Facebook Live 8/12- Answers

Sorry guys for the delay we had some technical difficulties! Hi everybody and thanks for being so flexible. The last two weeks I couldn’t get on, my son got married and it was great. Last week we were short at the hospital and I was on for twelve hours and I just couldn’t get on to talk with you, so we are going to try and catch up this week. We are going to talk about the Special Session coming up next week and of course talk about education and some other things. Let me start by talking a little bit about data for the state of Virginia. This is really important because I am going to be talking about data next week at Special Session as well. To me, data has been one of the biggest challenges we have had during this process because there has been such a lack of diligence in sharing with the public what data points are valuable and salient to decision making. It is not that hard because we have been talking this whole time about that. I think that we are in a different phase of COVID now and we have been for a while, we are in a post-peak phase where this is going to go on indolently for a while, it could be month, it could be until we get a vaccine, it could be until we develop an effective and reliable treatment, we just don’t know how long this is going to go on. So, we have to learn how we can measure safety while we are in that indolent course because it is different than before looking at the spike. What is being published on the Virginia Department of Health’s is not helping us with that, and the reason I say that is because we need to be able to measure when the number of cases and the location of the cases are such that we now have risk for more hospitalizations than the indolent number we are expecting, more people that are sick and more people that die. Don’t get me wrong, this is a situation unfortunately, where it is a medical issue that is going to continue to take lives. It is heart breaking and heart wrenching and it is vulnerable people, so it is even worse. The fact of the matter is the expectation that there won’t be any new cases and deaths, or hospitalizations is unrealistic and sets people up for panic when we don’t achieve an unrealistic goal. So, what are we looking for? We need a better discernment of who the new positive cases are. When you look at the Virginia Department of Health, all you are seeing is cumulatively what was the age group for the group of people who were testing positive, what was the age group for the group of people that died, or were hospitalized and that is not relevant for decision making now. For decision making now, we need to know in the new cases who are getting sick. We can stratify risk based on the age group that are getting it. It is not perfect, but statistically, the risk for younger people is profoundly less than for older people. Virtually 65% or more of our deaths have occurred in individuals 75 and older. So, as we are looking at stratifying risk and what markers of data we need to look at if we are in trouble or not. In my opinion, we need to be looking at who is turning out positive or not based on their demographics- their age group, but there are other demographics we need to look at and we have talked about this before. Those are like community living locations. That is going to be jails, nursing homes, group homes, that is a whole different risk group based on their proximity and social distancing limits and other issues that they have. We need to have age stratification, and we also need to have community living identified and I think the other piece of data we need to have is where are the outbreaks? How many of the new positives especially in a particular region are related to outbreaks that we are tracing? All of that is relevant for us deciding. For instance. If all of the new cases we have are coming back are coming from people who are 30 and younger with little or no hospitalizations and we are able to track when we are exposing people in a high risk group we now are in a containment scenario and that is where we need to be. This is important also because we are doing better is being recognized in the data and the way it is being reported. Our percent positive rate has stayed well under 10%, in Henrico it is under 7% and that is a really great benchmark. Let’s review because one of the questions I have today, and I am going to get to the questions in a minute, “what does the positive rate mean?” So, the general positive rate where you say 100,000 Virginians have tested positive for COVID, it doesn’t mean anything because you can’t use that number to analyze relative risk. When you say “percent positive” that is a reflection of how many tests you are doing and we know that we need to do a certain benchmark of tests in order to be sure that we are looking for outbreaks and other situations that could lead to a safety issue. We know that percent positive needs to stay below 10%. So, percent positive is more a reflection of the number of tests we are doing than really crises in the community. When we look at what the hospital rates are, we need to be able to compare percent of hospitalization and utilization of ICUs and ventilators to the baseline so when you look back on the historical perspective of the ICUs from data from 2013 it says that normal hospital occupancy is around 80-85%. That is what we are running in Virginia. You have to have perspective. Data in isolation is not helpful. Data is meant to be comparative – compare it to the benchmark. So, next week I am going to be asking the state to measure their data differently, to report it differently, and to give us the benchmarks that we need to use so that we can measure it again. Bottom line is we need to make sure that the public gets data that helps them make decisions because the media and the failure to give comparative benchmarks for data is part of what is making people so scared. Being scared doesn’t help. We need to deescalate the fear with data and reason and ability for people to feel as if they are in control as to what to expect. There is none of that now. It is incredibly frustrating because it is accessible, but it is not being reported.

