

And it remains just as deadly, especially for elderly with other afflictions. Through April 4, this seasonal influenza received little attention, but the number hospitalized was estimated between 410,000 and 740,000 (About 1,300,000 were tested with 19% indicating positive. Outlying treatment facilities did not have testing access and diagnoses were made from symptoms which accounts for the wide disparity in estimates). Between 24,000 and 62,000 died (those not tested tended to have pneumonia labeled as cause of death). Since COVID-19, even less attention is given to seasonal influenza as hospitals in many areas are overtaken by COVID-19. Testing for COVID-19 lags far behind reality and even today someone with symptoms must pass a priority screening to obtain a test so one can only imagine the true extent of the spread. This leads some to suggest, “Seasonal influenza was killing more people so what’s all the fuss.” “Let it pass, get herd immunity and get back to work.” The increasing dilemma in many countries at this time is either people die or the economy dies. The problem is that the number who die are someone’s loved ones who are dying isolated and alone. The emotional burden is immense. https://www.cdc.gov/flu/about/burden/preliminary- in-season-estimates.htm

Influenza A, H1N1
A study by the Center for Disease Control (CDC) showed that among 3,433 adults hospitalized with influenza and with information on underlying medical conditions, 92.3% had at least one reported underlying medical condition, the most commonly reported were cardiovascular disease, metabolic disorder, obesity, and chronic lung disease. This is a close correlation to those who are hospitalized and die from COVID-19. Among 569 hospitalized children with information on underlying medical conditions, 48.5% had at least one underlying medical condition; the most commonly reported was asthma. This implies that for younger students with asthma should be known to their teacher and discretely observed as any sign of discomfort can save them. This also applies to adults.
https://www.cdc.gov/flu/weekly/#S6

Why is What Happens Abroad Important to Us?
Although China, Hong Kong, Macao, Taiwan and Mongolia appear to be at or near the end of the contagion internally, borders are closed to all incoming foreigners as a precaution against reimporting the virus from affected areas. The longer this carries on uncontained outside of China, the longer borders will be closed. Even if other countries decide to reopen their economy, if the virus continues to spread, it will impact foreigners who wish to return as soon as possible as well as those who are planning to arrive in the autumn. Imagine a returning family spending a mandatory quarantine in a quarantine hotel instead of their accommodations. This is not much of an incentive to return until the autumn. And in the autumn, if quarantines are still in place due to conditions abroad, how will that impact the arrival of new teachers and new families? Some will not accept their posting.

It may also be difficult to determine which students will be returning as people wait to make decisions. Admissions teams will be struggling to enrol new or replacement students who cannot visit a school until after a quarantine and even then they cannot enter the premises. The previous viruses did not spread widely out of the northern hemisphere and were dormant during the summer. This virus has already been transported into the southern hemisphere during their summer and it remains to be seen if weather has an impact on the spread. If it does not, then the prospect of another year of recycled virus is a possibility. While China has proven they can contain and prevent it now. Avoiding the re-importation means stringently controlled borders. Most other countries do not have adequate border screening in place and the need to restart national economic activity promises to give the virus new life. In the US, screening of arrivals remains horribly lax. 
https://nypost.com/2020/03/23/travelers-shocked- by-barebones-coronavirus-screening-at-us-airports/

The Effect of Temperature and Humidity on Coronaviruses
Great hope is placed now on the virus spread being greatly reduced or eliminated during warmer weather. Therefore, an overview of research about coronaviruses and temperature and humidity is useful. Why is this important? Previous deadly pandemic viruses in China receded through containment, prevention and tracking and lost intensity by June or July in warm humid weather before evolving into seasonal influenzas that are still with us somewhere in the world.

If COVID-19 is already present in the southern hemisphere, it is possible that it can thrive in southern hemisphere winter and be passed back to the northern hemisphere in their following winter causing another round of havoc. Researchers are now trying to determine the effect of temperature on coronaviruses. The following are summaries of recent research studies that have relevance in the effect of temperature and humidity on coronaviruses. Only studies done since Mid-March are included as they are most relevant to this situation, except in a comparative fashion to other viruses.

MIT Technology Review
Researchers at MIT determined that the maximum number of transmissions occurred in regions that had temperatures between 3 degrees and 13 degrees Celsius (37.4–55.4 degrees Fahrenheit). The data also shows that countries with mean temperatures above 18 degrees Celsius (64.4 degrees Fahrenheit) have seen less than 5% of the total number of cases.

They also determined that this data is consistent with the data seen in the United States. Specifically, the southwestern, warmer states have seen dramatically less growth in the outbreak than the cooler northern states.

