Putting COVID school closings, and masking in perspective…

It seems as though everyone is using the #lockdowns, school closings, social distancing, and particularly mandatory #masking as a punching bag these days. The talking heads have decided that all of this was unnecessary from the get-go and it has created irreparable damage to our children and economy. So much so that the authorities that authorized these policies should be publicly flogged and executed.

We don’t know what we don’t know…

At the risk of going against the tide, and with all due respect, I would like to suggest that these actions may have saved many lives - perhaps hundreds of thousands of them.

OK, I can see the finger pointers immediately responding with “You don’t know that!” True. I don’t. I never said that lockdowns saved over 100,000+ lives, I said that they may have. Therein lies the difference between me and finger-pointers. They have been throwing around accusations of “police state” policies while claiming (or at least implying) that we now know it was all unnecessary. This is nothing less than promoting a “let it rip” policy while willfully dismissing the potential consequences of this inaction. Further, apart from creating a time machine to alter these detrimental policies, there is no way to prove whether these finger-pointers are right or wrong. This leaves them free to make almost any kind of wild claim they want while keeping their hands clean. Nothing to see here.

But the reality is that our government put in place protective measures that have stood the test of time for over two centuries. Had we not done these things there would have been more casualties. Of that, there is no doubt. It is the number of casualties and the cost-benefit of preventing said casualties that is under debate. Would we be looking at over 2 million deaths??Definitely possible – but far from certain.

Let’s talk about COVID and the schools…

A recent blog post dovetailed my thoughts on this issue: COVID, Closings, and Context. The author is a microbiologist known under the pen name of “Mike the mad biologist”. He makes some very good points with special regard to school closures.

?He points out that schools have been closed in the past in response to outbreaks of infectious diseases. So, there is a precedent for doing so. However, since almost all prior school closures have been of relatively short duration, I tend to think of the long-term school closures for COVID as an issue unto itself. But the point is well taken. Schools have long been shown to be hotspots for viral spread. From the standpoint of someone who has worked in case investigation for COVID, this convention seems very well founded. However, my observations, however well grounded, are purely anecdotal.

On masking and COVID transmission in schools…

Until now, much of what people observed with respect to school transmission (like my own observations) were opinions based on anecdotal evidence. We are only just starting to dig into the real data that has been accumulating.

In this case, the $1 million question is whether masking in the schools actually worked. A recent study about the impact of required masking in the Boston area indicates that required universal masking does work – and works quite well.

When masking requirements were lifted in Boston area schools, some school districts elected to keep the masking requirement in place while others lifted it completely. This provided a unique opportunity to collect data and compare the districts that lifted all restrictions to those that didn’t. A study comparing the outcomes in these schools has been published in the New England Journal of Medicine.

The bottom line from this study revealed that schools where requirements were lifted, had close to 12,000 additional new cases of COVID over a 15-week period. This corresponded to an additional 45 COVID cases per 1000 faculty and students in districts that lifted all masking mandates. In fact, the number of cases per 1000 faculty/students was 66.1/1000 for schools that kept masking requirements and 119.8/1000 for schools that lifted them. That is quite a spread. The graphs below show some of the data from the study. Note that the black line on each graph represents the data from school systems that continued masking.

What should also not be lost on anyone is that 12,000 additional cases is no drop in the bucket in terms of community spread. If you want fewer variants, you need fewer mutations. To get fewer mutations, you need fewer cases of COVID. To accomplish that, the chain of transmission needs to be broken. This stuff is not rocket science. Much of it is just common sense. The other issue is that from the standpoint of the students, more got sick than should have and this resulted in more days lost due to absence.

Another point made by the study was that districts that lifted masking requirements were those expected to have lower incidences of COVID to begin with. They had better buildings and high vaccination rates. This suggests that if anything, the statistics above were an underestimation of the efficacy of masking.

Checking our privilege...

Although checking one’s privilege has become a cliche, in this case, it is well-founded. Many who were pushing for the end of school shutdowns and masking requirements were all about the specific needs of those advocating for them. The vision of multiple Karen's on a rampage comes to mind. This was pointed out in the Boston school study and most eloquently by Mike, the mad microbiologist…

…The most glaring lack of context is the active ignoring the role children play in spreading COVID to adults. In those communities that were hardest hit, those (household) adults include older, middle-aged and elderly family members…The idea that, if we hadn’t shuttered schools in the actual America in which most Americans live…there wouldn’t have been a significant increase in adult deaths … is laughable….The question should be, how many more deaths were acceptable to open schools sooner? Which is an ugly question, and one many are desperate to avoid.

The point is obvious. Wealth and position have shielded the upper echelon of academics, politicians, and business people from the worst medical impacts of the pandemic. Perhaps not completely, but significantly. If Grandma lives with them, she probably has her own space and can easily isolate if necessary. The schools their children go to have the best ventilation money can buy. Classes are not overcrowded. The decision-makers of our society don’t feel these impacts directly. Their primary concern becomes the economic impact.?

For the most part, this is not malicious. People tend to see the world through the lens of their own experience. But it is diabolical in that top-down decision-making based on such personal filters can ruin (or even end) the lives of millions for no good reason. For the rest of America survival and long-term disability continue to loom large. The trouble is that the rest of America has no seat at the table where these decisions are made.

For the most part, this is not malicious. People tend to see the world through the lens of their own experience. But it is diabolical in that top-down decision-making based on such personal filters can ruin (or even end) the lives of millions for no good reason. For the rest of America survival and long-term disability continue to loom large. The trouble is that the rest of America has no seat at the table where these decisions are made.

?A couple of thoughts...

There is nothing wrong with a healthy debate. But way too many debates that should be based on the accumulation of facts and statistics have degenerated into political grandstanding and finger-pointing. Public officials often have to make decisions in the moment based on minimal information. Post mortems on such decisions can help guide future decisions. But the vitriol should be minimal with exceptions for deliberate deception, misrepresentation of the facts, cover-ups, or malicious intent.

There will be more pandemics. Let's learn from the mistakes we made this time without the political and ideological sideshows. In many ways, this is the least we can do for the over 1 million Americans that lost their lives to #COVID.