The System is NOT Failing Children

The System is NOT failing children, as Heather Knight implies in her piece "The system is failing all these children" (San Francisco Chronicle, 10/23/20). On the contrary. By shutting down our schools, we have saved thousands of lives, including those of our children and their family members. It is true that distance learning is inferior to in person learning and that it is more accessible and effective for some groups than others. This is not fair and needs to be rectified. However, opening schools in the middle of a pandemic, especially as we head into winter, is the wrong solution. A recent study out of Columbia University says between 130,000 and 210,000 lives have been lost unnecessarily because we failed to implement sufficient social distancing, masks and shutdowns. Researchers at University Of Washington predict we could start losing 3,000 lives per day as we head into winter, unless such measures are fully implemented. All across the country, new outbreaks are occurring where schools are reopening. Just look at the Covid Monitor website and it's clear: negligible school-related outbreaks in California, where many school districts are doing distance learning, and rampant school outbreaks in parts of the country with widespread school openings, like Texas, Iowa and Florida.

Most of California Now in Danger Zone, Newsom Shuts Down Schools

12 California counties are now in the highest alert red zone (as of 7/16/20), with over 25 new infections daily per 100,000 people, while an additional 28 counties are now in the dangerous orange zone (10-24 new daily infections per 100,000 residents), including San Francisco, which shot up from around 7 last week to well over 10 this week. (Data as of 7/16/20, from Harvard's Path to Zero website)

That's 40 counties in the red/orange combined. Governor Newsom has declared 33 of these counties to be on the "watchlist" severely limiting which businesses can be open. Further, he mandated that all schools, public and private, must be closed to in-person learning if located in one of these 33 counties. That means that both Marin and Orange Counties, which had both recently declared schools to be open this fall, will have to back down and close their schools, since they are both on the watch list.

California has been chalking up over 8,000 new infections daily for the past week and is on track to catch up with New York, though their mortality rate is substantially lower.

Why It's Hard for Americans to Trust the Experts

Is it any wonder that Americans don’t trust politicians, American institutions, even scientists? That they continue to go to crowded public places without masks, deny that covid infects children or that they can spread it to vulnerable adults, in spite of the solid evidence to the contrary?

Why should they trust the scientists when the scientists keep changing the “science?”

Certainly, part of the problem is the general public’s lack of understanding of how science works: Scientists makes hypotheses based on current data and then constantly revise and improve those hypotheses as new data comes in. Thus, what was considered the best explanation in February could look significantly different today, now that we have so much more data on how covid-19 spreads and how it affects the body. This can be confusing and frustrating to the lay person, particularly when politicians and the media continue to hype the now discredited preliminary data. Consider how many people still believe that vaccines cause autism, even after this myth has been repeatedly disproven in controlled scientific studies, (an excellent article on this topic here) and even after its main proponent, Andrew Wakefield, had his medical license revoked for publishing the fraudulent data behind this myth.

But there is a bigger problem when supposedly objective scientists make public statements about what is considered best scientific practice that are NOT based on scientific evidence at all, but on the dictates of politicians and capitalists, which is exactly what the Centers for Disease Control (CDC) seemed to be doing this week by buckling to the demands of Donald Trump and agreeing to change their guidelines for how to reopen K-12 schools, thus facilitating Trump’s dictate that ALL SCHOOLS MUST REOPEN ASAP.

In a glaring example, CDC director Robert Redfield said there’s no evidence that children drive the spread of coronavirus. While it is true there are many factors driving this pandemic (e.g., stupid back-to-work policies that force workers and consumers together without adequate PPE; people cramming into bars without masks; poorly trained and equipped employees at assisted living facilities and prisons), to say that children do not drive the pandemic is scientifically inaccurate and misleading. It implies that we don’t need to worry about sending our kids into crowded classrooms, that they are not going to bring the virus home and expose vulnerable family members, and that reopening schools will have little or no effect on the number of new infections.

It is so misleading and dangerous that even Trump’s own controversial health advisor, Deborah Birx, had to back away from Redfield’s statement, saying there isn’t enough data to arrive at that conclusion; the data is complete. Not enough children have been tested.

But we do have compelling evidence that kids catch the virus at the same rate as adults from two different studies, one from Germany and one from China. And this study from Switzerland, published on the CDC’s own website just last week, shows that symptomatic children shed just as much virus as adults, indicating they can, indeed, spread the virus to others. (Which makes one wonder if the CDC director even looks at his agency’s own website, let alone reads the latest scientific studies).

We also have considerable anecdotal evidence of the virus spreading in schools and daycare facilities, including among children. There were 950 infections at Texas childcare centers as of the end of June, with a third of the cases occurring among the children. And, as the UK reopened, schools there quickly become the second leading source of new outbreaks, after home care centers. France and Israel had to close schools soon after reopening because of new outbreaks among kids. There was also a cluster of juvenile infections after a high school swim party in Arkansas. And nearly an entire class in Quebec contracted covid, despite physical distancing and hygiene measures, after an infected student came to class, which strongly supports the hypothesis that children can, indeed, drive the spread.