The research from MIT is also consistent with work released Monday from Europe. That research determined that 95% of all cases globally took place in a temperature range of −2 degrees and 10 degrees Celsius (28.4–50 degrees Fahrenheit). This implies that as we now move into spring weather in the northern hemisphere with temperatures of 18C degrees and above the number of new cases should fall dramatically.

“Warmer weather could slow the spread of the coronavirus”, Karen Hao, MIT Technology Review, March 19, 2020 https://www.technologyreview.com/s/615381/coronavirus-spread-could-slow-with-warmer- weather/

National Institute of Health, SARS and COVID-19 
We established in an earlier message that COVID-19 is related to SARS. "In January 2020, a novel coronavirus, SARS-CoV-2, was identified as the cause of an outbreak of viral pneumonia in Wuhan, China. The disease was later named coronavirus disease 2019 (COVID-19)” This is important because comparisons can be made with studies on temperature that were done during the SARS outbreak in 2003. https://www.niaid.nih.gov/diseases-conditions/covid-19 , April 6, 2020

Tsinghua University, Beijing
This interesting study was conducted in 100 cities in China with at least 40 cases of COVID-19. “High temperature and high relative humidity significantly reduce the transmission of COVID-19. An increase of just one degree Celsius and 1% relative humidity increase substantially lower the virus’s transmission. This result is consistent with the fact that the high temperature and high humidity reduce the transmission of influenza and SARS. It indicates that the arrival of summer and rainy season in the northern hemisphere can effectively reduce the transmission of the COVID-19.” The researchers go on to apply their model to major cities worldwide based on 2019 temperatures and humidity through July.  This showed that the virus spread is larger for temperate countries and smaller for tropical countries in March and that there may be a significant reduction in transmission of COVID-19 in July, the arrival of summer and rainy season in the northern hemisphere.  In addition, in a comparison of 14 countries, the severity of the outbreak was greater in the northern regions with colder temperatures and lower humidity than in warmer climates with higher humidity.  

“High Temperature and High Humidity Reduce the Transmission of COVID-19”, Tsinghua University Beijing, Jingyuan Wang, Ke Tang, Kai Feng and Weifeng Lv, April 3, 2020, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767

The University of Maryland
This project examined climate data from cities with significant human transmission within communities as opposed to the virus being transported to other countries/cities without significant community spread. It was found that the dangerous, most significant spread or outbreaks occur along a 30-50° N’ corridor consisting of average temperatures of 5-11°C which is shown in dark blue on the map below. Although the coronavirus was transported to warmer regions, it is felt that wider community outbreaks have not yet occurred due to temperature and/or humidity in those areas. “It is tempting to expect COVID-19 to diminish considerably in affected areas (above the 30o N’) in the coming months and into the summer. However, as SARS-CoV-2 is only recently introduced into humans, there is presumably there is no pre-existing immunity.”

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“Temperature, Humidity and Latitude Analysis to Predict Potential Spread and Seasonality for COVID-19”, Mohammad M. Sajadi, U. of Maryland School of Medicine, April 6, 2020 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550308

Applying this information to the WHO world map and the Surveillance Table from the Situation Report on April 7, the number of confirmed cases below 30° N’ was 46,594 and on April 16, 2020, we can calculate that of the 1,991,562 confirmed cases 100,744 lie below 30° N’ an increase of 46%, but the southern hemisphere reports only about 5% of all confirmed cases. However, human to human transmission continues to accelerate even in warm, humid climates, mostly due to close family and social clusters and inadequate controls.

WHO COVID-19

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The red line indicates the lower range of the corridor at 30° N’.
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200416-sitrep-87- covid-19.pdf?sfvrsn=9523115a_2

Harvard T.H. Chan School of Public Health
Harvard researchers in their research on the effect of humidity on transmission concluded that “weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in case counts without the implementation of extensive public health interventions.“ https://www.medrxiv.org/content/10.1101/2020.02.12.20022467v1.full.pdf 

University of Hong Kong
According to Pathology Professor, John Nicholls at the U. of Hong Kong, indicated that, "Three things the virus does not like: 1. Sunlight, 2. Temperature, and 3. Humidity. The virus can remain intact at 4 degrees C (39 degrees Fahrenheit) or 10 degrees C (50 F) for a longer period of time. But at 30 C degrees (86 degrees F) then you get inactivation. And high humidity -- the virus doesn't like it either.”
https://www.accuweather.com/en/health-wellness/coronavirus-expert-says-the-virus-will- burn-itself-out-in-about-6-months/679415

National Museum of Natural Sciences, Madrid
These authors/researchers summarize, “A more probable scenario is the emergence of asynchronous seasons global outbreaks much like other respiratory diseases. People in temperate warm and cold climates are more vulnerable, with the disease will likely marginally affect the tropics.” The conclude the discussion by stating, “While the Coronavirus is likely to spread much more widely than at present, owing to seasonal changes of climate suitability, it is unlikely to do so with the same intensity, simultaneously.” They also validate the need for intervention by stating, “Only with adequate planning will unnecessary collateral damages be imposed on individuals and the global economy.” 
https://www.medrxiv.org/content/10.1101/2020.03.12.20034728v1

University of Guelph, Canada
As MERS was the latest of the coronavirus outbreaks, primarily in the middle east and Saudi Arabia, this study is important because of temperature extremes including temperatures above 38°C. Still, “Results suggest that primary MERS human cases in Saudi Arabia are more likely to occur when conditions are relatively cold and dry. This is similar to seasonal patterns that have been described for other respiratory diseases in temperate climates.”

