TO SCHOOL OR NOT TO SCHOOL-- THAT IS THE QUESTION

The Dangers of Over-Thinking the Decision to Open Public Schools to On-Campus Learning

As a parent of seven children and having been raised in a household with an educator, I completely understand the importance of face-to-face interaction between teachers and students.  The connection between teacher and student is the glue that often shapes the framework for healthy growth and development of children and adolescents.

All of us have stories about those special teachers that helped us 'become' the people that we are today.  Similarly, teachers have their own personal testimonies of the joy they experienced when witnessing the fruits of this labor of love called teaching.  

If we were to conduct a straw poll of educators globally, I am confident that the vast majority of them would collectively attest that they did not get into education to teach students virtually.

Even as a youth soccer coach I know first-hand that there is no true substitute for on-site and in-person dialogue and communication.

As a frontline physician, however, if I measure what I know about the value of in-person teaching against what I know about the devastating ongoing impact of this virus for which there is no cure or vaccine, I cannot envision any scenario, at least in the public school environment, where re-opening schools to in-person, on-campus learning is going to be successful.

I believe that these re-opening plans and intentions are honorable and admirable, but the road to destruction is paved with the best of intentions-- particularly when they are fueled by emotion and not grounded in logic or fact.

The present state of public health affairs in this country with respect to this pandemic makes it clear, at least to me and many others who are paying attention, that there is no scientifically-validated, practical or logistical way to bring in-building, brick-and-mortar teaching back… at least NOT yet.  

For the sake of this conversation, we will shift focus away from dysfunctional leadership at every level of government, partisan decision-making that is killing Americans to the tune of over 1000 each day, entitlement-driven decision-making on the part of many within the citizenry and policy that is being shaped by money and not science.  Instead, we will focus keenly on the data and how/why it should shape our decision-making with respect to the coming public school year.

Notwithstanding the disturbing yet compelling data recently published about the spread of the novel coronavirus through a Georgia summer camp, here are the facts, using six vetted metrics, which if met, would at least provide support for the possibility of re-opening schools with on-site, in-building teaching.

Metric 1– Percentage of Positive Cases Below 5% of Tests (WHO)— this datapoint represents the the total percentage of positive tests among those tested and not the percentage of positive tests among the general population.  Currently most major cities in the United States are FAILING in this metric, suggesting that there are considerably more positive cases within the community.

Metric 2– Regular-Interval (weekly) Decrease In New Cases (CDC)
— this measure is an indirect function of the current success or failure with respect to measures intended to reduce community spread such as social distancing, limiting group gatherings, face cioverings, hand washing and other hygiene measures.  Currently most major cities in the United States are FAILING this metric, suggesting that these measures are not being diligently or consistently practiced.

Metric 3– New Cases Below Threshold of 10:100,000 Population (CDC)— this metric provides epidemiologic data demonstrating the clear shift from older to younger patients.  It is no surprise that cases began to spike after taking a sequestered group of 18-30 year-olds and granting them virtually unrestricted access to beaches, bars, restaurants, and other places of large social gathering.  Currently most major cities in the United States are FAILING this metric, suggesting that the 'Re-Opening of America" was too much, too soon.  

Metric 4– R(infectivity rate) Below 1.0 (CDC)— this measure is again closely tied to community-based mitigation strategies.  This number depicts the number of individuals that an infected individual is believed to be able to infect.  Case spikes and surges are indicative of increased infecti vity rates.  In  other words, the more strategies to reduce spread fail, the higher this number will climb.  There is no doubt that prematurely opening school campuses to in-person learning will increase the infectivity rate-- not only on-campus, but in the communities where the students, faculty, administrators and staff reside.  Currently most major cities in the United States are FAILING this metric with rates around 1.2-1.4, suggesting that when schools re-open the brick-and-mortar campus, an already sub-optimal infectivity rate will increase.

Metric 5– Decrease in Total Hospitalizations (CDC)— the math is simple... more infected individuals, means more individuals requiring hospitalization and critical care.  It is illogical to suggest that community spread has been mitigated to the point where schools could or should re-open, when the number of hospitalizations in so many locations continues to be beyond the threshold to suggest adequate mitigation and containment.   And as we now move to this 'new ophase' described by the White House COVID-19 point-person, where community spread is now exploding within smaller cities, towns and rural locations, we can only expect to see the number of hospitalizations further increase.  Currently most major cities in the United States are FAILING this metric, suggesting that we are nowhere near being ready to resume on-campus learning.

