Prof. Collins Helps Create Educational Modules for School and District Leaders About In-Person Learning in COVID Era

As COVID-19 cases surge across the country, school and district leaders are looking for clear and consistent guidance on the safest ways to reopen school facilities. They want to know how to minimize COVID-19 infection risk for students, teachers, and staff in K-12 schools. In response to that demand, faculty from the Johns Hopkins Berman Institute of Bioethics, Bloomberg School of Public Health, School of Medicine, and the Consortium for School-Based Health Solutions, with support from Bloomberg Philanthropies, today launched online educational modules. These modules aim to help school and district leaders plan for and implement in-person instruction when they deem it safe and appropriate to do so, and to help schools and districts that are already open assess their current COVID-19 prevention strategies.

The series of self-paced, web-based, educational modules and videos is part of the COVID-19 Resources for Practitioners and the Johns Hopkins University COVID-19 Training Initiative, which offer expertise and practical guidance to anticipate and meet emerging needs in response to COVID-19 where people live, learn, and work.

These educational modules focus on a range of best practices and guidance on topics that school leaders need to be aware of, including considerations for implementing public health mitigation strategies, such as masking, distancing, ventilation, and creating cohorts of students, as well as screening and testing approaches.

“The goal of these modules is to provide schools and districts with accessible, practical strategies to help them tackle the responsibility of school reopening that minimizes risk of transmission. The modules can also help them identify gaps in their current plans,” said Sara Johnson, PhD, MPH, associate professor at Johns Hopkins School of Medicine and the Bloomberg School of Public Health, director of the Rales Center for the Integration of Health and Education at Johns Hopkins, and co-director of the Johns Hopkins Consortium for School-Based Health Solutions.

In the past nine months, Johns Hopkins faculty have offered technical assistance to school systems around the country to support reopening planning processes. “In speaking with school leaders, we’ve found they often have many of the same questions,” said Megan Collins, MD, MPH, assistant professor of Ophthalmology, Wilmer Eye Institute, the Berman Institute of Bioethics, and co-director of the Consortium for School-Based Health Solutions. “These modules are designed to walk school leaders through the process of developing, implementing, and continuously updating a COVID-19 strategy when they are ready to bring students and staff back for in-person school.”

Johns Hopkins created these educational modules to ensure that school officials have access to the same general information and approaches to decrease the risk of COVID-19 in schools.

“Although we designed these learning modules primarily for educational leaders, they may also help public health agencies, school health staff, and others who collaborate closely with school systems to synergistically plan, implement, and manage in-person school,” commented Megan Tschudy, MD, MPH, assistant professor of Pediatrics and medical director of the Johns Hopkins Harriet Lane Clinic.

“Schools are facing an enormous responsibility to reduce transmission of COVID-19 in their buildings to keep kids, teachers and staff, and communities safe,” said Kate Connor, MD, MSPH, assistant professor of Pediatrics at the Johns Hopkins University School of Medicine and medical director of the Ruth and Norman Rales Center for the Integration of Health and Education. “We hope the modules will help streamline the health and safety planning process and provide the kind of tailored support that many schools are asking for,” said Connor.

As the COVID-19 pandemic continues to affect the United States and the world, public health practitioners and other frontline leaders need clear, consistent guidance and tools. From early on in this global health emergency, the Johns Hopkins Bloomberg School of Public Health, with the support of Bloomberg Philanthropies, has provided practitioners at the national and local levels with free, online educational modules and tools to plan and execute evidence-based prevention strategies.

The free education modules can be accessed on Consortium website here.

Recapping the Berman Institute at ASBH 2020

ASBH Conference Logo

The Berman Institute will be well represented at the 22nd annual meeting of the American Society for Bioethics and Humanities (ASBH), with a group of faculty, fellows, and students scheduled to present online.

View the full schedule and summaries of all Berman Institute presentations.

You can also follow us on Twitter: #ASBH19, featuring our @bermaninstitute, @aregenberg@kahnethx@tnrethx@DiStefano_MJ, and more.

