July 2 covid-19 update

Covid-19 update – July 2

There’s no good news for the U.S. or South Africa in this week’s graphs. South Africa continues to have the steepest epidemic curve, with cases doubling every 2 weeks, although its death toll continues to be relatively low (see the June 11 post for more on why). Italy is still doing fine, and proving that it IS possible for a country to control a very serious epidemic.

As I wrote last week, the U.S. is still in the “lull” between rapid increases in cases and rapid increases in deaths, although I’ve been reading reports from desperate doctors and at-capacity hospitals in hotspots like Texas and Arizona. It’s horrifying. And it’s just going to keep happening… and happening… and happening, in a merry-go-round of cities/counties/states, until we decide we’re desperate enough to do what needs to be done to stop this deadly pandemic. (If you want to see how your U.S. county is doing, look here.) We continue to have disastrous and delusional leadership at the national level, very uneven leadership at the state level, and a whole lot of Americans who seem to have decided this whole thing is no big deal and it’s time to hit the bars and beaches. I shudder to think that in a few days we’ll be seeing pictures of people crowded together at barbecues and firework displays over the 4th of July weekend. American friends, PLEASE fulfill your patriotic duty to your fellow citizens this weekend by being responsible, socially distanced, and masked.

I’m also seeing dire reports out of South Africa, even as some kids are returning to school. School is what I want to talk about today, as the burning question for me and basically everyone else I talk to in the U.S. is – are kids going to be able to go back to school in August and September? Our new school year starts at somewhat different times in different parts of the U.S., but my kids are supposed to be back in a classroom in Illinois in just over 6 weeks. My kids’ former classmates in South Africa went back to school this week, and I got a little teary-eyed as I looked at the pictures. I am desperate for my kids to go back to school. I am desperate to not be in a situation of trying to handle remote learning for my own (little) kids while starting a new job teaching other people’s (big) kids, with the added complication of managing in-person (best case) and online (planned and necessary) instruction. (I have been hired as Assistant Professor at Wheaton College outside Chicago. Wheaton, like most colleges in the U.S., is planning for a hybrid model of in-person and online instruction this fall. The number of times I have heard other faculty members say this is going to be the most challenging term anyone has ever had... and what a time to start teaching!)

I’ve had a number of people ask me if I think schools should re-open, and I’ve been reluctant to answer. I don’t think there’s a one-size-fits-all answer, and I don’t want to criticize the decisions of local governments or decision-makers, who (hopefully) have a lot better insight into their local situations than I do. So I’ve done a lot of waffling, and said “it depends” a lot, but also have done a lot of thinking on this issue. I got into a friendly exchange this week with a good friend who works at the CDC and sees things somewhat differently than I do, and I certainly think there is room for smart, well-informed people to disagree. As my friend said, the storyline of this pandemic is changing all the time. I sat down tonight to see what recent research had emerged since I wrote about this issue 6 weeks ago or so, and found that Emily Oster at the Atlantic had done my homework for me and published an article on this very question only today. (Dr. Oster is a health economist whose work I’ve been following for years and with whom I have exchanged emails once or twice; I trust her work.)

This is where I’m at right now: I THINK KIDS NEED TO GO BACK TO SCHOOL. Here are the reasons why, and some caveats – chief among them that I am not trying to offer a blanket recommendation for the whole world. But in the vast majority of countries/places/settings I can think of, I think kids need to be back in school.

1) I think this pandemic may well be with us for the next 1-2 years (or longer), and I think the harm to kids of keeping them out of school that long is unacceptable. In being out of school, kids are not only suffering in terms of learning/education, but also in terms of mental health and development, socialization, and happiness. Many kids are also suffering in terms of physical health, nutrition, and safety. We know that all these costs are falling the most heavily on the kids that had the least advantages to begin with, and that many kids are experiencing inadequate care and protection, limited parental supervision, and outright violence and danger. In the beginning of the pandemic, decision-makers had to weigh these risks against the very real possibility that keeping schools open would greatly increase the death toll (for kids and others), so I think closing schools initially was absolutely the right call. I think we know now that letting kids return to school is likely not going to lead to massive outbreaks, which leads me to my 2nd point…

2) Kids do not seem to be major spreaders of the virus, so reopening schools will likely not lead to large increases in transmission in the community. I’m going to quote directly from Oster’s article, and the research she links to is also well worth a look:

• Are children major vectors for the virus? At least one government has argued that children could not transmit the virus at all. Some research teams countered that they were just as likely to transmit it as adults are. At this point, neither of these claims seems quite right. If a kid is sick and shedding virus particles and an adult is exposed to those particles, of course the adult can get sick; but children do seem to transmit the virus less than adults do. In an early case, an infected child went to several skiing schools and was exposed to hundreds of contacts without infecting anyone. Data from the Netherlands suggest that children are relatively unlikely to be the “index case” in their families—that is, they are unlikely to be the first case in a family cluster. (Parents Can't Wait Around Forever, The Atlantic, 2 July 2020)