Many back-to-school proponents argue that kids don’t get as sick as adults and rarely ever die. While this is true, statistically-speaking, it does not justify reopening schools. First, and most significantly, if kids can transmit the disease, and the evidence shows that they can, then they can spread it to vulnerable staff and family members. With one-third of all teachers being at elevated risk of severe symptoms and death due to age and underlying health conditions, not to mention all the children living with grandparents, and all those living with family members who have diabetes, heart disease, cancer, kidney and liver disease, reopening the schools would be criminal!

However, kids do catch the virus and sometimes get quite ill and die. Based on the preliminary and incomplete data we have, in many parts of the U.S. and Europe, mortality rates for children age 10-19 are in the range of 0.1-0.5%. These numbers probably reflect only the minority of infections that were symptomatic and bad enough to require treatment and/or hospitalization. Consequently, the sample sizes are small and the percentages are likely inflated. But if we divide these percentages by 10, since it’s estimated that there are 10 times as many infections as are currently documented, that would bring the mortality rate down to 0.01-0.05%. With roughly 50 million K-12 students in the U.S., if 50% of them contracted the virus, and 0.01-0.05% died, there would be 2,500-12,500 juvenile deaths. This, too, should make us question the safety and efficacy of reopening the schools.

If it wasn’t safe to go to school in May, when most of the nation’s schools were first shut down and infection rates were miniscule compared with today, then why would it be safe to return to school in August and September, when infection rates are going out the roof? Especially with watered down “safety” protocols?

Last night, I watched a San Francisco Unified School District Town Hall Meeting on Reopening, in which an unprepared and incompetent representative from San Francisco’s Department of Public Health bumbled incoherently through a set of talking points on school “safety” measures she clearly had never seen before. The guidelines she read were only recommendations and they only applied when conditions permitted. For example, students were to have 9 feet between them, except when this wasn’t possible. Then they could be as close as 3 feet from each other, which is only half of the standard 6 feet, which is, itself, insufficient to protect against aerosolized particles. Windows were to be opened, except in the numerous rooms that lack windows. Schools could choose to do temperature checks, or trust parents to do it at home. If someone passed the health screening at the beginning of the day, and got sick later, they’d be sent home (but apparently, all those who were in contact with that individual would remain).

It was absolutely appalling to witness SFUSD and the health dept being so ill-prepared on a recorded public forum with thousands of live viewers, but even more so when you consider the stakes. It gave me absolutely no confidence that either institution could be trusted to protect the health and safety of my child, or his teachers and school staff. Many of the families participating asked questions like, “Would the district base its decision to reopen on the recommendations of the CDC?” But if the CDC is weakening its recommendations to appease Trump and Wall Street, then they’re not going to keep our children and their teachers safe either.

The only safe and rational option is to:

·       Keep schools closed to live, in-person instruction until the pandemic is over

·       Provide sufficient teacher training, time and extra pay to develop higher quality remote learning experiences

·       Provide parents training and resources to help them support their children in their remote lessons and with their mental health and social development

·       Keep ALL workers home who are not truly essential for our day to day survival (e.g., workers who help produce food, utility services, emergency services and healthcare), or who cannot be provided a safe, uncrowded, well-ventilated work environment with adequate PPE

·       Provide everyone with the money and resources necessary to survive, including protection from evictions and foreclosures and utilities shut-offs

·       Provide safe childcare options to parents who are essential workers, including support for their children’s remote learning experiences

Teachers, Students-Do NOT Go Back to School!

In California, Governor Newsom has extended the Shelter-in-Place (SIP) through May, but at the same time, he wants to reopen schools early, in July. This would be a deadly mistake and should be opposed by everyone.

What should happen before anyone is sent back to work:

1. Infection rates need to decline to 1 new case per million residents, as prescribed by epidemiologists at UW. California is currently at 1,289 cases per 1 million residents. So, we're not even close. This low infection rate is required both to ensure that the medical system is not overloaded, like we saw in New York and Italy and Spain, AND to ensure there is sufficient time, resources and human beings to implement #2, below
2. Universal testing, contact tracing and mandatory quarantines of all infected people and their contacts. This is the only way to significantly reduce the chances that infected people don't show up at schools and work and infect others. But to do this, we'd need 20 million tests per day, and we're currently only at 150,000.

So far, there has been no serious attempt to achieve either of these goals. California is certainly flattening the curve, but we're still seeing over 1000 new cases a day. We're definitely not yet on a downward trajectory. Consequently, there's no way it'll be safe to go back to work or school in July or August.