Special Events

Portrait Photo of Henrietta Lacks

Plenary: Social Justice and Bioethics through the Lens of the Story of Henrietta Lacks
October 15, 2020
1:15-2:30 p.m.

Join Jeff Kahn, Ruth Faden, Jeri Lacks (granddaughter of Henrietta Lacks), and Patricia King for a panel discussion examining social justice and bioethics through the lens of issues and challenges raised by the story of Henrietta Lacks and the HeLa cell line derived from her cells.

Zoom performance of Antigone in Ferguson

Antigone in Ferguson: Free Online Zoom Performance
October 17, 2020
6- 8:30 p.m.

A groundbreaking project that fuses dramatic readings by acclaimed actors of Sophocles’ Antigone with live choral music culminating in a powerful, healing discussion that will foreground the perspectives of people in Baltimore whose lives have been impacted by racialized police violence and health inequity

Berman Institute Launches Public Bioethics Program with Creation of the Dracopoulos-Bloomberg iDeas Lab

The COVID-19 pandemic has demonstrated in unprecedented ways the critical need of the public, governments, and the private sector to access clear, accurate and timely information about the ethical issues surrounding decision-making in science, medicine and public health. To help provide such vital information more broadly and effectively than ever before, the Berman Institute of Bioethics today announced its intention to create a new program in public bioethics, fueled by the receipt of $3 million in philanthropic support to establish the The Dracopoulos-Bloomberg Bioethics iDeas Lab.

“Virtually every aspect of our nation’s response to COVID involves an issue of bioethics: balance between personal freedom and public safety in wearing masks, and the closing and reopening of schools and businesses; allocating scarce medical resources; safely developing vaccines; using new contact tracing technology, and much more,” said Jeffrey Kahn, the Andreas C. Dracopoulos Director of the Berman Institute.

“Our public bioethics effort will significantly increase understanding about critically important issues in bioethics and ethics in science more generally. Higher levels of engagement with bioethics issues that impact our communities, locally, nationally, and internationally, will inform public discussion and debate and ultimately impact policy decisions.”

The Dracopoulos-Bloomberg Bioethics iDeas Lab, named in recognition of Andreas C. Dracopoulos, a trustee of Johns Hopkins University and member of the Berman Institute of Bioethics’ national advisory board, and former chair of the University’s board of trustees Michael R. Bloomberg, is an important first step in this effort. The Lab will enable the Berman Institute to pioneer new approaches for creating bioethics content, taking advantage of new media strategies, the latest media technologies, and innovative approaches to visualization of information and research results.

The $3 million contribution will support new physical space to house the iDeas Lab, provide new technology, and support new professional staff and faculty colleagues devoted to the creation and distribution of engaging digital, audio, and video content with a focus on dissemination professionals, policymakers, and critically important, the public. Dracopoulos previously funded creation of a similar and very successful lab at the Center for Strategic & International Studies (CSIS) in Washington, DC, one of the nation’s leading national security think tanks. The CSIS iDeas Lab was an early leader in bringing together their scholars with content producers, developers and designers to create a compelling range of digital products of research.

“The iDeas Lab will make possible for the work of bioethics, and ethics and science more generally what the creation of the Johns Hopkins Coronavirus Resource Center provided for political leaders, journalists and the public looking for authoritative thought leadership,” said Kahn. “We will employ cutting edge techniques and technologies to share the research and analysis of our faculty on the most pressing issues facing our society.”

Additional components of the public bioethics program will unfold in coming years. The Berman Institute will reach policymakers with a series of high-profile bioethics events in Washington, DC. Experts from the iDeas Lab will work with faculty across Johns Hopkins to devise new ways of sharing academic research with the public. And the Berman Institute will seek to add additional faculty with expertise in assessing the societal impact of increased public dissemination of scientific and public health scholarship.

Climate Change Places Vulnerable Populations in a Double Bind During Storm Seasons in COVID-19 Era

By Vivian V. Altiery De Jesús, MBE
Program Coordinator | Berman Institute
Doctor of Medicine 4th year -Student (MD) | UPR-SOM

The National Oceanic and Atmospheric Administration predicts an “extremely active” hurricane season for 2020. Climate change is responsible for increased hurricane strength and frequency in the Atlantic Ocean, with residents of islands like Puerto Rico and the Bahamas suffering devastation of environmental phenomena caused by industrialized countries’ carbon footprints. Previously, this has been framed as climate injustice .

