CV-19: It’s All About The Kids

There’s enough risk with CV-19 as it is, but the unknowns could really kill us: opening schools, super-spreaders, herd immunity, and long term damage among recovered patients. There are things we know for sure: for example, masks help. And things we don’t know: for example, how to get people to wear masks. But in between the known improvements in treatments and the known unknowns of when we’ll get effective vaccines and cures, lie several issues which could really harm us if we handle them the wrong way. Let’s start with schools… but to do so we first need to start with herd immunity.

In brief: there won’t be any herd immunity for this virus. My colleague Bruce Laird has a complete analysis of the issue too complex to cover here, but that’s the bottom line. First, herd immunity just means the spread slows down. Second, there is increasing evidence that immunity to CV-19 lasts a few weeks to months^[1]; it’s not permanent^[2]. Third, even the Republican Governor of Mississippi thinks that the health care system would be overwhelmed if we tried to achieve the mythical herd immunity. Fourth, we’re very likely heading into a worse outbreak this fall/winter.^[3] The implication is that nothing is coming to rescue us – the more people that catch this, the worse off we’ll be. Even survivors are showing long term damage.^[4]

The drive to reopen schools is political and understandable, and madness. Political, because the motivation of Republicans is to get the economy running so Trump can get re-elected. Understandable, because we need people to be able to earn money and not suffer more economic damage, and because the children benefit from the education and socialization at schools – we could be retarding years of educational progress.

So why is it madness? First, because there is evidence that children are efficient transmitters of the virus.^[5] And that puts teachers, parents, and older household members at risk – and we’ll have even more hospitalizations and deaths. Note that the evidence is mixed, and that some countries have been able to open schools. However, THOSE countries have done the hard work of containing the virus. Iceland, for example, seems to have safe schools, but look at what they did first to control a severe CV-19 outbreak. A country like Sweden, which left grade schools open, is more likely a proxy for the U.S., and they’re one of only eight (8) countries WORSE than the U.S. in CV-19 deaths per million. Further, Sweden has excellent national health care and a stronger social safety net than the U.S.; so we’ll be worse than Sweden if we try opening grade schools.

Secondly, reopening schools is madness without a plan, and without resources in place to make it safe. And there is no federal plan, no guidance (and VP Pence even said he didn’t want CDC guidance to prevent schools reopening), and no resources in place. Heck, teachers are still expected to buy school supplies for their students. We certainly don’t have PPE for everyone at school, testing for everyone at school, a nurse at every school, extra social distance in classrooms – we don’t even have HEATING at every school. Until the government has an expertly approved plan and the money is spent and the safety equipment and protocols are installed and tested, schools will just facilitate spread across families.

Third and finally, it is madness to reopen schools now because we are being presented with a false choice by a government that has failed to do the hard work. The choices are not just: a) reopen the economy and die in numbers, or b) stay home, be evicted, and starve to death while the economy collapses. The real choice, the one we have not yet pursued, is to do the Hard Work. Establish extensive daily testing with same day results, quarantine affected people, trace their contacts, test and quarantine those contacts. Dozens of intelligently run countries have done this already, which is why the Prime Minster of New Zealand danced a little jig when her country was CV-19 free, and schools are open in Germany and many other nations.

The United States is completely out of control regarding CV-19.^[6] We’re worst in total cases and deaths and – even adjusting for population – the former world leader in pandemic response is 9th worse in deaths/million and 2nd worst in cases/million. Our case trends are worst in the developed world. (graph at left). Finally, we have huge numbers of unnecessary CV-19 deaths compared to Germany and other well-run countries (table below).

