You must realize these criticisms applies to every single plan we can come up with, right? You must explain why a blanket lockdown addresses them better than a selective lockdown.
And then there is the issue of dense urban areas where people need to use public transportation to get to their jobs, even if the jobs themselves are relatively low-risk. Biking is an option for some who live close enough to work, but in Chicago in December? Not so much.
Well, what’s your plan for this? This is literally the only way I think we can end all these deaths in nursing homes:
First of all, there can be zero re-admittance of any patient who leaves the home to spend time in a hospital, without being quarantined off-site for 3 weeks first. It doesn’t matter if they were at the hospital because they had covid themselves or not, not when they’re so susceptible and it’s so prevalent in hospitals.
Next, everyone who works with them will need to also undergo quarantine. And then they need to move into the nursing home too, so they’re not accidentally exposed at home, on public transportation, while shopping or going to bars. As the average age of a person working in a nursing home is 36, many of these people are parents of minor children. Provisions to have their children taken care of will need to be made.
I don’t think people would buy into my plan. What’s yours?
We can’t lock down everybody totally, no. And, at least in the USA, we haven’t at any point come anywhere near trying.
What I’m objecting to is the theory that we can somehow isolate all older people from all younger people, in order to allow the younger people to go about their lives with absolutely minimal precautions, if any at all: hugging whoever they please.
Yes, we need to be selective. We need to be selective by what activities cause greater risk. Hugging people you’re not living in intimacy with anyway is high risk. Gathering in large groups is high risk. Gathering even in smallish groups, if the group members keep changing out and the gathering is indoors, is high risk. In-person choirs are high risk because singing means projecting particles and inhaling deeply. Gyms are high risk because people are breathing heavily in enclosed spaces. None of this can be dealt with by saying ‘just lock all the old people up and then the young folks can hug whoever else they want’.
It makes sense to selectively protect some people more than others, yes, to the extent that this can be done. But it can’t be done by separating the generations entirely from each other. It has to be done by affecting everybody’s behavior.
We haven’t, while we’re at it, been selectively protecting people in any rational fashion. The people who have been least protected have been those without much money, many of whom live in crowded quarters, travel on crowded public transport or group buses, and do most of what’s been declared essential jobs which can’t be done from home. They’re also more likely to have poorly controlled health problems of various sorts which put them at more risk. And these are the people who we put into what are currently the most dangerous jobs.
Yes, college aged kids, the vast majority albeit not all at very low risk of serious disease, are going to get this, many of them never knowing they did. No they won’t be rigidly compliant with protocols long term. And that will be true if they are in their parents’ homes or on campuses. This seems to me to an unavoidable thing. If they are going to have a certain rate of infection better that they are on campus when they do. Of course try to limit the numbers of them, no big lecture halls, no bars open or big parties, require mask wearing in public as enforceable campus policy, sorry about not having big crowds at the games, so on, but know that there will be cheating despite best efforts, maybe less than if at home, but still.
Thanks for this. I’m a college professor and I was starting to feel like I was the only person in the world who thinks holding face-to-face classes in the fall is neither crazy nor irresponsible. (I think there should be a good range of online course offerings too, enough so that both faculty and students can go online-only if they want or need to, but the fact is that there are a lot of students who do not want it and a significant minority who cannot do well in online courses, either because of technology access or general temperament. I imagine the number is even bigger at the K-12 level, and that the gap between the upper-middle class kids who will basically be fine and the others who will not is also bigger.)
NYTimes agrees with you.
Uh, no, the NY Times is taking the position that campuses shouldn’t open in the fall. I think that they should.
Oops, I misread you. My bad.
I can’t remember where you teach. Has your campus made a final decision about fall classes yet?
I’m in the California State University system, and the vast majority of classes are going to be online, with exceptions for some labs and other classes that really require in-person attendance. All of my classes are scheduled to be online.
I’m not quite sure how I feel about it, at least regarding the issue of coronavirus. If they made us teach face to face, I think I’d be fine with it, but I also understand playing it safe.
Regarding pedagogy and my own enjoyment of my work, I would much prefer to be in the classroom. It’s not even close. Face-to-face interactions with my students constitute, for me, the most enjoyable part of my job and, if I can be a little immodest, I think it’s also the part of my job that I’m best at. I’m a pretty solid lecturer, and as long as I have a critical mass of students willing to participate, I’m a good discussion facilitator as well. There’s a real buzz that comes from running a good class discussion, and getting the students to really push themselves, think about complex arguments and ideas, and articulate their thoughts in front of their fellow students. I’m going to miss that, and I think that students benefit greatly from the sort of person-to-person interactions they get from talking with me and with each other in the classroom.
