Context: Recommendations for COVID-safe, in-person, high school education have included masks and distancing between students but do not describe a scalable surveillance solution to rapidly identify and mitigate disease prevalence or exposure. Methods: Through an Internet application, all school participants reported symptoms, illness, or exposure daily. Physiciansupervised follow-up interviews were reviewed and recorded in daily rounds. Students and faculty were allowed or prohibited to enter school based on the results. Results: From August 30, 2020, until April 13, 2021, a high school in Bergen County, New Jersey (an epicenter of high COVID prevalence), with 889 students and 214 faculty members, staff, and volunteers, generated 1497 assessments. Reasons for initial evaluation included 48 (3%) participants with positive COVID tests, 520 (34%) COVID-exposed, 178 (12%) exposed to someone with symptoms and unknown COVID status, 208 (14%) subjects with symptoms themselves, 525 (35%) exposed to a high-risk geography or air travel, and 12 (1%) contacts of a contact. Of the 61 subjects ultimately diagnosed with COVID, the sources of infection were 36 (57%) home exposure, 16 (27%) confirmed nonschool sources, 8 (13%) unknown, 1 (2%) travel to a high-risk area, and only one potential case of in-school transmission. Conclusions: Masks, distance, and aggressive contact tracing supported by an Internet application with consistent application of quarantine protocols successfully permitted in-school education without COVID spread in a high prevalence environment. This finding remains important to guide safety measures should vaccine-resistant strains-or new pandemics-challenge us in the future.
Neonatal hypotonia can have many different etiologies. Floppiness in an infant can be caused at various levels of the nervous system from disorders of the brain to spinal cord lesions, neuropathies, neuromuscular junction disorders, and myopathies. A variety of diagnostic tools are available for defining the source of the hypotonia, but before any serum values, muscle biopsies, electromyelograms (EMGs), or nerve conduction studies are ordered, a thorough neurologic examination is essential for determining the diagnosis. The first goal in diagnosing the source of neonatal hypotonia is to ascertain if it is central on peripheral. Infants who have central hypotonia from a brain source usually have other central deficits.
Erythema infectiosum (EI), also known as fifth disease, is one of the most common childhood exanthems. The condition first was described by Tschamer in 1889 and initially was thought to be a manifestation of rubella. It is seen most often in children ages 4 to 15 years and has peak incidences in winter and spring. It can present in focal outbreaks or in community-wide epidemics, which can last from 3 to 6 months. Infection rates of 20% to 50% have been noted in families and classrooms. The condition was termed fifth disease because of the numerical designation it originally was given (following measles, scarlet fever, rubella, and Filatov-Dukes disease, now regarded as a mild atypical form of scarlet fever).
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