Are We Headed To a Coronavirus Apocalypse In the Fall?

A laboratory technician of biotechnology company mAbxience is seen working, amid the outbreak of the coronavirus disease (COVID-19), in Buenos Aires, Argentina August 13, 2020. REUTERS/Agustin Marcarian
August 16, 2020 Topic: Security Region: Americas Blog Brand: The Reboot Tags: CoronavirusCOVID-19PandemicSchoolsFDA

Are We Headed To a Coronavirus Apocalypse In the Fall?

One former FDA head has some thoughts.

Gottlieb: Look, I think that these decisions should be made by local districts because every local district faces a different circumstance in terms of what it can do with respect to the measures I talked about. And, unfortunately, a lot of districts that are already disadvantaged have the least opportunity to implement some of the measures. And so you have students that are already facing disadvantages in getting access to education being the ones who are in a position where their districts can open. So we need to try to address that. But I do think we need to leave discretion to the districts, and that’s not what’s happening.

You’re seeing states stepping in and saying, “You’re opening five days a week for in-class learning, regardless.” In states that have major epidemics underway — so if you took Southern California right now, Florida right now, parts of Texas right now — I’ve said all along I think it’s going to be very hard to open against the backdrop of an out of control epidemic. I don’t think the measures that I outlined can feasibly prevent outbreaks from happening in the schools. And so you can be one of those who says, “Well, there have been outbreaks of schools. Kids will be fine. They can get sick. It won’t worsen the epidemic and the kids won’t have bad outcomes.” I’m not in that camp. I think that if there are outbreaks in schools, it’s going to seed the community and the kids are going to be at risk. I don’t want to see outbreaks in schools. And I don’t think that you can prevent that in the setting of major epidemics.

I think in states that have a measure of control over their spread — and you don’t have to have perfect control over your spread, but a measure of control of your spread so you don’t have sustained community transmission — I think you can open the schools against the backdrop of some transmission. We’re never going to get transmission down to exceedingly low levels like you’ve seen in some other countries where you have a handful of cases being reported a day. Even New York has 500 cases a day. Connecticut still has 100 cases a day, and it’s going to probably go up. But in those states, I think that there’s an opportunity to open the schools. In states that are challenged, but not out of control, I think there’s an opportunity to open the schools. I think in the states where you see an out of control epidemic, you see a positivity rate above 10, those are going to be very difficult circumstances. And even a positivity rate above five is challenging. But there’s about, probably 15 states right now with a positivity rate above 10. And those are challenging circumstances for those states.

Mike, even in those kinds of situations, where we have high positivity rates and a lot of spread… do you think that the economic downsides are so significant that even in those situations schools need to reopen? Get the kids some masks, open windows, have class outside, but there’s such an overwhelming case about the potential damage that we just need to get our schools open.

Strain: I think I would be willing to tolerate a greater degree of risk and a greater degree of infection than it sounds like Scott would. The point that we need the public health community to understand is that there are more considerations than just medical advice in play here. But I think we need to think of that as really an extreme thing to do. Shutting down schools for a year after they were already closed for the spring semester: That’s a very serious thing to do.

But I don’t think we should be having that conversation in isolation. We should all be wearing masks every day when we leave our houses. We should be doing that because doing that would help get kids back in the classrooms. When we’re deciding whether or not bars and tattoo parlors should be open, we should be thinking about the effect that will have on allowing kids to go into classrooms. Schools should be one of the very last things that we shut down. And we certainly shouldn’t be shutting down schools because we don’t want to issue orders about wearing masks in public.

I think a lot of people are asking, “How much infection would you tolerate? How much spread would you tolerate in order to keep the schools open?” I think that is a useful question because that trade-off — the trade-off between more infection and a more normal life — is something that we should be grappling with more explicitly than we currently are. The reason not to frame the question in that way is because these options don’t exist in a vacuum. There are a whole bunch of other things that we can and should be doing that would both reduce the spread of the virus and allow kids to go back into classrooms. And I do think a root cause of the challenge here is a lack of appreciation for the real value that schools have for kids. When your kid is in sixth, seventh, eighth, ninth, or 10th grade, school is not just daycare. It’s not just a mechanism to allow you to go to work. It is really doing something for your ability to function in society as an adult and to function in the economy as an adult.

Hess: And I’ll just say, Jim, that if I was in Florida as a parent, I wouldn’t want the schools to open. When you think about frameworks and you think about conditions, it’s the scaffolding Scott is talking about. So look, there’s got to be a continuum here. But I think there are lots of places. We were talking about Northern Virginia a couple of months ago, where we both live. It seems to me that public health situation in Northern Virginia is such that it should be entirely feasible to open schools in a hybrid fashion. And whether or not kids go five days a week is one question. I think it’s vital to understand, though, how hugely important it is for kids to get into school buildings on a semi-regular basis. Whether that’s two days a week and that makes it feasible to socially distance and to have time to deep clean, or whether that’s half days.

Look, the thing we’ve got to remember is that for huge numbers of children — especially millions of kids who were on the wrong side of the opportunity gaps — this is where they have stable adults in their lives. This is where they have friendship networks. There’s the human piece that actually connects them to what they’re learning. They actually need to know their teacher as something other than an occasional square on a Zoom screen. To ask kids to show up for school and spend the fall semester or an entire year as eight-year-olds or 14-year-olds learning from somebody whom they have never actually interacted with in person is to be profoundly unrealistic about how kids learn and how teachers do their job.

And Rick, on the question of whether kids can catch up if they miss a considerable amount of time in school?

Hess: We have this phenomenon called summer learning loss. We still got this a lot in the early no child left behind. It’s one of the reasons that you see these huge gaps by race or by income. During the academic year, there’s less spread than you would imagine. But what happens typically during the summer is kids from middle class and affluent families hold or increase their performance because they get to go to enrichment opportunities and they have resources. And kids from low income families are stuck in smaller homes without enrichment opportunities and they go down. So basically, what you’ve done is you’ve now created that phenomenon for six months, potentially for 15 months.

What we are talking about is a massive lift to try to get the kids who are losing out here back where they need to be. Can it be done? Hypothetically, sure. With enough intensive tutoring, enough supports. Are we willing to fund that? Are we able to figure out how to deliver it? It’s an open question.

Scott, why are we sitting here with 65,000–70,000 cases a day? We’re a rich country. We have an advanced medical system. We have great biotech companies. States are relatively well-run. Why are we still sitting here with 60,000 plus cases a day while Western European countries are opening schools and they have 5,000 cases a day? What explains that gap, to the best of your knowledge?

Gottlieb: There’s the decentralized nature of our country in terms of how decisions get made at a state level and local level, rather than at a federal level. And I think the individualism of this nation, our aversion to regulation — while all those elements are normally the ingredients of the dynamism of this nation, I think they have worked against us in this setting. I think that we weren’t able to implement a coordinated strategy. We weren’t able to get uniform adherence to it. Our individualism caused splits over things like wearing masks, where there should have been, I think, more collective acceptance and collective action. So all of the things that make this nation great, I think that make us dynamic, also make it hard to respond to a public health crisis in an intensive, coordinated fashion.