Coronavirus Strategy Guide: <em>Schools as a disease vector</em>

July 27, 2020 RSG

IN OUR VIEW

The United States is entering perhaps the scariest part of the infection wave, with dozens of "little" outbreaks around the country that will each face a similar experience to New York City. In the next few weeks, health systems in many states and hot spot regions will break down. States will be under extreme pressure to reenter lockdowns as hospitals become overrun, while they bring field hospitals online that they prematurely removed.

Studies show that cutting non-essential activity by half may reduce the spread of COVID-19 by 45%. Decreasing non-essential activities by 75% would reduce transmission by 60%. Reduced activity alone will not be enough to contain the virus; however, communities still require near-universal mask compliance to end the pandemic. Pro-mask messaging from Republicans will be necessary to achieve those rates, and there is no evidence yet of a large-scale coordinated PR effort indicative of a serious attempt to corral supporters.

History suggests that the pandemic run amok can cause death knells for nation-states, which lose total legitimacy when they're unable to protect their citizenry. There is also a disconnect between the reality of the mostly-peaceful protests and police reactions. Over 70% of Americans report agreeing with the protestors. Continued over-hostility to protestors will push suburban moderates over-the-edge, squarely into the camp of progressive Democrats for a generation or more.

All this adds up to a perfect storm for the United States, which will face the proverbial hammer-drop around the same time that debt bubbles finally burst, the occurrence of which the Federal Reserve delayed with its initial steps to prop up the stock market. The Trump Administration will likely go to extraordinary lengths to keep the stock and bond markets afloat because Trump views that economic indicator to be his ultimate reelection test.

Making things worse, it appears that antibody resistance from a traditional COVID infection may only last for a few months, suggesting that—like the seasonal flu—coronavirus may never go away. On the other hand, many tests currently available to Americans are less-than optimally accurate or 'sensitive' in detecting for the presence of antibodies. While the viral PCR (nasal swab) test determines whether the virus is present in the body, antibody assays are mostly "yes-or-no" tests that often do not detect the presence of antibodies in enough quantities to measure until long after active infection. So, people may remain immune for longer—just that the concentrations of antibodies remaining are undetectable on the test. The frustrating inconclusion means that the scale of the epidemic is still challenging to predict. Long-term immunity will have a better outcome than short-term resistance, which could see recurring bouts of the disease regardless of who is President.

The pandemic will be in a deadlier posture come late September as colder temperatures spread over the country, forcing many schools to abandon reopening plans, if they have not already done so. For many engaged in unrelenting political debates over a return-to-the-classroom strategy, there likely will come the point in time when all the risk-assessing and all the mitigation efforts will be inadequate defenses against worsening community spread of COVID-19 throughout the land and in the schools.

PROGRESS TOWARD VACCINES

Pharmaceutical giant Pfizer and a German company, BioNTech announced they had reached a $1.95 billion deal with the U.S. government for 50 million doses of a COVID-19 vaccine — assuming it works. The new type of vaccine has shown promise in early trials, and it could enter late-stage trials this month.

If successful, Pfizer and BioNTech say, they expect to seek Emergency Use Authorization (or some form of regulatory approval) as early as October 2020. The deal is the federal government's largest Covid-19 vaccine contract to date, and the price of $19.50 per dose (or $39 per two-dose course), was higher than some analysts expected.

The vaccine is one of more than 150 currently in development around the world. Last Monday, two leading vaccine candidates published their peer-reviewed results in The Lancet. One vaccine candidate was developed in China, the other by a team based at Oxford University in the U.K. Last week, the American company, Moderna, published findings from an early-stage trial suggesting that its experimental vaccine may be useful in generating an immune response against SARS-CoV-2.

The implications of these developments are dividing experts, with many stressing how difficult it is to bring a safe, effective vaccine to market — not to mention ethical, logistical challenges of distributing millions of doses.

The pandemic has also brought sudden public attention to the cumbersome and highly technical process of finding a vaccine. Critics accuse some research teams of downplaying potentially harmful side effects, and of frantically rushing to announce their results in marketing press releases before submitting their scientific findings to peer review.

Still, most experts remain cautiously optimistic:

"Realistically, it is going to be the first part of next year before we start seeing people getting vaccinated, but we're making progress."