Traditionally, people living in hurricane risk zones without the option to move in with family members or friends are relocated in shelters until the storms goes away and the country regains some stability during the storm aftermath.  However, the 2020 Storm Season is different. The COVID-19 pandemic imposes more risks to the population. And even prior to COVID-19, people in shelters had (and still have) communicable disease outbreak risks, as well as mental health and other health risks.

Climate changes and the COVID-19 pandemic have exacerbated vulnerabilities and placed disadvantage population in a dilemma. The first option is that people remain at their house located in the high-risk flood zone. This option may delay COVID-19 exposure; however, the household members could be at risk of drowning if the rescue team is not successful. On the other hand, if the rescue team is successful, the victims would be relocated to a shelter. Household members could be exposed to COVID-19 during the rescue attempt or at the storm shelter. The second option is choosing to relocate at the shelter before the storm arrives. In this scenario, household members are at risk of COVID-19 infection for longer time, but do not risk third parties involved in the disaster response.  Under a utilitarian perspective, the second option would be desirable since it minimizes the harms for household members and rescuers. However, there is an ethical responsibility at local and global levels owed to this vulnerable population.

In summary, vulnerable populations are in a double bind. The strategies for surviving hurricane seasons are high-risk for infectious outbreak. Climate change increases the likelihood of both devastating hurricanes and infectious disease outbreaks like COVID-19. Climate injustice are exacerbated for vulnerable and disadvantage populations that cannot safely weather from the storms.  What can we do to mitigate the harms imposed by climate change and the current pandemic?

At local level, efforts should be made to maintain social distancing among the people located in shelters. This could be through either by increasing locations or implementing features that facilitates social distancing (e.g. installing dividers).  Special locations should be considered for high risk COVID-19 patient such as elderly and immunocompromised population. Careful planning is needed, though, since complex cases will arise (i.e. an immunocompromised 10-year-old should not be separated from her non-immunocompromised mother). Nonetheless, minimizing the exposure of the high-risk COVID-19 population would be helpful.  Masks should be mandatory at the shelter. It is most likely that the quantity being sheltered exceeds the recommended quantity during gathering (e.g. no more than 10 people in a room). Therefore, interventions that slows COVID-19 spreads, such as wearing masks, should be implemented.  Hygiene efforts must be maximized; hand sanitizer, water and soap should be available. Countries at risks of Hurricanes should devised planning designs that encourage and promotes personal and overall hygiene at shelters without increasing the risks of COVID-19. The CDC offers guidelines for Public Disaster Shelters & COVID-19, providing insight to personal preparation and safety measures.  Lastly, local authorities should implement infectious surveillance for communicable disease, including COVID-19, in an attempt to mitigate outbreaks in the population.

At the global level, countries should collaborate in mitigating Category 5 Hurricanes formation. Warmer water in the tropics, means stronger atmospheric systems. Scientists had created models that shows the consequences if temperatures continue to increase. Unfortunately, even if all the Caribbean region eliminated completely their carbon footprint, it would not be enough to mitigate climate change. Regardless of the pandemic status, Category 5 Hurricanes, places vulnerable population in economic risk (e.g. losing their house), social risk (e.g. assessing education, employment after the event) , and health risks (e.g. mental health, diabetic complications).  Which again highlights climate injustice.

Lastly, the pandemic is forcing restructuration in various social system such as education, health, traveling, and workforce. In a more dramatic light , it feels like we are “re-inventing civilization”. This is our chance to incorporate designs that mitigates climate change. It is hard to see any positivity in the COVID-19 pandemic, but if we were to choose one, we should take the opportunity to aim for a fair climate in our new post-COVID-19 society.

Planning How to Allocate and Distribute a COVID-19 Vaccine

Researchers from the Berman Institute of Bioethics have co-authored a new report providing an ethical framework for making decisions about allocation and distribution of a COVID-19 vaccine during the initial period when such a vaccine has first been authorized for use and is still in limited supply.