With that in mind, let’s talk about a couple of things. We have some state data to look at over the last week. We have some high percent positives in some other states, but we have hospital capacity that is at low average. Looking at all of this now- I haven’t had a chance to review all of this but the bottom line is that Virginia’s rate today is 7.2% so we are in check and doing what we need to do. I am going to go to some questions and then we will talk about Special Session for next week.

The first question is: I’m very confused about what the positivity rate means. I thought that it would show the spread in the community, but he seems to indicate that is not the case and it is a measure of testing ability? Can someone clarify this because the Governor and so many report this as a number indicating prevalence. If that’s not the case, then I’m not sure why it’s being used in the manner it is to determine what is open and what to close.

The bottom line is, we can use percent positive as a comparative analysis. If you know the benchmark that it should be 10% and below, when a state goes over 10% percent positivity that’s a spike. But, just the raw number in of itself doesn’t matter. But this is the one variable that we have been talking about all along. You have the ability to make a benchmark comparison to. So, what you have to think about – you don’t to look at the percent of people positive as a total number, you want to look at the percent positive and track that to see as it varies we need to dive deeper into the data to say is our increase in percent positivity related to an outbreak? Is it related to prisons or nursing homes? Is it in the community? Where are the contact tracing we need to ensure that we isolate that exposure and make sure that it is limited or not spread at all to the high-risk populations? If that starts to make sense it is the first marker we look at as it is trending.

Also, is the question I had about hospitalizations and how it is possible for the number of COVID patients to continue to increase despite the fact that discharges are outpacing admissions by 2 to 1 this entire month being looked into?

I think that that person is looking at the Virginia Hospital and Healthcare Association Database and that is a specific data question where you are just trying to look at what they are reporting. I am trying to go to that site now so I can get you that answer, but one thing about the hospital data that you need to know is that anybody in the hospital that is positive for COVID is listed in their COVID positive numbers. I have reached out to VHHA and I have asked them to report their data differently because there are people who are hospitalized because they are sick with COVID and there are other people who are hospitalized, most hospitalized are screening elective admissions now, so that they know if they have to isolate someone because they are COVID positive. They are screening them before they come to the hospital and there is a percentage of those people- let’s say it is 7% like the rest of Virginia that is positive for COVID that is going in for non-COVID related procedures and interventions. They are being lumped together with people who are being treated for COVID. I think that the take home message for that question is that I don’t know you can get the answers you are looking for by looking at how many people have been admitted versus how many people have been discharged. What you need to look at is the total ventilators in use. That is a really important number because the scary part of COVID is what happened in Italy which is when they ran out of ventilators and we were afraid it was going to happen in the USA, and with the adaptations they needed to make in New York and other places it never did. We never ran out of ventilators. We never ran out of accessible beds. But, that is the real scare. We want to make sure that everyone who is sick with COVID has the benefit of medical interventions and so that is what we are always tracking. We are at a 20% use of our ventilators now. So, with that in mind, I think that is one of the most important metrics you can look at on the VHHA database.

Is there anything we as parents can do to push Dr. Cashwell and the school board to acknowledge next steps to be open in-person?