From a practical and personal standpoint, though, I benefit greatly from the decision to hold classes online. My wife and I moved to the east coast last year so that she could take up a new job, and if my university were teaching face to face, I would need to rent a room in California for the semester and spend the whole semester out there teaching my classes. Not only does that cost extra money, but it means being away from my wife for almost four months. I did that in the Spring, at least until our campus closed down in mid-March. It went fine, but I won’t lie: being able to come back home to be in the same house as my wife was nice, and I’m looking forward to teaching from home again in the Fall.
I think that the biggest problem for many faculty and students is that some universities are being really bad about communicating how things are going to work, and what the expectations are. I know one friend whose university seems to be offering each individual student that chance to decide for him- or herself whether they want to take their classes in person or online, for every one of their classes. So you might have a class of 30, with 15 students coming to class, and 15 taking the class online. The faculty, it seems, will then be expected to come into the classroom to teach the students who choose to come to class, while also catering to the students who want to learn from home by having the material available online. That is complete bullshit, IMO.
First it must be recognized that the vast majority of infections in nursing homes are brought in by, and spread by staff. Not by residents, including not even residents with resolved COVID-19. Staff.
The second part of your proposal would be the platinum plan, has been done, and worked well.
The cost of doing that a bargain on the scale that this disease has travelled in. But agreed that maybe it is not a plan that would get universal buy-in.
So a Silver Plan.
- Adequate PPE with adequate training and follow up on proper usage both of PPE and on social distancing between residents and between staff in break rooms inclusive. Ongoing QI projects regarding proper usage. Think people already know and do? Sadly even hand-washing is not reliably done even in hospitals but QI projects done right work.
- Cohorting. The current circumstance in which staff rotates around not only complete facilities but between facilities sets up disasters. The same staff teams take care of the same limited pools of residents every day.
- Testing of staff and residents frequently (on site swabs taken) and immediate contact tracing/isolation for positives. Not just when there are positives but asymptomatic individuals on a regular basis as well. This is a population that testing testing testing contact tracing and isolation can work.
- Ongoing review to improve best practice standards and to implement them.
- Standardizing this care by way of regulation, enforcement, and payments support.
FWIW I would also place a high priority on developing means for loved ones to be able to visit in ways as safe as possible. Yes a visit by a family member, even masked and in a well ventilated space, presents some risk. But the cost to quality of life and even to mortality of not having that loved ones occasional presence and touch for prolonged periods of time is so great that informed risk may be worth it.
@Eva-Luna, indeed a group of higher risk individuals who take public transportation are a hard group to lower risk for while allowing to work. Maybe there are some answers with brainstorming. Not sure for them. Vouchers provided for cabs or Ubers (all masked and windows cracked open)?
mhendo, I’m at a state university in the deep South. At the moment, the state higher ed board has decided all of the state universities should be face-to-face in the fall. (This might change, obviously, and I think one reason why most colleges are saying they’ll be F2F now is that it’s easier to change to online later than it would be the other way around.) My institution already has a ton of online classes, enough for students to complete their degree online if they want to, and I expect there will be a few more than usual in the fall. I’m hoping they will let people like my 70-something-year-old colleague opt for online if she wants to, but personally, I’m fine with F2F.
We’ve been told we can’t require physical attendance in the fall, and in classes that are too big to accommodate physical distancing in the classroom, there may be this weird hybrid thing going where half the students are physically present in class every day and the other half participate via Zoom. I’m in English, at a school that is essentially a SLAC, and a “big class” for me is 20 to 25 students – upper-level classes are capped at 15 and, in practice, tend to top out at 10 or so, so it’s possible this may not be an issue in either of my upper-level lit classes. It probably will apply in my two gen eds, and I have to admit that I’m more freaked out by the technology complications than I am by the virus! What I’m hoping is that we’ll be allowed to put some lecture-type content online, treat the face-to-face sessions as separate discussion sections, and maybe have a few Zoom meetings for the whole big group, rather than trying to run an online class and a face-to-face one simultaneously.
I’m planning to have a participation requirement instead of an attendance requirement, and let F2F and Canvas participation count equally. That part seems not-too-hard. I’m also hoping it won’t be too hard to make students feel like coming to class is fun and worth their while, even if they don’t HAVE to be there. But yeah, it does kind of feel like we’re being asked to be all things to everybody, and I’m probably going to cut back on some of the more complicated interactive activities that I usually do.