Released by the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, the report, Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States, proposes specific tiers of high-priority candidates for receiving a first vaccine based on this framework, including recognizing the contributions of essential workers who have been overlooked in previous allocation schemes:

Tier 1 includes those:

  • Most essential in sustaining the ongoing COVID-19 response.
  • At greatest risk of severe illness and death, and their caregivers.
  • Most essential to maintaining core societal functions.

Tier 2 includes those:

  • Involved in broader health provision.
  • Facing greater barriers to access care if they become seriously ill.
  • Contributing to maintenance of core societal functions.
  • Whose living or working conditions give them elevated risk of infection, even if they have lesser or unknown risk of severe illness and death.

The framework is guided by the following ethical principles, which the report authors believe should guide COVID-19 vaccine allocation and help identify more specific policy goals and objectives around vaccine policies:

  • Promotion of the common good, by promoting public health while enabling social and economic activity.
  • The importance of treating individuals fairly and promoting social equity, for example by addressing racial and ethnic disparities in COVID-19 mortality, and by recognizing the contributions of essential workers who have been overlooked in previous allocation schemes. 
  • The promotion of legitimacy, trust and a sense of community ownership over vaccine policy, while respecting the diversity of values and beliefs in our pluralist society.

The Berman Institute’s Anne Barnhill, Carleigh Krubiner and Alan Regenberg are among the co-authors, as is former Hecht-Levi Fellow Justin Bernstein, and Ruth Faden contributed.

You can access the new report here.

Maternal Health Pandemic Act Proposes Concrete Actions

By Carleigh KrubinerRuth Faden and Ruth Karron
Originally published by the Center for Global Development

Prior to COVID-19,  the US already had some of the worst maternal mortality rates among high-income countries. Now, the country faces growing concerns about how the pandemic can negatively impact maternal health and exacerbate racial inequities in care and outcomes surrounding childbirth. But even as the pandemic poses new challenges to supporting healthy pregnancies and deliveries, there are also opportunities to address longstanding data gaps, break down structural barriers to quality care, and reform outmoded paradigms that leave pregnant individuals behind as medicine advances.

And there’s a move afoot in the US Congress to do just that. Senator Elizabeth Warren and Representative Lauren Underwood have introduced new legislation that aims to address shortcomings in maternal and postpartum care across the ongoing pandemic response. The Maternal Health Pandemic Response Act includes provisions authorizing much-needed funding to (1) strengthen disease surveillance and data collection related to pregnancy, (2) appropriately include pregnant people in the development of new COVID-19 therapeutics and vaccines, (3) enhance health communication efforts, and (4) monitor and address sources of structural racism that put people of color at especially high risk of preventable maternal death during the ongoing crisis and beyond.

We previously issued guidance to equitably address the health interests of pregnant women in emerging epidemics, and a call to action for COVID-19 vaccines, and are encouraged the legislation seeks to advance a number of key recommendations we put forward. Below are a few highlights from the measure.

Data Collection, Surveillance, and Research on Maternal Health Outcomes:

The bill would authorize $190 million to enhance existing surveillance programs and data collection efforts related to pregnancy and COVID-19. Routine health information systems and infectious disease surveillance systems are essential to an appropriate and rapid response to emerging threats like COVID-19. Without high-quality and timely data, there is no way to know whether or how a new infectious agent puts pregnant women and their developing babies at risk. Importantly, this bill not only calls for just this kind of data; it also calls for data to be disaggregated by race, ethnicity, State, and Tribal location. Disaggregating data in this way is critical to assessing and addressing how the COVID-19 pandemic is differentially impacting various communities and population subgroups.