I know there are a lot of people who are hopeless out there and I have talked to Dr. Cashwell several times and I will be carrying legislation next week that they feel is essential to give them the tools that they need to open. So, I still find this a mystery when we see that 92% of our teachers were willing to go back in person and we’ve discussed the evidence and data. If you actually look at the data of transmission between children and adults and how well children and adults in other childcare situations have done with transmission, if the data was presented in a good way it would support being back in person in school at least for those who chose to. There should always be a robust virtual option for those who don’t want to go. Here is the problem with the decision, people who don’t want to go to school and who have the means and resources to be at home have the option, but people who need bricks and mortar don’t - and let’s remember, schools are not just curriculum, it is not just sending out on the internet the classroom information. Schools are so much more than curriculum and we have fought, and we have funded to make sure those resources are there, it is a safe place. It is reliable food; it is screening experts and subject matter experts who know how to identify challenges for kids and know how to intervene early. School is so much more than curriculum and virtual education, honestly, is curriculum only. So now, families and parents that depend upon schools to be a safe place for their children and to provide all those other services have to figure out how to find another place. That is the crisis in Virginia. It is not a conflict between people the crisis is we don’t have our normal safe place for our kids. We must figure that out. Our kids must be somewhere. I can’t tell you how many families I have talked with over the last several months that have their 12-year-old or their 15-year-old in charge of three or four other children at home trying to help them with their school work, trying to make sure they are fed and they are safe because their parents are essential workers and have to go to work every day. So that is the crisis we have to identify. Dr. Cashwell told me that one of the things she needs is education so that people understand what the risks are and she could have used a lot better advice from the state and from the governor. What should have been said to our school divisions is “spend your energy, your time, and your resources figuring out how to open school for those who need it for a safe way for teachers and children.” But that didn’t happen. They were instead given an unsolvable riddle of how to abide by a bunch of guidelines. Guidelines are not what the goal here is. The goal here is our children being safe and getting the opportunity to learn which is the ticket to succeeding and achieving in America. We all know that, and we know that is one of our disparity and inequity issues, that not everybody has access to an equal education. By all means they should have access to a school building. So, if you want to help Dr. Cashwell, we need to make sure the state provides reliable data to the schools and the teachers and other people to help reassure them so they aren’t panicked.

What is "our" next step in advocating to get schools opened back up? I feel like since the decision to go virtual was made, we (parents, county residents, etc.) haven't really had any "calls to action".

I know most parents are scrambling to find a place for their kids. Especially two working and two income families. It was ironic to me that Dr. Cashwell said “I don’t have the time to prepare to open schools by the beginning of September because I need more planning time.” But, by default our schools didn’t open and parents were given that short timeline to figure something else in a world where childcare providers and private schools were already pretty much fully booked. I think that you need to be a part of the constructive conversation next week to provide schools with the tools that they need to reopen. They will need money. I personally believe the state should reimburse the school divisions for monies they invest for PPE and for cleaning. I know Henrico has already spent the money. I think with limited resources at the state’s level we need to make sure that families have the resources they need to find a safe place for their kids for the next nine weeks, longer if necessary and when schools open and provide that space, I think we should be reimbursing them for those investments that they made. They do have big investments. PPE is expensive and it is hard to get, and so is cleaning supplies. We all know this. Training is also going to be different. We need to make sure they have those resources and they have done a good job articulating that. I just right now am not motivated to give the cash up front because with such limited resources, the people who need money in their hands are the parents that have to pay for the child care, and the schools I want to incentivize to reopen because I feel like they haven’t been incentivized to reopen, and we need to give them a good message to reopen and we need to give them the reassurance that when they do we are going to reimburse them for those investments. I do want to point out that I think it is egregious that Fairfax County came out and discouraged parents from finding resourceful solutions for their children’s education, that is a parent’s job, we are a parent’s rights state. That is a variable that we respect resoundingly even though it makes things much more complicated. It would be so much easier for the state to say we are going to say what we are going to do about everything, but we have always respected the rights of the state. Parents want to make sure their children are moving along the trajectory they need to succeed. We all know, if you aren’t reading by the third grade, you aren’t graduating from high school, if you aren’t in algebra by the eighth grade you probably aren’t going to college, and if you aren’t getting the right classes in high school you probably aren’t going to whatever certification or licensure that you want, so parents are advocating for their kids and I hold this school division in contempt because they are upset that the disparity between what the parents are doing and what the school divisions are doing makes them look bad, shame on them.

What is the alternate plan for children that cannot be a home during the day to "attend" school?