 

 

 

 

 

The time to reopen the schools is after we have done the job of containing the virus. Pushing to reopen schools now just highlights the incompetence and criminality of the federal, and several state, governments. And when I say criminal, yes, I mean criminal.^[7]

So what could be done?
First, the nation could decide to control the virus. Failing that, secondly, would less money be better spent giving every child access to high speed internet and a tablet or laptop? European countries have invested in superior internet coverage, rather than allowing capitalism to pick and choose its customers. The result is equitable coverage and tremendous performance which allows large portions of the population to work from home, and middle schoolers to learn at home. However, home schooling doesn’t ease the tremendous burden on parents for both working and teaching. Perhaps, thirdly, we could make use of lots of unoccupied hotel and office space to establish a network of ‘school pods’ with 6 or less children. The pods would also facilitate contract tracing and containment and reduce school disruption, because there are a lot of unanswered questions about how schools can continue to function with the virus at large. Pods would require many more teachers, which could be part of a temporary employment solution until the disease recedes.  Pods would present a transportation burden, but would free parents to work for part of their day.

I’m not an expert, but it seems to me that putting a lot of money into a school infrastructure – originally designed for group learning and social interaction – will still present a high risk for shutdown due to viral outbreaks ^[8]. That money would be better spent on approaches like the two mentioned above. I know I’m not alone in my concerns about reopening schools without the proper protocols and resources in place. Here’s what one teacher thinks about the danger and inequality of school reopening.

To me, it’s slow motion manslaughter^[9]. to proceed with school openings, as our national ‘leaders’ are requesting, while we are under-planned, under-funded, and out of control with this pandemic.  Do the hard work you should have done in January and February.  Get the virus under control.

FOOTNOTES:

[1] Evidence that ‘recovered’ patients can ‘re-catch’ CV-19 (60+ patient study in China), and that antibodies fade quickly (patients giving plasma shown  losing antibodies) and that ‘herd immunity’ ISN’T for this virus. here are some links:

A. Spain’s coronavirus antibodies study adds evidence against herd immunity
B. Warning of serious brain disorders in people with mild coronavirus symptoms.

[2] COVID-19 immunity could disappear after a few months, study says
While 60% of participants showed a “potent” antibody response while they were battling the virus, only 17% maintained the same level of potency at the end of the three months, researchers said.

[3] In each of the eight influenza pandemics to hit the United States since 1763, a relatively mild first wave — no matter what time of year it arrived — was followed by a larger, much more lethal wave a few months later, noted Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We will go much higher in the next 12 to 18 months,” Dr. Osterholm said. Because this is a coronavirus, not influenza, it may not follow the same pattern, but it is “a much more efficient transmitter than influenza.”

[5] Viral load studies in kids:
A. “…our findings suggest the necessity for children to wear masks, especially in schools, where children would talk in close proximity.”
B. Kids do better with the disease:
“Adult patients show suppressed adaptive immunity and dysfunctional over-active innate immune response in severe infections, which is not seen in children. These could be related to immune-senescence in elderly. Excellent regeneration capacity of pediatric alveolar epithelium may be contributing to [children’s] early recovery from COVID-19. Children, less frequently, have risk factors such as co-morbidities, smoking, and obesity.”

[4] Long term survivor damage: https://twitter.com/meganranney/status/1285354398265282563
JAMA Paper: Damage lasts months…
“Patients were assessed a mean of 60.3 … days after onset of the first COVID-19 symptom; at the time of the evaluation, only 18 (12.6%) were completely free of any COVID-19–related symptom”

[6] And one could argue, several other things.

[7] Involuntary manslaughter: Why Trump is guilty of involuntary manslaughter:

[8] Older children spread the virus as readily as adults, per South Korean study.
The study found that children between the ages of 10 and 19 can spread the virus at least as well as adults do, suggesting that middle and high schools in particular may seed new clusters of infection. Children younger than 10 transmit to others much less often, the study found, although the risk is not zero. “Recent reports on COVID-19 transmission have estimated higher secondary attack rates among household than non-household contacts ” “We showed that household transmission of SARS-CoV-2 was high if the index patient was 10–19 years of age.”

In Israel, at least 1,335 students and 691 staff members contracted the coronavirus after the country reopened its entire school system without restrictions on May 17, believing it had beaten the virus. The spike in infections among the children spread to the general population, according to epidemiological surveys by Israel’s Health Ministry.

[9] Manslaughter is a common law legal term for homicide considered by law as less culpable than murder. The distinction between murder and manslaughter is sometimes said to have first been made by the ancient Athenian lawmaker Draco in the 7th century BC.