Fair Inclusion of Pregnant and Lactating People in Vaccine and Therapeutic Development for COVID-19:

Section 6 of the bill incorporates several key recommendations to ensure pregnant and lactating people will not be unjustifiably excluded from participating in COVID-19 research trials. Including them in trials is the best way to generate much-needed evidence on the safe and appropriate use of new treatments and vaccines in pregnancy; they should be offered the opportunity to join trials whenever the prospect of the benefits to participating outweigh the risks. The bill’s provisions also address the importance of shaping the portfolio of investments in vaccine development to help ensure that at least one product will be suitable to their needs. For example, the legislation includes reporting requirements for all drug and vaccine developers receiving federal funds to submit their plans for evaluating safety, efficacy, and dosing of products as it relates to pregnancy and lactation. There are also provisions related to using other important sources of data, such as systematic data collection from inadvertent exposures in pregnancy, and animal studies that may shed light on potential safety signals.

Additionally, the bill addresses plans for the fair inclusion of pregnant and lactating people in clinical trials, taking the position that exclusion would require justified rationale. This reflects an important shift away from the historical trend of automatic exclusion without justification toward a default position of inclusion. Decisions to exclude pregnant or lactating women should be based on sound scientific and ethical reasoning.


This bill is incredibly timely. As of August 4, there were nearly 16,000 pregnant women in the US confirmed positive for COVID-19 and 37 maternal deaths recorded. With jurisdictions across the country exploring options to sustain essential services, re-open schools, and meet the ongoing health needs of patients affected by COVID-19, there will be many pregnant individuals among those working the front lines as essential workers–particularly true in fields like education that tend to skew highly female. Compounding concern is emerging evidence published by the CDC that COVID-19 can be more severe in pregnancy as compared to in non-pregnant populations in similar age bands, with higher rates of hospitalization and ICU admission among pregnant COVID-19 patients. Pregnant and lactating people must not be overlooked as we work to combat COVID-19. To ensure that, strengthening efforts to collect much-needed evidence on how maternal health is being affected by the pandemic–particularly among those disproportionately burdened by this disease–and shaping the pipeline for new therapies and preventives that can be safely offered to people across their reproductive journeys are both critically important to achieve that goal. And while this bill is focused on the domestic context, US efforts to enhance our understanding of COVID-19 disease in pregnancy and bring about products suitable for pregnancy could also have implications for ongoing global response efforts that address maternal health needs.

The Public’s Role in COVID-19 Vaccination

Authors:
Schoch-Spana M, Brunson E, Long R, Ravi S, Ruth A, Trotochaud M on behalf of the Working Group on Readying Populations for COVID-19 Vaccine
Date posted:
July 09, 2020
Publication type:
Report
Publisher:
The Johns Hopkins Center for Health Security
See also: View PDF

Introduction

This report considers human factors in relation to future vaccines against the novel coronavirus (SARS-CoV-2), drawing on insights from design thinking and the social, behavioral, and communication sciences. It provides recommendations—directed to both US policymakers and practitioners, as well as nontraditional partners new to public health’s mission of vaccination—on how to advance public understanding of, access to, and acceptance of vaccines that protect against COVID-19.

Problem

The protracted COVID-19 pandemic has placed multiple stresses on the US public: the threat of illness and death, the isolating effects of physical distancing measures, and the uncertainties and hardships associated with disrupted economic activities. People’s resilience is being sorely tested. Operation Warp Speed (OWS) is taking extraordinary steps to develop SARS-CoV-2 vaccines as swiftly as possible and, along the way, to inspire hope that relief is coming. Despite vaccination’s promise of release, some Americans—including those most at risk of COVID-19 impacts—may miss out on, or opt out of, this life-preserving public health measure. Some may worry about whether SARS-CoV-2 vaccines are safe or if they work at all. Some may be mistrustful of vaccine manufacturers, the agencies that regulate the industry, and/or the public health authorities recommending the products. For others, the issue may be access: Will a COVID-19 vaccine be affordable, easy to get to without losing wages or taking public transportation and risking infection, and/or provided in a place that feels safe? Under these circumstances, what can be done to ensure that target populations benefit from SARS-CoV-2 vaccines? With the current lag time in vaccine availability, US vaccination planners and implementers can exercise foresight and take proactive steps now to overcome potential hurdles to vaccine uptake.

