COVID-19 and School Closings. Overkill? No

Mar 12, 2020

I’m not an infectious disease doctor, or a specialist in public health. I’m a primary care doctor, and more than a few people at Harper Health seem to trust my take on things. So I’ll share my thoughts and you can process it yourself and make your own decisions about how it makes you feel.

What is going on with school and university closings? You may have heard that schools such as Harvard and Columbia have canceled onsite classes and sent their students home, and they’ve pulled them back from studies abroad.  Local grade and high schools are shutting their doors as well. This is real for me. A friend’s daughter goes to Stanford and was told to not come back to school after spring break. The grammar school where another friend’s wife teaches and daughter attends was shut down because a parent was diagnosed with COVID-19. My own son, a student at Loyola Marymount University came home yesterday for spring break. His school told him to not come back after break for at least two weeks. Looks like we’ll be paying for two meal plans now!

Is this overkill? I was watching CNN’s Sanjay Gupta today and he’s usually a good resource and has thoughtful perspective. On this issue, I think he fell a little short. He said that the same behavior that you’re trying to limit kids do at college they’ll just do at home. Well, no. Why?

Let’s go back to the R0 (R naught), the number of people, on average, a person with SARS-CoV-2 can infect. It’s 2.3. Let’s make it simple and shorten it to 2.0. How is it spread? As a reminder, if an infected person expresses an airborne particle and someone within six feet breathes it in, they can get the infection. Or, if the virus lands on a surface and someone touches that surface (a fomite) and then their face – poof. Ahh, but if you keep the surfaces clean and keep people six feet from each other…

Dorm rooms.

Clean surfaces? Ha!

Social distancing? Defined by the CDC as: “remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible.” College life is the OPPOSITE of social distancing. Young adults are learning to figure out how to be intimate, how to navigate adult relationships. They’re also sitting around in dorm rooms with the lights dim drinking whatever, smoking whatever, talking about how to save the world or at least what pizza to get this time.

So, let’s go back to the R0 of 2.3. We’ll be conservative here and use 2 as the number of people who an infected person could spread it to. At universities with all of its intimacy it’s probably higher. Say one student comes back from Seattle or New Rochelle or the even the concert with the hot new local band and is now infected. That one student gives it to his roommate and best friend (Now there’s 2 new infections). A few days later the best friend gives it to her roommate, and the first student’s roommate gives it to his girlfriend (4), then they spread it (8), then again it doubles to 16. Okay, now instead of just one person coming back from break with the infection we have 10. So in that same time period instead of 16 people who are infected we have 160. See how fast this can spread?

But, doc, I heard that young people don’t get as bad an infections as older. What’s the big deal? This is true, the death rate for young people is significantly lower than that of older adults. There are two issues with this: 1. That young person can be a vector and quietly spread it to the nursing home where she works, or the homeless shelter where she volunteers. Those people are at much higher risk. 2. While 80% of the cases are mild 20% are severe requiring hospitalization. That 20% isn’t limited to older people. Young people can get really sick, too. While they are more likely to survive their severe illness, it doesn’t mean they won’t be super sick in the hospital, on a ventilator. Have you seen the images?

And, while the death rate in younger people are at lower risk of dying from the illness, the death rate isn’t zero. Let’s do the math: the death rate of young adults from COVID-19 looks to be two in a thousand. The Ohio State University has 30,000 students. Let’s say 5% of the student population gets infected with SARS-CoV-2. That’s 1,500 students with the infection and then an estimated 3 deaths. How many deaths of young people – preventable death – are acceptable? If I’m a university president, that number is zero. Stay home. I appreciate their discretion.

Sanjay says that young people will just do at home what they do at school. Well, no. Now it’s my wife’s and my job to talk to my son, and our other children, about COVID-19 risk and how to mitigate that risk. Michael won’t be going to concerts. His room will be much cleaner with a lot less traffic in and out of it. We can better advise hand washing.

It’s now on us. It’s on you.

More to come.

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