“The risk of primary human cases of MERS was associated with a decrease in temperature and humidity, and an increase in ground visibility. The temperature and humidity findings are consistent with associations between the environment and other respiratory diseases.” This means that regardless of higher temperatures in summer months, the disease spread more rapidly in the winter months and decreased during the summer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362578/

“The major disease spread was discovered in Jordan in April 2012 and the last reported outbreak was in Korea in 2015 which was started by a traveler returning from the Arabian Peninsula. All known cases were traced through travel to or residence in and near countries near the Arabian Peninsula.” This means that outside of the middle east all transmission was from travelers. 
https://www.cdc.gov/coronavirus/mers/about/index.html

School of Civil and Environmental Engineering, University of New South Wales, Sydney Feb 2019
This study illustrates the role of transportation, particularly aircraft, in the spread of contagious disease. It takes into account the importance of advanced planning and deployment of preventive measures as quickly as possible after discovery of a virus or other infectious disease. “Hence, in efforts to mitigate large-scale pandemics, it is critical to cautiously deploy control strategies to minimize disruptions and maximize the reactiveness of the system. At a global scale, passenger air travel is known to play a critical role in the spread of infectious disease. Additionally, border control has been shown to play a pivotal role in mitigating epidemics, especially during the emerging stage of outbreak. Border control is typically deployed at airports in an attempt to prevent the spread of an infectious disease between cities, states and countries through passenger air travel.”
www.nature.com/scientificreports

When Can the US Safely Reopen?
“The three fundamentals of epidemiology are test, trace, and isolate.” China’s unwanted experience with coronaviruses led them to be prepared and they have done these basics extremely well. Two months into the pandemic and the United States is unable to do any of these things to the extent needed to reopen the economy safely without falling into repeated cycles of isolating hotspot communities and social distancing. This fascinating article describes how the US has failed in all three areas and that no solution is in sight until a vaccine is developed. Still only able to produce 150,000 tests per week, the US needs to test about 500,000 people per week quick analysis and action steps. The US is preparing to reopen its economy in May, but this may be too soon, with the prospect of dragging out the epidemic for 18 months or more.
https://www.yahoo.com/news/three-steps-to-ending-the-covid-19-lockdown-and-why-were- not-prepared-for-them-155139502.html

Germany was Prepared 
Scientists in Germany developed a swab test early on and have been doing mass testing for over a month. “In the week ending 4 April, 132 laboratories across Germany carried out an average of 116,655 swab tests per day.” While the US is struggling to test 150,000 per week, Germany is testing 816585 (116,655 x 7). The key to trace and treat is to test as widely as possible.
https://www.bbc.com/news/health-52234061

Summary of Important Points from Research:

