Updated October 9, 2020
The COVID-19 pandemic in Fall of 2020 is not identical to the COVID-19 pandemic in March of 2020. In March, we knew very little about this disease, Governor Whitmer called for a statewide shutdown in order to “flatten the curve,” and allow our hospitals to maintain the capacity and resources to treat patients without having to ration life-saving equipment like ventilators.
Michigan was one of the most successful states in the U.S. in this effort. Even though we were one of the earliest and hardest hit states, as was predicted by experts at Johns Hopkins University, we have held our hospitalization and death rates at a stable, low level for the past several months. Contact tracing is in place state wide, and despite the Michigan Supreme Court’s recent revocation of Governor Whitmer’s executive orders, many counties have already begun issuing public health orders to make sure that masking and social distancing remain in place.
Ann Arbor Public Schools (AAPS) has chosen a set of metrics with which to determine when it will be safe to return to school. These metrics include two measures of “case count,” using the MI Safe Start dashboard, and the Harvard Global Health Initiative dashboard. Unfortunately, while choosing two metrics may give the appearance of being thorough, it really just makes attaining the threshold set by the district nearly impossible.
It’s important to understand how the two dashboards collect data. The MI Safe Start Map uses data collected from the Michigan Disease Surveillance System (MDSS) for confirmed cases and these cases are represented by disease onset date (where available) or specimen collection date (as a surrogate for onset when an onset date is unavailable). As time goes on and more is learned about each case, the data will change and be accurately reflected on the state dashboard. When this data is observed over a long period of time, drastic “spikes” in cases tend to level off after these data adjustments are made and the accuracy is improved.
The Harvard dashboard, on the other hand, uses data that is gathered daily from various internet sources for the State of Michigan. As counts change and possible duplicate reports are discovered, the Harvard data does NOT get updated. Harvard is also using probable cases, which confuses the comparison since on the MI Safe Start Dashboard you can get the data without probable cases for the most accurate representation.
AAPS, the Board of Education and the district leadership should use one dataset with which to determine when case counts have met an acceptable level. Public health experts that were consulted strongly recommended to us the use of only the MI Safe Start dataset.
A second issue with the metrics chosen by AAPS for making the move to implementing their hybrid plan for in-person learning is that only case counts and percent positivity were chosen by the district as metrics to monitor. Percent positivity has been low for Washtenaw County since late April when testing became more widely available, which speaks to the excellent public health resources available in our community. Our case counts are higher, however, in part because we have two large universities in our county and in part because we are testing so many people. Hospitalization and death rates remain low.
The Harvard Global Health Institute and the U.S. Centers for Disease Control and Prevention (CDC) recommend considering multiple other metrics in making the decision to begin opening schools, and those metrics would place AAPS in a favorable position for opening, at least for the youngest students and those with special needs that require in-person teaching. For example, the Harvard Global Health Institute suggests that even in level “orange,” grades PreK-5th and those kids who need special ed services in grades PreK-8th are the first priority for opening. As long as the conditions for pandemic resilient teaching and learning spaces can be met and achieved.
“Society has to forge a path forward with school openings based on the reality facing us,” says Joe Allen, Assistant Professor and Director of the Healthy Buildings Program at Harvard T.H. Chan School of Public Health. “We wanted to provide guidance not just on when it’s okay to open, but also evidence-based strategies for how to do it safely.”
“Our students should not have to learn in conditions of suffering; our educators should not have to teach in conditions of suffering. We owe it to our children to get them back to school safely,” says Danielle Allen, director of the Edmond J. Safra Center for Ethics at Harvard University.
While it is important to monitor metrics regarding the spread of disease, it is also important to monitor metrics that measure how ready and able the district’s surrounding community is to respond to outbreaks of illness. The CDC published guidance on bringing children back to school safely in which it suggests monitoring multiple measures, including not only case counts and percent positivity, but also hospital bed availability, ICU availability, and what proportion of hospitals beds are currently filled by COVID-19 patients. While our most recent “spike” in cases was largely tied to the return of students at the University of Michigan, we also had the Washtenaw County Health Department, University of Michigan, and the School of Public Health’s all working to contact trace and perform widespread testing of both symptomatic and asymptomatic students, which led to a very rapid turnaround in the increase.
Finally, and even more importantly, the CDC includes in its “core” indicators a set of mitigation strategies to help determine their readiness for resuming some level of in-person instruction. These strategies include whether the school is able to implement mask wearing, social distancing, hand hygiene and respiratory etiquette, cleaning and disinfection, and contact tracing in collaboration with the local health department. On September 11, 2020, AAPS Superintendent Dr. Jeanice Swift told the Board of Education that PPE had been purchased and that classrooms were prepared for students to return to them, with social distancing markers in place. In addition, the district published a preparedness plan for all employees, visitors, and contractors in July. We are ready.
Reasonable Return requests that the AAPS leadership and Board of Education consider all metrics recommended by the CDC for implementing in-person school and consider those as well as case counts and percent positivity in making the decision to move forward with implementing the hybrid plan as was promised in the Back to School plan promoted to families and students at the start of the school year.
We all feel a great sense of uncertainty and fear about the COVID-19 pandemic as most of us have never lived through a health crisis of this scope. However, it’s important to consider two other pieces of data in order to bring the fear into perspective. While there have been deaths from COVID, in this county of over 360,000, the risk of death from COVID-19 in Washtenaw County is low and likely similar to the risk of many activities that most of us choose to do every day. For example, the number of COVID-19 deaths in Washtenaw County from July 4 to Oct 4 (8) is similar to the average number of motor vehicle accident deaths in the county for a three-month time period (7.25 three-month rate based on 5 years of data).
The other important metric is the availability of healthcare resources, which is referred to in the CDC guidance for reopening schools. The availability of hospital beds is critical to a community’s ability to respond quickly and effectively to a COVID-19 outbreak, especially now that effective treatments are known. This is another area in which Washtenaw County is well positioned, with two major health systems and very high availability of hospital and ICU beds.
Reasonable Return requests that the AAPS leadership and Board of Education consider the full risk/benefit ratio that exists for children and teachers returning to school, and allow the data to guide decision making, rather than fear and speculation.
Published in Science, Sept. 21, 2020
By Matthew D. Snape and Russell M. Viner