What I hear from the childcare centers is that they are scrambling hard to ensure they have broadband so that the childcare providers can be available while the children are in school. Here’s another problem with a lot of the plans that are coming out of school divisions, we have school divisions that have set blocks that are the same across all the grade levels. So, even at home when the parent has the ability to be at home either work from home or stay at home, that have broadband and have access to the devices that they need, all three of their kids need to be online on device for the same forty-five minute blocks all during the day. It’s not doable. What I can tell you now, is I do not see any centralized organization to solve any of these problems. I see the resolution of these problems being left to parents and the private sector. I want to support them any way I can as we go into Session next week. But, you are right. Having a daycare provider supervising a bunch of kids on computers, trying to learn maybe at different levels is not anywhere near the value of our schools.

What exactly does it mean that the schools are waiving accreditations for the next 2 years? What does it mean for school funding next year?

I need to look into that to give you a precise answer. But, the accreditation process for schools is where we hold them accountable for things like enrollment and attendance and SOL performance and learning benchmarks. That is how schools get accredited. When they are not accredited, there is a variation in how they are funded. We all know our children are not learning the same way they did, and they are not meeting the benchmarks they need to make in order to perform on the measurements of where they are academically. What I understand that to mean is that the state is waiving those requirements because they know we can’t meet them. As we go forward, some of the things I will be looking at next week are that we need a measure of quality for virtual education. Everybody has talked about what a mess it was last Spring. We have many different things going on in Virginia. Difference when you are talking about quality is a scary variable. Consistency is what helps you achieve quality. We have Virtual Virginia, which by the way, Henrico is not using. But Virtual Virginia is a single platform where the Department of Education has all of the curriculum and the lesson plans from K-12 that meet SOL requirements. They have specially trained teachers that do didactic and real time interactions with the kids as well as send assignments and check and hold them accountable. That has quality measures built in with it. We have a lot of school divisions that are developing their own because they made investments before they knew that was going to be available because Virginia has not taken care of this at a state level as I have asked them to do for the last four years. So, we have a lot of makeshift happening. Teachers are developing curriculum, they are using new platforms, and we don’t exactly know how it is going to go. But, we do know that kids are going to be incredibly variable in how far along they are on the continuum of education when we go back to real school and we are going to have to measure that. So right now we need to put into place some sort of standard if accreditation isn’t going to be it and if SOLs aren’t going to be it, there has to be some sort of quality measure for whether or not our kids are actually learning with virtual education. Providing it is not the only variable. We have to both provide it and measure it. We all know our kids weren’t measured in the same way at the end of last year, so I will be putting in legislation to look at how we are going to measure quality outcomes for our kids on virtual education. When we get to Session in 2021, I am going to be talking about measuring our kids. This is something I have talked to many of you about before. There is a way for us to evaluate our kids and where they are in the learning process. There are two things we can evaluate: where they are in their benchmarks for education, but also how they learn. We need to individualize our learning when we go back, we can’t just put kids in a classroom and hope that they will catch up because we don’t know where they are starting. We have got to measure where they are and we have got to have some sort of learning agenda and learning measurement of kids to make sure they are catching up and they are achieving and they are hitting those benchmarks. We need them to achieve to get to ultimately having the kind of life they want to have because they have an education that can prepare them to have a meaningful life experience and job and self-actualization. So that is going to be coming.

Henrico County emailed parents of IEP students saying we would be hearing from our case managers (I still haven’t heard from my child’s even though I reached out to her a couple weeks ago) and that IEP’s would be adjusted to accommodate a virtual learning setting. Does this mean the county is trying to rewrite IEP’s to eliminate in-person instruction? Have you heard anything about children with IEP’s being allowed back in the building for in person instruction?

I can tell you this is an area of debate and conflict. I can tell you that the Department of Education itself was shocked that school divisions said IEP’s were going to be virtual and that was never included in their plan. Face-to-face learning is an important part of the accommodation of IEP’s. We have so many problems with our IEP’s both on making sure we’ve evaluated children appropriately and providing those services which has been compounded by COVID. And so that is what I understand them to be saying. I will be following up on that, but I believe the Department of Education is already fighting that battle with the school divisions. I will try to get you more information on that, but I know that to be true. I’m not sure what they’re doing to make sure that IEP’s are implemented but you should advocate for your child and do what it takes to advocated for your child because this isn’t ok. You can reach out to my office. If you have IEP issues specifically that is a complex problem and we're going to be working on solving it. Obviously, Special Session is coming up next week so reach out to my office specifically and let's have a conversation and let me see how I can help you.