The current proposals to "safely" reopen the schools are pathetic and absurd, and FAR FROM SAFE. Indeed, even Anthony Fauci has said that massive testing, contact tracing and quarantining will only help ensure the second wave is LESS DEADLY. Not risk-free. There will still be a second wave. There will still be more infections and death.

People are talking about blended learning systems with 10 kids per class, so that social distancing can be continued at school, and continued online learning for the 2-3 days per week students aren't in school. But why not stick with SIP and online learning for everyone, every day? Logistically, it's much easier and it's obviously safer.

More importantly, the 10 kids per class proposal is predicated on the assumption that the disease spreads entirely through droplets and that 6 feet distancing is sufficient protection. But we know the virus aerosolizes and remains viable in the air for up to 3 hours. So, even after an infected student or teacher leaves the room, and there is no one to stay 6 feet away from, the germs are still present and could still infect students and teachers in that room for the next few hours. 

Also, what about desks, doorknobs and lab benches? Who is going to disinfect them? Are custodians going to clean each classroom between every class period? And what about K-5 students? Are they going to suddenly behave with the maturity and punctiliousness of doctors with respect to washing their hands and not touching people's faces?

Administrators and politicians will be able to hide in their offices and make video announcements. Teachers will be forced to spend hours inside of potentially infected rooms. They will not be given N95 masks because there aren't any to give. Probably the same with gloves. And even if they did, these PPE are designed for brief interactions in uncrowded conditions and to be replaced often with clean, uncontaminated ones. And what about shoes and clothes? Are teachers going to have to "suit up" in special work clothes before they get out of their cars and then decontaminate before getting into them again at the end of the day?

Also discussed in some of the planning phases has been how school districts can avoid liability. This implies that they know full well they are forcing students and employees into a dangerous, potentially deadly environment. They should not be allowed to do this and certainly not without any accountability. If children are going to become orphans because their parents were forced to work in unsafe conditions, then the employer should be held liable.

Speaking of compensation, what about sick leave? If teachers or classified staff catch covid-19, they could be out for more than 2 weeks, much longer than the amount of paid sick leave most school employees are given. And what about other leave, like staying home to care for sick family members? Are school districts going to increase the amount of paid sick leave provided to their employees, or are they going to be jettisoned, like so many other workers, and left without income when sickened with covid-19?

And what about work hours? If teachers have to teach both in person and online, if they lengthen the work day or the school year to compensate for the reduced in-person learning, are they going to double or triple teachers' pay to compensate for all the extra work? Many districts are laying teachers off because of lost revenues. Where's the money going to come from to pay teachers more? 

Even if they paid teachers double to work year round, this would not be desirable. Summers are when teachers develop their curriculum for the following year, something that will be even more urgent and critical if schools reopen before the pandemic is truly over. Teachers need time to reconfigure their curriculum and develop new curriculum compatible with these new conditions.

And what about teachers' own children? If all the schools move to a blended learning model where students attend classes in person for 1-2 days per week and do online learning at home the rest of the time, who will look after teachers' children when they have to go into work? Many teachers have children who are too young to leave at home, unsupervised. Are they going to force teachers to subordinate their own children's health, safety and education to those of their students, by placing them in overcrowded childcare settings at public libraries and recreation centers, or bringing them to work with them? 

It's complete madness to be talking about reopening schools under these conditions. The only sane option is to continue with distance learning until the pandemic truly ends. Education is one of the few industries that can be done remotely. It's not ideal. Learning in a live classroom is far superior, as children benefit from the social interactions and there are countless important learning opportunities that cannot be replicated as effectively or efficiently remotely (e.g., labs).  But children are a major vector driving this pandemic, spreading it to older people with underlying health conditions. Sending children back to school too soon risks turning them into orphans, as they spread the disease to older family members.

Politico says the CTA opposes a July reopening, and that both the NEA & AFT would authorize strikes if teachers were sent back before it was safe. Problem is, there is phenomenal pressure on unions, politicians and even the health experts to get everyone back to school and work, and to say whatever they have to convince us it's safe. It would be naive to trust that the unions will continue to oppose July or August starts.

This whole thing is a terrible tragedy. Frankly, it scares the hell out of me and I see no quick way out of it. But as terrible as it is now, both in terms of deaths and economic and social hardship, this is truly just the beginning. It is likely to get far worse, even if California continues with the SIP. Too many other states have already "reopened." Infections and deaths are going to go up in those states. And in fall, when influenza picks up again, the deaths and economic problems will worsen further, possibly to the point of mass food shortages and even starvation, if too many people in the food industry get sick (as we have already seen on a small scale at Tyson, JBS and Smithfield).

Keeping the schools closed is not just about protecting students, teachers, and their families. It is a necessary tool for protecting all of us. 