—Michael Ryan, WHO Emergencies Program Director

INOCULATING AGAINST MISINFORMATION

Any of the vaccines in development now will be subjected to rigorous, multi-phase testing involving thousands of subjects in a randomized controlled environment. And, a safe and effective vaccine will take time to manufacture in enough quantities for the world's population to bring the coronavirus entirely under control. Yet a worrisome issue will loom: the willingness to accept any vaccine.

People genuinely question the safety of a vaccine developed on an expedited timeline; an issue that has been raised even by ardent supporters of one for COVID-19. We know there is a certain percentage of the population that likely will remain resistant to becoming vaccinated against a virus that will have killed hundreds-of-thousands of people in the U.S. alone.

The anti-vaccine movement has been linked historically to affluence. Now, there appears to be an odd alliance being expressed by those who consider themselves politically progressive — often who embrace a more naturalistic approach to health — and conservatives that inherently distrust government while touting individual liberty. There can be no assumption that Americans will take a COVID-19 vaccine once it is developed. In short, no vaccine can be useful if any sizable percentage of individuals refuse to accept it.

A recent Washington Post/ABC News poll revealed 7 out of 10 Americans would get a coronavirus vaccine. But 27% say they would "probably not" or "definitely" not agree to be vaccinated. That's a troubling percentage, and one that, if not reduced significantly, won't result in a nationwide 'flattening' of COVID-19 cases.

SCHOOL (ALARM) BELLS ARE RINGING

The long-delayed CDC guidance on school re-openings is unscientific, dangerous, and wrong. It indicates that President Trump succeeded in politicizing the recommendations of the CDC. This move is in-line with others that undermine the validity of U.S. data, including long-delays in test results. The U.S. is covering up official numbers and guidance, placing it on a clear trajectory for a worst-case scenario, in-line with other authoritarian countries like Brazil.

Why is it dangerous to reopen schools?

In addition to the fact that immune-compromised children, teachers, and staff exist, many children go home to multi-generational households. Sending children back to school will turn schools into disease transmission vectors that infect entire households and communities. Impacts will be most severe in households with grandparents or elderly individuals, which includes many families in minority and low-income communities.

RSG suspects that the CDC and White House realize this, and that is why the White House blocked the CDC from testifying on reopening schools, saying,

"Dr. Redfield has testified on the Hill at least four times over the last three months. We need our doctors focused on the pandemic response."

DON'T CHILDREN HAVE BETTER OUTCOMES?

The data suggest outcomes can vary wildly by age group, with as many as 25% of all coronavirus victims experiencing long-term symptoms. Another trend that commentators misinterpret from data is that children seem not to get coronavirus in equal numbers to adults. This interpretation is wrong.

Another explanation holds that children under 10 are simply more compliant than children 10-19, who face infection rates in the same numbers as adults. So, they listen when parents tell them to avoid contact with people outside the household. Children under ten also usually cannot get to most places without adult supervision, limiting their likelihood of contracting or spreading COVID in the first place.

This analysis also explains why children age 10-19 contract and spread COVID at the same rates as adults. Children in those age-cohorts are typically less-compliant than their younger cohorts. They're also newly sexually active, making it difficult to limit their activities and contact outside the home.

Under this analysis, placing children under ten in an indoor environment where it is impossible to comply with best-health-practices will guarantee rapid, community spread of the virus in schools and homes.

Teachers' unions are suing school districts across the country, and threatening a nationwide strike to prevent them from reopening. They warn that other challenges with reopening schools include:

SUBSTITUTE TEACHER SHORTAGE

The nation was experiencing a substitute teacher shortage before COVID-19 even existed. Requirements vary across states and localities, but in many places, a substitute only needs to be 18, have a high school diploma, and pass a criminal background check. Many teachers are unable or unwilling to return to work. All teachers will need to quarantine for a minimum of 14 days when they are inevitably exposed. In many schools, if a teacher is out without a substitute, the standard protocol is to split the class up for the day and put them in another teacher's room—an impossible task while still maintaining social distancing and reduced class-size guidelines.

Many substitute teachers will be unwilling to take jobs because the default assumption will be that the teacher, and thus all their students, were exposed to COVID-19. Other schools will have teachers give up planning time and take turns covering a class, increasing the potential chain of exposure. In some situations, the support staff cover classes. Those staff members will need to plan and work as teachers while getting paid less than they deserve and facing all the same health risks.

