Monday, April 6, 9:24 AM

April 6, 2020

Good morning everyone, the Spring Quarter officially begins today! My thoughts are with all of you as we provide the best educational experience for our students in this moment in history, continuing with the priorities of public health, academic excellence, supporting students and each other. We continue to prioritize public health, academic excellence and supporting our students and each other.

Arts & Sciences, you got this. We are starting a quarter like no other in the history of higher education and the university’s greatest asset is you, fantastic teachers and staff. Nobody knows the content better than you; others knew the technology first but we are all catching up quickly. You can do the best of anyone in this time and place.

Academic Affairs put out an important “Faculty Guidance” email, the corrected version went out Friday at 1:26 pm. It addresses many of the highest frequency questions of the past week or so. Do take a look at it. Download PDF of Faculty Guidance Email

A note on the CR/F cutoff. There has been some conversation about the new student option to take a course for CR/F rather than a grade, particularly around the issue that Seattle University published guidelines provide class credit for a D+, D or D- . I understand why some faculty would prefer not to provide credit for a grade of D, however, that is a university guideline we have to follow. It may be helpful to know that very few students earn D grades in the College in typical years. Over the past five years, D grades have been only 1% of all grades in the College; 1,290 of 117,687 grades over the past five years. If we see a proportion above that it would likely be attributable to circumstance.

Friday’s University-wide COVID-19 update has good information. The email came out at 6:20, it is also posted here and includes a message from the President, links to the new Student Support Center, an update on positive tests (there are now 3 confirmed Seattle U cases) and a new email for reporting cases you become aware of.

This is the most concise piece I have seen on how to prevent “Zoombombing” Here is a bullet list of tips via the Anti-Defamation League. If you do create a “waiting room” just remember to keep an eye out for people joining it.

COMMUNITY UPDATES:

All state public lands are now closed through May 4 as noted here, matching the extension of the Governor’s Stay Home – Stay Healthy order.

 Mike Myint update. Yesterday one of our neighbors gave our family cloth masks that she made herself, so this posting was quite timely:

 Public masking and the ambiguity of Covid-19 science

The White House and then the CDC recommended people use home-made masks in public. This has been a debated topic for quite a long time (see my prior post for the 1918 yesterday for the pandemic flu). One comparison was in 1918 San Francisco relied on masks relatively more than social distancing and had more deaths than cities like Seattle that did both masking and social distancing.

Making decisions where the data is ambiguous

All of us would like studies to show us statistically significant results which give us direction on a "right" or "wrong" action to take. Unfortunately Covid-19 (C19) masking the general public is not one of those situations.

Scientists usually use a confidence interval of 95% to state whether the result is statistically significant. Though this doesn't assure with certainty the interpretation, it gives an objective standard. This means that even a well-designed study, by this standard, has the potential of up to 1 in 20 studies actually not having a valid conclusion.

The more studies that validate the initial findings, the more confidence we have in the interpretation and actions that come from this. For those ID/Critical Care docs, many well known studies in sepsis that have initially indicated a strong benefit, then shown in larger studies to hurt, not help this condition. Xigris (a drug no longer on the market) and tight glucose control are two such interventions found to be ineffective in this way. Making decisions with ambiguous data is less about "right and wrong" than a matter of degree of certainty, putting new information together with data and inferences for which we have some confidence.

The known unknowns of masking

Masking, both for healthcare workers and the public is still an area of ambiguity despite multiple studies in this area. To some, it may seem like a "no brainer" to wear masks in public, and cite articles like this one (one of my favorites) as to why studies would only obfuscate the "obvious" conclusions.

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials, Gordon C S Smith, and Jill P Pell

This tongue-in-cheek article pokes fun at needing a randomized control trial to test whether parachutes save lives. It may surprise people that "common sense" masking such as surgeons and OR staff wearing masks in the operating room has a fair amount of evidence that it does not decrease post-operative surgical wound infections. We still do it, but it is more of a ritual than evidence-based.

This is the same with masking in public. Most studies show little or no benefit to this for influenza and other previously studies respiratory diseases in masking healthy people. But C19 is novel and has not been studies in this way, so other studies in the past are informative, but not definitive.

For masking healthy healthcare workers the evidence is also mixed. There are risks of transmission from healthcare workers to patients, patients to healthcare workers and from healthcare workers to healthcare workers. The evidence on these use cases are dependent on things that we don't fully know at this point about the virus including the degree of asymptomatic spread and how the dynamics of droplets with C19. The use case for expanded masking for healthcare workers is more based on theories on transmission and often obscured by the headline rather than the reality. A recent article in the NEJM indicated that in a lab situation one could aerosolize Covid-19 and keep in aerosol for a period of time. How this lab induced aerosol translates to the real world transmission isn't clear, but the headline can lead to confusion.

Observations of the C19 Asian experience can be used to justify masking or argue against. Some would argue that the high rise in Hubei was despite a relatively high use of public masking and thus argue against it's efficacy. Conversely, one could use relatively higher rates of masking be the reason why China, South Korea, Japan and Taiwan have better controlled the epidemic. There isn't enough research presently to say which is correct.

As the CDC wrestled with their recommendations they were asking the following questions
Does masking make the user safer?
Does masking make others safer?
Does masking may make people less likely to wash/sanitize their hands and more likely to go out when sick?
Does masking take away supplies from healthcare where the evidence is greater on benefit?

For the concern of this recommendation taking away available masking from healthcare workers, I can cite my anecdotal observations this weekend, almost everyone was masked and almost every mask was a commercially made mask. And would we expect anything else from people concerned about their health? Myint's law of unintended consequences is that there are always unintended consequences for any decisions we make.

Given all what I mentioned above, wearing a mask in public, per the White House, is a personal choice. One should continue to do the basics of social distancing, hand/respiratory hygiene, especially if sick regardless of the choice of masks in public. If one chooses to wear a mask in public, this article linked here discussed how to do this. It discusses material choice and refers to the CDC patterns as well as a cool origami use of a vacuum filter bag.

Stay safe.

MM
04-05-2020

What’s the Best Material for a Mask?