Covid Tests Now Available for Healthy SF Residents, But the Results Could be Meaningless

San Francisco-based One Medical is now offering coronavirus tests to anyone without symptoms. While this is step in the direction of universal testing, a prerequisite for relaxing the shelter-in-place, the test results could be meaningless without (1) repeated testing; (2) contact tracing; and (3) mandatory quarantines for those infected and their contacts. Also, One Medical is not offering the test for free, which should be a prerequisite before the shelter-in-place restrictions is relaxed. They claim they will bill your insurance company, assuming you have one.

One reason why a single test is meaningless is that a person's viral load varies over time. During the first few days after exposure, the viral load could be undetectable, even with a test. Hence, a person who runs off for a test immediately after coming into contact with an infected individual might get a negative result, but a few days later start showing symptoms. In those days when they thought they were corona-free, they could have gone out and exposed vulnerable people, family members, colleagues.

2nd, when they do open the economy back up, every time we go into public, whether it's work or school or shopping or religious or social events, we will risk coming into contact with infected individuals. So, until the pandemic has truly died out or we have developed an effective vaccine or treatment, universal testing, contact tracing and quarantines will need to continue and be repeated regularly. Indeed, perhaps the least risky approach is to develop a 5-10 minute test that is administered at the entrance of every facility that is open and operating and require a negative result before anyone is let in.

Should you go and get a test? I don't see the benefit, unless you think you might have been infected recently, or you are a front line worker where the risk of exposure was high, or you are worried about infecting your clients. The rest of us in the Bay Area have supposedly been staying home, staying at least six feet away from others on our walks, and wearing masks in grocery stores. So, our risk of infection should be extremely low.

61% of Covid-19 Infections in S.F. are People Under 50

61% of Covid-19 infections in San Francisco are in people under the age of 50 (Graphic and more data available from the SF Dep of Public Health)

Staying Home is a Luxury--Coronavirus Disproportionately Kills the Poor

Family scavenging for food in Paraguay

The New York Times reported yesterday that Staying Home Was A Luxury.

Well. . . duh. Who would've thought otherwise? 

Poor and working class folks are much more likely than wealthier folks to work in essential industries, like food production and distribution; shipping and delivery services; public transit and utilities; even a large segment of the healthcare industry. They cannot stay home. And their kids are more likely to be continuing to attend crowded day care to allow them to continue working.

The poor and working class, especially those who've lost their jobs, have to stand in long, crowded lines to get food from food banks and pantries. The desperately poor and hungry, like the family in the photo above, must brave crowds to get food from whatever sources they can. The homeless are being infected at crowded shelters, even in liberal cities like San Francisco, which has commandeered thousands of hotel rooms for the unhoused residents, but has been slow in getting them into the units. In many cities, like Las Vegas, which has 30,000 unoccupied hotel rooms, they are continuing to force unhoused folks to continue living in the streets and parks.

However, the worst outcomes for the poor will likely be seen in the poorest countries of the global south, where malnutrition is high, and access to clean water and medical care is very low.

Anyone with a computer and internet can check out the real time data on social distancing themselves, on Google's new Covid-19 Mobility Tracker. Check out the comparisons below:

Here was see California, with the 5th richest population in the U.S., with significantly more compliance with the stay at home orders, than Alabama, the 7th poorest. And below, I've compared California's wealthiest County, Santa Clara, with its poorest, Lake County. (Santa Clara County, until very recently, was the epicenter of California's outbreak, until Los Angeles surpassed it. Perhaps their compliance with the social distancing policies are having the desired effects???)

Is the Curve Flattening in San Francisco?

Is the Curve Flattening in San Francisco? Considering how early we started the shelter-in-place in the SF Bay Area, one would think we would have a slower transmission rate than other regions. Let's look at the recent data:

Yesterday, 3/30, there were 34 new cases of Covid-19, for a total of 374 (See graphs below).

Day before yesterday, 3/29, there were 32 new cases, for a total of 340.

Day before that, 3/28, there were 29 new cases, for a total of 308.

Day before that, 3/27, there were 56 new cases, for a total of 279.

Day before that, 3/26, there were 45 new cases, for a total of 223.

We were doubling every 3-4 days up until March 27, when we saw our highest number of new infections (56). But since then, we’ve had 3 days in a row with closer to 30 new infections per day.

So, have we really flattened the curve? Will this trend hold? Time will tell. One thing to consider is the large number of recent infections at Laguna Honda skilled nursing center. Another thing to consider is that California, as a whole, has done very little testing, and still has 50,000 or so tests pending results. Once those results come in, the total number of cases could skyrocket. One last thing to consider: Santa Clara County, just south of SF, had a spike of 200 new cases between 3/29 and 3/30. Their curve is definitely not flattening, and infections could spill over into SF in the coming weeks.