Some Henrico County parents would like the county board of supervisors to tie additional funding to a concrete back to classroom learning plan. For example, Virginia Beach will reopen classrooms when the positivity rate dips below 10% (we are below 10%) and the county has less than 265 per day.

Brilliant. I did see that editorial and people should look at what Virginia Beach has done. That’s what I’m talking about. That’s exactly what we started this conversation about. Metrics must have benchmarks against which they can be measured. What does all of this mean if we don’t say “if this-then that”? We're just looking at numbers rolling across and people are guessing at what they mean. This is not ok. We have great minds in our state government that know what they should be doing on this. I think that the problem is that when everybody knows what benchmarks mean and what the data means they don’t have the ability to be confused over the situation. But, right now, Henrico meets those criteria to reopen schools. Where is that conversation? So you’re exactly right. We need to have benchmarks. We need to have consequences and also benefits from achieving those benchmarks.

Why does it seem so difficult to have HCPS agree to reasonable metrics?

I don’t know the answer to that and I didn’t know that it was a problem. I know that I’m concerned, and it has come to my attention, that the Virginia Department of Health is about to release some new dashboard for school metrics. I don’t know if it is going to be public or not, but I think the schools have it. What scares me is the same thing that we’ve talked about before. You need to have data and the right data points. You don’t get any answers if you don’t ask the right questions of your data. So, the question here is what are the benchmarks we need to go back to school? What is the relative risk of being out of school? We could probably measure that. I could give you a relative risk ratio for kids being out of school compared to the risk of reopening schools. That’s what the American Academy of Pediatrics did. They said the relative risk of not opening schools outweighs the relative risk of opening schools. Do whatever you have to do to open the schools. So, I think that’s a really important point and I’m worried because I don’t have confidence in the data from the Department of Health thus far. You know, there are oscillations of when data gets dumped and other things. That doesn’t bother me. They have been very transparent about that. I just don’t see them measuring and reporting the right things. What they’re reporting is data so that people have something to look at but its not actionable data because they’re not using questions and giving benchmarks. So, I’m going to be working on that next week.

A few other things to talk about: Community colleges are virtual right now. Obviously, most of our school divisions are virtual. We have something called Online Virginia Network which is an online learning program for college credits. We’ve always had challenges with dual enrollment. We have something called Passport Credits (which is something I passed back in 2017 or 2018) which means certain credits earned at community college are universally recognized. They’re core curriculum credits. They’re universally recognized for credit at any four-year university. I had kids that took dual enrollment classes and they had to repeat them when they went to college because colleges did not recognize those credits as counting towards that class. So, English didn’t count for English; it was an elective. Physics didn’t count for physics; it was an elective. So, they got some college credit, but it didn’t abbreviate the time they were in college and it didn’t help them move along faster. Online Virginia Network has that. I’m going to be carrying legislation next week to make that platform available to kids in high school. So, if your kids are home for their high school time working on virtual education, they can at least count that towards abbreviating their college time. I also want to make that available for licensure and certification. Our workforce credentials and the credits for that are co-located at our community colleges and supported by the state. Why not let people be working to their ultimate educational goals while they’re stuck at home doing virtual education? I don’t think there is much difference between high school virtual education and community college virtual education except that it counts toward your ultimate goal. So, that is something that I’ll be carrying.

It seems to me that PPE has universally been a challenge for us across the course of this event. It’s troubling because usually the solution is to give the private sector places where they can go purchase PPE. However, it’s a competitive market, it’s expensive, and most of the market wants you to buy in high volume which is hard for smaller providers like childcare providers and people providing mental healthcare in the home. These are things we really need to have accessible for smaller entities. There’s an opportunity to have a public-private partnership here to make it easier to access PPE at an affordable rate. We're going to have to have it if we're going to go forward. The schools say they need to have it. Everybody needs to have it. Let's see if we can’t find a way to make it easier for everybody to have it. What we need to do next week during special session is erase obstacles to managing the current status quo and keeping this at a very low rate of infection, hospitalization, and death (but not making it go away all together).