Cross-Cutting Recommendation: Put People at the Center of a Revolutionary SARS-CoV-2 Vaccine Enterprise

US research requires reconfiguring to value the contributions of both bioscience and social and behavioral science to inform SARS-CoV-2 vaccine development. If embedded within the COVID-19 response, rapid social, behavioral, and communication science can deliver timely data and empirically based advice to support vaccine delivery strategies and uptake. In the SARS-CoV-2 vaccine enterprise, communities can be active research partners, rather than passive study subjects. Finally, human-centered design principles (aka “design thinking”) can help improve the planning and implementation of the COVID-19 vaccination program.

  • Joined by private foundations, OWS should commit a portion of its budget and work through the National Institutes of Health (NIH), the National Science Foundation (NSF), and the Centers for Disease Control and Prevention (CDC) to support rapid response research into the social, behavioral, and communication issues related to COVID-19 vaccination.
  • NIH should adapt the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) model to include social/behavioral research on COVID-19 vaccination. Minority serving institutions are well-placed for partnering with communities in which hyper-localized understanding of vaccine access and acceptance issues is very much needed.
  • State and local health officials, along with university researchers from the social, behavioral, and communication sciences, should partner with grassroots groups in projects to understand how their communities are thinking about, and wanting to learn more about, SARS-CoV-2 vaccines.

Johns Hopkins Launches K-12 School Reopening Policy Tracker

A multidisciplinary team of Johns Hopkins University researchers today launched a new website that provides a range of tools dedicated to assessing and guiding K-12 school reopening plans across the United States, including a School Reopening Policy Tracker that provides real-time analysis of the latest guidance documents from every state.

According to researchers from the JHU eSchool+ Initiative, 46 State Boards of Education and 13 national policy organizations have thus far issued policy guidance about reopening K-12 schools. Equity issues are at the crux of a safe return for low-income children and children of color, and yet, one-third of reopening plans do not mention equity considerations for disadvantaged students at all, and most others mention them with little detail.

“As the United States continues to think about reopening, schools are at the forefront of every conversation. For parents to resume full-time work, schools will need to reopen, but only in a way that makes every effort to protect the safety and health of students, teachers and staff,” said Annette Campbell Anderson, deputy director of the JHU Center for Safe and Healthy Schools and an assistant professor at the School of Education. “Schools will also need to find new ways to make up for losses in learning, health, and support systems that occurred as a result of the closure. These discussions are happening right now, and our tracker analyzes how states’ proposed recovery plans support students, teachers, and parents.”

The Tracker and additional resources created by JHU’s eSchool+ Initiative are available here, and include:

“What children lose by not being in school is enormous; school attendance is a life-defining experience that is critical for educational, social and emotional development. School-age children, who very rarely die or become seriously ill from COVID-19, are being denied the benefits of attending school to protect the rest of us, particularly those at greatest risk of contracting the virus,” said Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics.

“The biggest ethical challenge for decision makers is determining how to balance the interests of children and the interests of the rest of society. Factored into this moral calculus is the additional argument that school reopening is integral to economic reopening; parents need the full-day child care schools provide in order to return to their stores, offices and factories. This big-picture trade-off decision does not, however, exhaust what is ethically at stake. Many difficult ethical decisions about exactly how schools should reopen need to be resolved.”

A collaboration between JHU’s Consortium for School-Based Health Solutions, the Berman Institute, the Rales Center for the Integration of Health and Education, and schools of Education, Medicine, and Public Health, the eSchool+ Initiative is a cross-disciplinary effort to provide actionable real-world information and guidance that has characterized the University’s response to the COVID-19 pandemic.

“Schools are a nexus of health and well-being for children, particularly in less resourced communities where the burdens of the pandemic are being borne disproportionately,” said Dr. Megan Collins, an assistant professor of ophthalmology at the Wilmer Eye Institute and Berman Institute, and co-director of the Hopkins Consortium for School-Based Health Solutions. “While schools will be monitoring the COVID-19 ‘learning slide,’ what is missing is an eye on equity for disadvantaged groups. Even as education and public health leaders advocate for making classroom-based education a priority for those children most at risk for missing school, there is no clear guidance from school districts about how structural justice problems should be addressed. By creating the eSchool+ Initiative, we hope to contribute to ongoing discussions about narrowing health and academic equity gaps for disadvantaged students.”