Cases declining in Tampa area but concerns that state interventions in local school reopening decisions could trigger spike if prevalence still high

August 13, 2020 - August is the first month of the local outbreak (defined as > 1/100K cases) in which Tampa has seen a decrease in average number of new cases month over month (March 1.5/100K, April 2/100K, May 2.5/100K, June 20.4/100K, July 42.3/100K, and August 24.3/100K), the lowest 7 day rolling average (8/5-8/11 = 22.4/100K) since mid-June (6/17-6/23 = 21.9/100K) and positivity has dropped to less than 10% (9.4%) for the first time since May 2020 (May 20-26, 7.4%) while the growth rate of new cases has also decelerated rapidly.

This is a tenuous time though - with new cases still in the 20/100K range, that is still over 20Xs higher than when schools closed in Hillsborough County in March. In June, a small number of super spreader events (a bar, a graduation party and a closed box cross-fit gym) led to a rapid acceleration of cases, a surge in hospitalizations that threatened local capacity and a lagging increase in deaths that is now being realized.

On August 6, at an emergency school board meeting, board members listened to medical experts who unanimously stated that brick and mortar school reopening on 8/24/20 would be unsafe for Hillsborough County. However, on August 7, Department of Education Commissioner Corcoran stated that the board did not have the power to make this decision under the emergency order from the Governor's office that mandates face to face reopening options by 8/31 in all districts that that have moved past Phase 1 reopening guidelines.

On August 13, The Hillsborough County Schools Superintendent returned from conversations with state education officials and delivered news that the state was moving forward with their requirement that schools in Florida reopen to full face to face options by 8/31 or risk an actual decrease in funding (estimated at $23 million dollars for the School District of Hillsborough County) that had been previously threatened.

Attempting to follow the board orders after a 5-2 vote delaying implementation of his choice plan on 8/6, the Superintendent opted for implementation of his initial reopening plan on 8/31, still allowing a week delay in return to face to face learning but also succumbing to the demands of Commissioner Corcoran. Whether the state has the legal authority to operationalize their emergency order to reopen or not is still in question and, previously, Hillsborough County School District Attorney (Jim Porter) has suggested that the state did not have the ability to direct a reopening date.  

Legality and politics are often separate and the ability to move funds or to cripple local leaders through asymmetric power flexing sometimes is not codified into state constitutions or other legal document but instead exists within the cognitive and social spaces of human culture.  

Complicating matters more is the actual language of the Emergency Order filed by Commissioner Corcoran on 7/6/20. The executive order states that schools should reopen by 8/31/20 UNLESS advised differently by local health officials. At both the school board meeting on 7/7/20 and 7/28/20, multiple physicians spoke during public comments expressing concerns about a lack of a data driven reopening plan and continued high positivity (>15% at the time) and daily case numbers (>30/100K at the time). This culminated in the 8/6/20 board meeting in which the Dean of the Morsani College of Medicine and Vice President of USF along with the lead hospital epidemiologist and infectious disease doctor for USF/TGH and the Chair of pediatrics at USF were all joined by a community pediatric endocrinologist representing the group of physicians that spoke during previous public comments as well as the medical director for the Hillsborough County Health Department. School Board member Tamara Shamburger directly asked each of the physician local health experts if schools should reopen on 8/24 for full face to face learning and each physician local health expert said no, except for the medical director of the Department of Health who stated that his role was to present data that would facilitate decisions.  

The physicians were unanimous in their recommendation that positivity should be < 5% to return to Face to Face learning. Later, reports were published that Department of Health employees, including the medical director for the department of health, had been told not to give advice to the local school boards, creating a catch-22 to the emergency order issued from the Governor’s office but also begging the question as to whether the panel of other physicians did adequately capture the definition of a local health expert outlined in the emergency order language. The school board and Superintendent Addison Davis ensured that they had every local medical expert on Covid-19 weigh in and all of these experts (including myself) stated that, at the time of the 8/6 meeting, cases were still too high for an 8/24 return.

This is important to understand to avoid any appearance of false equivalency between rogue or other physician voices – the team that was assembled to weigh in on school reopening is the team that has advised counties and hospitals and is closest to the data and to the patients in this community. The direction by the federal government (President Trump issued a tweet on 8/3 stating “OPEN THE SCHOOLS!!!”) to the state is now being forced on to the local school board in a way that sidesteps medical experts and forces political will.  