Additionally, testing has been a mess. I just talked to a father today who’s kid is supposed to be going back to William and Mary. She is supposed to be one of the students helping the freshman reorient. She has to be tested for COVID before returning to campus. She was guaranteed her test would be completed in 72 hours. She still hasn’t been cleared. How can that be? I have seen the rapid tests that can be done. They are accessible and it is like doing a pregnancy test. It's different than a pregnancy test because it's not urine its blood. You put a drop of blood on and add the re-agent and in minutes you know whether you are COVID positive. Our essential workers need that. Our teachers need that to go back to school so that they know if there is a kid in the classroom who is positive. How are we going to manage classrooms f we don’t have rapid testing results? We need it for healthcare providers. We need it for first responders. We need it for law enforcement. We need it for people who are in the supply chain. We need it for hospital workers. We need to make an investment in rapid testing. We need to make it accessible to those essential workers upfront so that people who control the ability, like the school board, know that they have a rapid, reliable way to ensure they are providing the safest environment. They really want to make sure they’re safe. We need to give them the tools. I’ll be carrying paid leave coverage for our teachers. They need to have that 14 days where they can be out. I know there’s workers compensation legislation as well so that if teachers do have to long-term sick outs (or first responders and healthcare workers) they’re going to have coverage. That should be covered if they’re getting that in the line of their employment. We're going to get CARES money. I can’t promise what I’m going to get. We’ve been told, in a way, we're going to be shut down at the special session next week. We’re going to be limited to three bills. All these months and all these weeks wave been away the democratic process of expressing all of the ideas we’ve gotten out of our district and they’re going to limit it to three bills. It's ridiculous. The budget, apparently, is not going to allow for budget amendments either. I want to make sure you get a tax refund for your childcare deduction in Virginia. If you don’t pay enough money into taxes to get all of that money back. I want an earned income tax credit for you. 40% of our kids in school are on free or reduced lunch. That means their families are at a financial threshold where they don’t have the resources to make sure they have healthy food. They don’t have the resources for childcare either. It is not ok we don’t know where these kids are going to be. We need to give those parents resources. A tax credit isn’t going to happen until next year so I’m going to ask that they redirect (when we talk about the crisis of where our kids are going to be) CARES money. If it's not going to schools so that they can be open, CARES money needs to go to families so that they can make decisions about where those kids can be safe and where they can be to learn.

Telemedicine has been a wonderful compliment to healthcare through COVID. It has been what I’ve said all along it could do which is reach out to people who don’t have access. It's so hard for people to get to the doctor’s office and to wait and the inconvenience. Now you can go into somebody’s home. I want to protect home as a location of where telemedicine can be provided as long as it can be provided privately and safely. I want to reimburse for that. We need to reimburse for Telehealth. Telemedicine meets all the criteria of an actual doctor’s visit. Telehealth is all the other things we can do via video like this including mental health services. So many parents have said their kids are depressed and they cannot get an appointment. We not only need to provide the Telehealth but we also need to reimburse that at a higher rate. We need to make sure people are not neglected because they’re trying to do the safe thing by staying at home.

There’s more that we want to talk about. We're going to have liability for COVID for our schools which is one of the number one thing needed. However, I am not going to be carrying this bill, I am going to co-patron it, as we are limited to three. We're going to be championing all of these issues to try and solve the problems. I’ve made a list of the issues and looked at all of the things we need to be working on. Those are the solutions I am offering. Again, we are goal directed. How do we manage where we are now? Thank you for your input. Send me your emails. I’m happy to keep helping. I appreciate your time and sorry I went long today. There was some catching up from previous weeks. I won’t be on next week because we’re going to be in Session. So, if we can I might do a different time but for now I’m going to plan to not be on because I’m going to be at the medical practice, session, and committee meetings. I’m just not sure of where I'll have windows of time. Thank you everybody. I appreciate the community that we’ve built of trying to find solutions in a positive way for both Henrico and Virginia. I’m just going to keep plugging. Thank you so much. Have a good afternoon.



PAID FOR AND AUTHORIZED BY FRIENDS OF SIOBHAN DUNNAVANT

Dr. Siobhan Dunnavant
Office:

804-698-7512
Email Me 
Mailing Address:
PO Box 70849
Henrico, VA 23255

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