  1. School age children are among the least affected age groups impacted by the coronavirus.
  2. With proper temperature controls at entrances and strong cleaning and hygiene regimens, schools can and should be among the safest environments in Asia.
  3. The step by step approach of re-opening to certain grade/year levels is useful in practicing controls and cleaning before all students return.
  4. Travel restrictions and border checks are vital in preventing the virus from recycling.
  5. Quarantines, as much as they are dreaded, really work as many people who contracted the virus were surprised to learn that they had it.
  6. Travel on aircraft for long time periods is once again a place of prolific spread.
  7. Most imported cases in recent weeks are from Chinese citizens returning from an infected area abroad.
  8. The research from MIT is also consistent with work released Monday from Europe. That research determined that 95% of all cases globally took place in a temperature range of −2 degrees and 10 degrees Celsius (28.4–50 degrees Fahrenheit).
  9. COVID-19 was originally named SARS-CoV-2 which allows for useful comparisons about the spread and possible length of transmission.
  10. An increase of just one degree Celsius and 1% relative humidity increase substantially lower the virus’s transmission.
  11. The most dangerous, most significant spread or outbreaks, including 96.1 % of all reported cases, occur along a 30-50° N’ corridor consisting of average temperatures of 5-11°C.
  12. 98% of all reported cases are found above 23.5° latitude, the Tropic of Cancer.
  13. “Three things the virus does not like: 1. Sunlight, 2. Temperature, and 3. Humidity. The virus can remain intact at 4 degrees C (39 degrees Fahrenheit) or 10 degrees C (50 F) for a longer period of time. But at 30 C degrees (86 degrees F) then you get inactivation.”
  14. COVID-19 was transported into warm, humid climates where human to human transmission continues to accelerate because there is no pre-existing immunity and the virus spreads rapidly as it easily finds new hosts, largely within social clusters and family units.
  15. Increase of temperature and humidity as spring and summer months arrive in the Northern Hemisphere will not necessarily lead to declines in case counts without the implementation of extensive public health interventions.
  16. There is little sign that extensive health interventions are possible consistently in new areas of outbreaks.
  17. “While the Coronavirus is likely to spread much more widely than at present, owing to seasonal changes of climate suitability, it is unlikely to do so with the same intensity, simultaneously.”
  18. MERS spread more rapidly in winter months and decreased during the summer. Outside of the Middle East, all known transmission was from travelers.
  19. The United States is a country whose economy relies on domestic and international travel, imports and exports, and foreign students. It is poised to reopen out of necessity, but prematurely, potentially becoming a recycler of the virus.
  20. As of April 16, 2020, the United States is unable to determine adequately who has the disease, they are, therefore, unable to trace the disease and the sudden number of patients have overwhelmed medical facilities and staff, making it very difficult to treat.
  21. “Border control has been shown to play a pivotal role in mitigating epidemics, especially during the early stages of outbreaks. Border control is typically deployed at airports in an attempt to prevent the spread of an infectious disease between cities, states and countries through passenger air travel.”

Conclusion:
The big picture questions seem to be, “When will all this come to an end? When can we get back to normal?” The previous coronaviruses that hit quickly in winter months, SARS, H1N1 (Swine Flu), H7N9 (Avian Flu) and MERS, struck quickly and hard, but managed to be contained.
As warmer weather arrived, with the aid of prevention through tracking, they all became dormant by July. Research studies have consistently validated that the transmission of the virus decreases with increasing temperature and humidity. The big question that remains to be seen is will COVID-19 behave as the other viruses. The hope is that, with warmer weather approaching, the spread of the virus will be greatly reduced.

The difference this time is significant. The virus has already been transported into the southern hemisphere in the midst of warm weather. While not spreading as rapidly as in temperate climates, this will be a problem as the weather in the southern hemisphere cools. It remains to be seen if affected countries there can contain, track and treat those affected and quarantine those who had contact with affected people.

The need for strict border controls is necessary to prevent the disease from recycling from one country to another. Infected people need to be screened and quarantined at entry points into a country. Thus far, this is happening in very few countries. What this means is that if the virus does not recede greatly during the coming summer months in the northern hemisphere the more likely the virus will be with us for some time to come, perhaps 18-24 months. In China, this implies that strict border controls will remain in place to prevent recycling of the virus from one hemisphere to the other and from affected countries to those where containment has worked.

A glance at the WHO map illustrates countries that will be most subject to border controls. China will have a big decision to make with allowing foreigners to return, for the sheer number of returning and new working expatriates is so great that the system cannot accommodate them except over time. In addition, it may be some time before any other visitors or tourists may be able to enter China and the same may be true for Chinese students trying to reenter countries where they were studying. This will have a dramatic impact on education everywhere, including universities private schools outside of China and international schools within China.

The implications on enrolment in Schools for Children of Foreign Nationals (SCFN) in China does not look good, perhaps for the next two years, depending on the need to maintain strict border controls to prevent the virus from re-cycling and routine tourism will decline significantly. This may also impact routine school needs such as participation in accreditation visits, both as schools undergoing accreditation and team members who may face quarantine in two directions. University admissions representatives will not be able to make personal visits for student recruitment and students may not be able to enter other affected countries. Travel to conferences or professional development activities outside of China may come to a halt if participants face quarantine upon return. As educators, we will have to rethink many aspects of what we do. Hang in there, we will get through this, but it may take longer than we imagine. Sharing concerns and collaboration will help to get us through!

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The Wall Street Journal, March 30, 2020. https://go.steadyinvestor.com/e/279272/ns-11585561393-mod- djem10point/f7c5n/654219767?h=6PT3QHNRoNXj-a8rGqLc9jxG2LLunQQDCd_sw_U01RA

 

CDC estimates* that, from October 1, 2019, through April 4, 2020, there have been:
39,000,000 – 56,000,000 
flu illnesses

 

18,000,000 – 26,000,000 
flu medical visits

 

410,000 – 740,000 
flu hospitalizations

24,000 – 62,000 
flu deaths

https://www.cdc.gov/flu/weekly/index.htm

 

 

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