3) Evidence continues to accumulate that kids themselves are at very low risk for serious illness or death from covid-19. Again quoting from Oster:

• But one of the robust findings about COVID-19 in the past few months is that children are among the least affected groups. They are less likely to contract the disease, and if they do contract it, they are more likely to have a mild or asymptomatic case. Death rates are much lower. This evidence doesn’t mean that kids cannot get sick, and or cannot fall seriously ill, but older adults are far more susceptible. (Parents Can't Wait Around Forever, The Atlantic, 2 July 2020)

4) Caveat 1: I think we should be very concerned about teachers who are older or otherwise at high risk. I have two close family members who are teachers and have significant risk factors, and I do not want to see either of them in the classroom this coming year. I don’t have good answers on what it might look like to protect the group of teachers who are at high risk for serious complications from covid-19, but this group is my biggest concern if/when kids return to school.

5) Caveat 2: Kids who are similarly at high risk, or who have caregivers or family members who are at high risk, may need to stay home. Obviously the older the student is and the more technology is available, the more feasible it is for students to virtually join an in-person classroom. Wheaton College, where I will be teaching, is giving all faculty members and students the option of joining the classroom virtually rather than in-person. I assume many colleges are doing the same, while I've read about other colleges which plan to be online-only this fall. I realize remote learning may be impossible in resource-constrained environments, but in my ideal world schools would think radically and creatively about how to serve the needs of the minority of teachers and students who are at high risk, while letting everyone else resume (modified) in-person instruction.

Another way I’ve been looking at this school issue is that we need to distinguish activities not only according to their level of risk, but by how important they are. In this pandemic, I envision risk (to ourselves and others) as a kind of point system. The goal for all of us is to get through this pandemic accumulating as few “risk points” as possible, but some things are more worth accumulating points for than other things. Most of us can’t totally avoid risk. We have to buy groceries, go to the dentist, and interact with other people outside of our immediate families to some degree. We don’t have to go to restaurants, gyms, movie theaters, or U.S. presidential campaign rallies (!!!). We may decide to take on a bit more risk for things that are really important, like visits with friends and family (hopefully in outdoor, socially-distanced visits). I see a big difference between occasionally doing something that’s higher-risk, and for a good reason, than making a habit of higher-risk activities. Collectively, we can only accumulate so many “risk points” before we see infections surge in the community. Unfortunately, when some of us decide to do a bunch of really high-risk things, it affects everyone.

My point is that I think we need to treat kids returning to school as very, very high priority, even if it carries risk, and that we collectively we need to do whatever we can to reduce other higher-risk activities, so that community transmission stays at an acceptable level and schools can remain open. There will inevitably be some transmission caused by kids returning to school, and there will be some ensuing deaths (even if we can’t conclusively trace deaths in the community to transmissions at school). But if communities can collectively make decisions that stop transmission, hopefully increases in transmission from kids returning to school won’t spark big outbreaks. It burns me up to hear of people crowding into bars or going to large rallies or concerts, because in my mind they’re using up those “risk points” that are desperately needed for more important things, like kids being in school. It burns me up that so many people are not wearing masks, because I think every single person (who doesn’t have a major medical reason they can’t wear a mask) should be committed to sacrificing a bit of their comfort and convenience so that transmission stays low enough so that kids can stay in school. I want kids getting as many of those “risk points” as they possibly can, because I think getting kids back to school should be our absolute number one priority, after reduce severe illness and death from covid-19.

So that’s my mini manifesto on the school issue. On the topic of all us accumulating fewer "risk points", here’s a good infographic that I saw today that ranked activities by risk level. I unfortunately haven’t been able to find a copy online, or verify that it’s actually from the Texas Medical Association (I searched their website unsuccessfully), but the rankings seem solid to me. It doesn’t list every activity under the sun, but it does cover quite a few common activities, and I think it’s a useful guide as we all make decisions about how much risk is wise and responsible (for our own health and that of our fellow human beings).

This interview with Francis Collins, head of the U.S.’s National Institutes of Health, was the most hopeful and encouraging thing I read today. Not only because he holds out hope we might have an effective vaccine by the end of the year, but also for his beautiful words at the end of the interview about integrating faith and science. There’s also a lot of fascinating info on the science of the virus and vaccine development. In the midst of the political circus we are witnessing during this pandemic, I feel comforted to think of Francis Collins and Anthony Fauci (two deeply brilliant and ethical men who also happen to be good friends) having phone chats at the end of the day. I’ll leave you with some of Dr. Collins’ wisdom: “It’s one of the great tragedies of this current moment that scientifically based public-health measures have somehow been captured as cultural or political phenomena. Your chance of spreading the coronavirus to a vulnerable person has nothing to do with what culture you come from or what political party you belong to. Your responsibility is to try to prevent that from happening to vulnerable people around you.”