FUNDING

The virus has placed schools in an economically impossible situation. The CARES Act provided only a small amount of funding compared to the massive strain that reopening during a pandemic requires. Schools have already invested in PPE and cleaning supplies, which are likely to be in scarce supply in the coming months. Many school districts will resort to hiring unqualified employees, increasing necessary (if neglected) investments in Professional Development. Schools also need to cover the cost of internet access for some students to close the "homework gap."

MENTAL HEALTH

COVID-19 has caused an increase in trauma for students. There is a lack of adequately trained mental health professionals in schools. Schools need to hire more mental health workers to meet this demand. Schools also need to invest in training for teachers, support staff, and administrators to identify students who require services, whether learning takes place in person or online.

AMERICA'S SCHOOLS: A MORAL, MEDICAL CATASTROPHE

Pulitzer-prize-winning scientist and biotechnology writer and author, Laurie Garrett, writes in the July 24 issue of Foreign Policy magazine that we are headed down a dangerous path for this country's planned reopening of many schools.

Garrett is one of the most widely respected science journalists, and her predictive insights on the coronavirus pandemic have been almost without error. Garret writes that when Donald Trump demanded last week that schools nationwide reopen this fall, regardless of the status of their community's COVID-19 epidemic status, Secretary of Education Betsy DeVos announced no policy for reopening whatsoever. Her feckless approach, Garrett wrote, was that school districts necessarily would need to develop independent schemes for a safe reopening — threatening to cut off federal funding for those districts and schools that did not.

"This is nothing short of moral bankruptcy. The Trump administration is effectively demanding schools bend will, without a hint of expert guidance on how to do it safely, much less the necessary financing." — Laurie Garrett

Garrett reminds us that since the pandemic began to spread in earnest across the U.S., it has amplified "the nation's unresolved problems and poor leadership." She writes that any hope at controlling the coronavirus nationwide will require an unprecedented commitment from every arm of the government to ensure the continued education of America's youth.

MAKING PUBLIC TRANSIT SAFE

Finally, some good news in the coronavirus fight and the economy, research shows that transit can be safe with universal mask-wearing and rigorous cleaning. For those reasons, buses are the best option because it's easiest to clean and control access. Permanent bike lanes are another COVID-friendly infrastructure upgrade that will keep cars off the road.

Coronavirus presents an opportunity to reset public transportation since it will take years to rebuild transit agency budgets, which were already still reeling from the long-term impacts of the 2008 housing crisis.

Learning from the example of Europe, trains are more useful when they are affordable and ubiquitous. Europe is currently limiting theirs to essential workers only. Large metropolitan areas with train systems can combine best-practices, enforcement, and the European framework to resume safer service.

LESSON LEARNED—TRUST: THE SYSTEM

The Economist warned readers that bad government and climate emergencies are the biggest risks to containing the spread of COVID-19. Globally, despotic countries, including the U.S., are failing to contain coronavirus compared to healthy democracies.

International watchers hoping to gain insight into better ways to fight the virus consider South Korea to have the best mitigation strategy, due to the lessons it learned fighting the SARS outbreak in 2015. When the pandemic overran Asia, South Korea dusted off its TRUST framework, its rehearsed epidemic containment strategy.

T = Transparency
R = Robust screening and quarantines
U = Universal and widespread testing
S = Strict Control
T = Treatment

Transparency is fundamental to containing a pandemic because it clarifies the chain-of-command and makes it easier to scale PPE procurement efforts.

CONCLUSION

The numbers continue to stagger us. Confirmed cases worldwide topped 16 million Sunday, according to a tally by Johns Hopkins University. The U.S. leads the count with 4.23 million cases and 147,000 deaths.

Florida surpassed New York on Sunday to become the state with the second-highest number of coronavirus cases, with more than 9,000 new cases pushing Florida's case count close to 424,000. California currently has the most cases in the U.S. with more than 455,000.

As if surging cases in so many of the country's largest states and cities weren't bad enough, politicos expect the Trump administration and Senate Republicans to roll out a $1 trillion virus aid plan Monday after a $600 federal unemployment benefit expires Friday. Democrats say it isn't enough by far. Talks within the party had unraveled last week as the White House and GOP Senators were at odds over various items, including how to cutback the jobless benefit without entirely doing away with it.

As August approaches, there is little good news related to battling the pandemic — medically and economically. The next several weeks may be the most decisive in a multi-year effort in restoring normalcy as we once knew it — or at least a reasonable facsimile of what Americans so casually took for granted for so long.

Resolute Strategies Group