The surrounding legal issues of these decisions have not been overlooked by the Florida Education Association which filed suit against the state on July 21, 2020. Contested by the FEA, a lawsuit has moved from a higher positivity, more profoundly hit area (Miami-Dade) to a less impacted, lower positivity area (Tallahassee) but is set for procedural motions and initiation of an eventual decision on 8/14/20, potentially in time to effect the planned 8/31/20 emergency order mandated opening of physical classrooms. The FEA is not the only organization representing teachers. The Pasco County union has also filed suit to halt forced return to physical classrooms.  

Disagreements between local school districts, even in alliance with Superintendents, and the state are occurring across the country, even in other high prevalence areas (>25/100K/day). Predictably, schools that have attempted to return to full face to face learning have failed in those efforts in Georgia, Mississippi, and Indiana where students have been quarantined (over 2,000 in Georgia) and classrooms have been quickly closed after attempting to reopen. I posted last week that, utilizing the Georgia Tech/NYTimes calculator, approximately 6 individuals would be expected to arrive at Hillsborough County schools on day 1 with infection. Dean Lockwood, USF, estimated this number might be 4 individuals (a lower estimate than the calculator) but likely in line with current estimates as cases/100K have decreased and are on a downward trajectory as of 8/13/20.

The recognition that multiple students/staff across multiple schools at one time would have infections tilted School Board Member Hahn to vote for a delay in reopening at the 8/6/20 school board meeting and this likelihood remains a looming and important consideration especially in light of the opening/closing difficulties being observed in other states. Teachers returned to classrooms on 7/31 and the district has already begun sending out notifications of infections at schools across the district. The exposure, optics and impacts of those district letters notifying staff and parents of a positive test will be significantly magnified when students are also present in the classroom.

Important to note here, while everyone from the CDC, American Academy of Pediatrics and the local physicians and health experts all agree that face to face learning is preferred, all of those organizations and individuals also agree that face to face learning and virus transmission mitigation can only be done when prevalence is low and incidence is decreasing to a level in which public health intervention strategies can be effective.  

A data driven return to school model might be more in line with a specific return to school date. The delay in implementing Superintendent Davis’ plan in Hillsborough County would have allowed review of data on 9/8/20 with potential return on 9/24/20, instead of locking out students for an arbitrary period or allowing a deferment to occur past an arbitrary period. To that point, currently in Hillsborough County, the overall epidemiology of Covid-19 has trended in a hopeful direction since the beginning of July. A

Overall, the concern is that a single super spreader event (e.g. school reopening) could quickly shift trend directions, rapidly accelerating the incidence rate as well as the lack of ability to fully engage in contact tracing or viral transmission mitigation at positivity > 5% or incidence > 10/100K.   

Finally, there is national nervousness and uncertainty again around the national message from President Trump and the coronavirus task force as Dr. Anthony Fauci and Dr. Deborah Birx have seemingly taken a minimized role and backset to new task force advisor, Dr. Scott Atlas, a radiologist who, while advising Senator Romney during his presidential run also criticized his economically and medically successful Massachusetts health care plan.  

REFERENCES

July 7 SDHC Meeting https://schoolboard.hcpswebcasts.com/html/meetings/hcsb2020-07-07.html  

July 28 SDHC Meeting https://schoolboard.hcpswebcasts.com/html/meetings/hcsb2020-07-28.html ‘ 

August 6 08/06/2020 - Special Called Board Meeting 

https://www.usatoday.com/story/news/nation/2020/08/07/florida-health-directors-told-not-give-schools-advice-reopening/3317014001/ 

FEA Lawsuit https://floridapolitics.com/archives/357792-judge-moving-quickly-on-school-reopening-fight 

Pasco County Teacher Union Lawsuit https://www.tampabay.com/news/education/2020/08/12/pasco-school-employees-union-sues-to-keep-classrooms-closed/ 

Georgia Quarantine https://www.cnn.com/2020/08/13/us/schools-quarantined-coronavirus/index.html 

Scott Atlas https://www.forbes.com/sites/mattperez/2020/08/12/who-is-dr-scott-atlas-trumps-new-covid-health-adviser-seen-as-counter-to-fauci-and-birx/#6bfc696920a4