Schools are opening…and then closing

Since our last update nine days ago, deaths in the USA from COVID-19 have increased nearly 10,000, close to the tragic number of 173,000. Positive tests in the US have increased to 5.5 million (This may be skewed downward by decreased testing deployment). Thirty-three states still report a positivity rate (% of tested people who are positive) of greater than 5%, with eleven states still above 10%. Fortunately, Ohio’s positivity rate is 4.4%. Unfortunately, coronavirus testing has decreased 13% in the US over the last two weeks according to The Covid Tracking Project. COVID-19 outbreaks have occurred on educational campuses of 22 states since they have resumed in-person instruction. University of North Carolina-Chapel Hill has sent students back home and Notre Dame has suspended in person instruction for at least the next two weeks. Michigan State University has changed course and moved to continue online learning, instead of the previously planned September 2 reopening. The FDA has put a hold on the use of convalescent plasma for treatment of COVID-19 as its effectiveness has been brought into question. The FDA has issued an emergency use authorization for a saliva test to be utilized to detect the virus responsible for this dreaded disease. Lastly, the quest for developing a safe and effective vaccine continues but may be delayed because insufficient numbers of Latino and African Americans have been recruited as volunteers. Clinical trials must include minorities according to federal law and National Institute of Health policies, yet only 10% of the potential volunteers who have registered online are Black or Latino.

Although it is unclear as to why testing has decreased, what is truly clear is that good public health policy amid a pandemic would dictate that testing should be increasing. It is also very clear that testing has never been a true priority of this President as he has consistently refused to implement the full authority of the Defense Production Act and repeatedly and openly downplays the value of this basic epidemiology tool. A slowdown in testing makes it much more difficult for science-based policymakers to generate recommendations that balance public safety with relaxing restrictions. When testing is inaccurate, unavailable, under-utilized, or has delayed results, person to person transmission rages and contact tracing is of little value. The consequences are more lives lost and more livelihoods destroyed.

It remains an inconvenient truth that Blacks and Hispanics bear a disproportionate share of the adverse impact of COVID-19. We have known and reported on the disparate impact on adults, but it is now clear that children of color are not immune to the ramifications of healthcare disparities. A recent CDC study confirmed that Hispanic children are eight times, and Black children are five times more likely to be hospitalized from COVID-19 than their white counterparts. Similar disparity is seen in the occurrence of the rare, but extremely dangerous, multi-system inflammatory syndrome. A recent study by an organization named amFAR quantifies that the prevalence of COVID-19 is much lower in counties that are predominantly white. The social determinants of health need to be recognized and measures taken to mitigate. These findings are additional justification for increased testing and resources in the areas where our kids reside so that their schools can safely reopen for the preferable in-person instruction.

While we await the development of a safe and effective vaccine, we must WEAR masks, WASH our hands, WATCH our distance from each other, and avoid convening in large groups. These measures are the actions that WE can take to save our lives and livelihoods. We cannot emphasize enough that the simple act of 95% of our citizens wearing masks will save tens of thousands of American lives. A recent viewpoint in the Journal of the AMA recommended a federal mask mandate, with justification consistent with the national seatbelt requirement.

The public, especially those who are most impacted, deserves a commitment to a national strategy and resource allocation to include testing, isolation, tracing, and treatment which would help to get and keep our schools and lives open as we navigate through this pandemic. The abdication of management down to the state level has resulted in this summer surge and will allow for a fall tsunami when flu season begins.

Clyde E. Henderson, MD
Cincinnati Medical Association