Metric 6– Decrease in Total Deaths (CDC)— with the spike in cases comes the proportional and expected spike in deaths-- though it often lags behind the spike in cases by several weeks.  Currently most major cities in the United States are FAILING this metric

The DIsparity 'Elephant' In The Room- from the very beginning of this pandemic experience in the United States, people of color and people of poverty have been disproportionately impacted by this virus.  Hospitalization rates and death rates are significantly higher in communities of poverty and disenfranchisement.  In many communities, access to testing is similarly disturbing and consistently lacking.  Within the context of public school education, the schools in these communities are at even greater risk than the already high risk in the general population.  The COVID-19 pandemic has magnified the impact of health equity and social determinants of health and there is no doubt that these factors will produce a negative ripple effect within these high-risk communities.  It is understandable that there is concern regarding the education of students in these communities due to limited access to technology and the logistical challenges of supervised education in household with parents whose jobs do not permit working from home, however, opening school campuses too soon, will jeopardize community health and ultimately compound the problem.

What About The Teachers? in the effort to return to in-person, on-campus learning, it appears that m,any of our public school teching work force have been similarly placed in harm's way.  As teachers are the on-campus rate-limiter, meaning that classes cannot proceed without their mission-essential expertise, teachers will be exposed to every student.  Students may alternatively move between 'virtual' and 'live' teaching environments, but teachers will not have this luxury.  And because educators are the rate-limiters, what will happen within our schools districts, where many are already facing a shortage of quality teachers, when the teaching work force is depleted because of exposure, infection, quarantine and hospitalization.  The loss of teachers due to illness on a large scale will cripple school districts and grind all teaching to a halt.

Add to this sobering but true data the fact that there is still not adequate community-based testing, no framework for timely test-resulting, no reliable “surge capacity“ mechanism for contact-tracing once school-based cases begin to accumulate, and no vaccine; there is no evidence-based reason to open school campuses to in-person learning.

No surplus of masks and other personal-protective equipment or amount of custodial diligence, disinfecting and decontaminating of the physical space justifies bringing thousands of individuals back together in closed, indoor spaces.  

The logistics of having families self-monitor and report symptoms, students waiting for the bus, riding the bus, consistently distancing themselves on the bus and in the building, washing their hands, consistently and properly wearing masks, eating their meals and traveling the halls-- all in indoor spaces-- is a recipe for disaster.

If the data from these metrics represented a report card for any one of the students in any of these schools, it would raise questions regarding teaching methods and thought-process, yet despite this overwhelming data, many school districts are still intent on getting back to on-campus education.  

The schools are not failing, but the infrastructure that is necessary to support and sustain the mission of the schools is failing.  Pressing forward with any plan to resume in-person learning in the next several weeks is flawed and doomed to fail miserably-- at the expense of our children and the dedicated educators that have been given stewardship over the education and wellness.

Remember we are still reeling from the impact of the first wave of this pandemic-- a wave that may have crested, but has not yet completely dissipated.

The second wave is on the horizon, and like a tsunami, even though we know it is coming, it is inevitable and unfortunately unstoppable.

Schools that are planning to return to on-campus learning before the first of the year, will inevitably have to re-close, which will pose yet another logistical layer of complexity.

I do not pretend to know what the answers are, I simply suggest that the data simply do not support what many have adopted as their plan for the coming school year.

The game-changers will include rapid, free, point-of-care testing, continued bolstering of the public health infrastructure to further re-fine contact tracing, and a safe, free and widely-distributable vaccine.

I am in no way implying malicious intent on the part of school districts, but unfortunately SARS-CoV-2 doesn't 'care' about the motivation.  The virus is on the constant prowl for vectors for infection, and open school buildings will provide this insidious culprit with everything that it needs to survive and flourish.

Reverend Christopher T Conti, MD is the Pastor of Emmanuel Pittsburgh and a licensed emergency medicine physician, author, community advocate and Christian Life Coach