But, at the same time, I miss the energy bounce I usually get from an in-person class, and the awed look students get when they get to see an actual page from a medieval manuscript up close, and I know a lot of our students do want to be back, and some of the others don’t do well online at all. So I’d rather give face-to-face a try, come what may. I hope it works out. I feel kind of guilty for hoping it, knowing there are lots of other faculty who are completely freaked out by the idea, and that I’m personally pretty low-risk.
Here’s a scarily plausible chain of events. College students, staying at home, act like college students, be they on campus or at home. They meet over coffee, go to parties and bars, pair off on dates and congregate. The virus quickly spreads among students, who mostly recover quickly or are entirely asymptomatic.
But soon the virus reaches the older, more vulnerable members of their extended families, as well as local residents, having much more contact with these groups of more vulnerable individuals than they would if they were on campuses. Infections surge. Hospitals are quickly overwhelmed. No one wants to see this happen.
Campus towns can keep bars closed or only operational under very strict criteria (no idea why so many states had opened up bars early), they can restrict parties, likely better than will be done in most of these young adults’ home towns. They can provide the means to have intense social interaction in classrooms and at cultural events, and political activities, in lower risk ways. Higher risk staff can be distanced as needed to lower their risks, including some providing hybrid models with some staff opting for online interactions and others for approaches that give them enough social distance.
For society as a whole having college students not intermingling with as many vulnerable individuals as often, by having them on campuses, is the dramatically lower risk choice.
That could work for college students that live on campus, if you don’t let them leave on the weekends or holidays. Many do not. In fact, many colleges don’t even have on campus housing.
Even if you can completely deal with the issue of the students, you still have staff, both educational and support. Are they in quarantine with all the students? What about staff that are at higher risk? Many of your best teachers are at least in their 50’s.
As stated:
Would this make the risk to higher risk staff zero? No. But greatest good to the greatest number.
The alternative is college students exposing many MORE possibly significantly higher risk individuals and those staff of higher risk taking risk reduction measures likely being exposed to similar risks just living in the world. Honestly though, on the scale of risky front facing jobs, standing in front of a classroom, more than 6 feet away from students, insisting on masks being worn when near you and wearing one yourself, is pretty low. The biggest risks they’d likely take is getting sloppy in their other staff interactions, not in the classrooms.
I worry more about the practical impacts of cutting off family, as well. Most people who work in skilled nursing facilities are hard working and well-intentioned, but they are often stretched too thin. And sometimes, like in any profession, there are people who can’t or won’t take care of their patients like they should. It takes shocking little time for a fragile person to develop bed sores or get dehydrated. It is entirely possible for a fragile person to be unable to communicate to a stranger that they are in pain, or for that claim to be dismissed.
We’ve had a handful of family members in skilled nursing facilities, and frequent visitation was a big part of ensuring their care and comfort. I’ve thought on that a lot these last few months.
Would this make the risk to higher risk staff zero? No. But greatest good to the greatest number.
The idea that College students would be dedicated in more activities outside college if they are not open could result in worse contagion rates might have merit, but opening the schools in many locations will give less good to the greatest number IMHO, as others report.
A number of American colleges and universities have decided to bring students back to campus this fall, believing they can diminish the risk of coronavirus transmission if everyone wears masks, uses hand sanitizer and social distances. Some schools also plan to reconfigure dorms to create family-size clusters of uninfected students, who could socialize in relative safety, if only with their suite mates. These plans are so unrealistically optimistic that they border on delusional and could lead to outbreaks of Covid-19 among students, faculty and staff. (Laurence Steinberg, 6/15)
Public transit is dangerous for everyone, not just higher risk individuals. If significant numbers of people use public transportation, social distancing is essentially impossible, and the idea that transit workers can make it happen is even more delusional. I imagine that’s a large part of the reason the NY area was so heavily hit; public transit there is absolutely essential, many people don’t have access to cars, and it would be logistically difficult (not to mention ruinously expensive) to commute to Manhattan by car even if they did. In Chicago and many other cities, it’s not quite as extreme, but it’s still a huge issue, and will only become more so when the weather gets worse.
And don’t forget about higher risk people who live with people whose only realistic transit option is public transit. All the people in the NY area who commute from NJ, or Connecticut, or Staten Island - are they supposed to take taxis and Ubers to work?
I don’t doubt that riding public transportation incurs some risk. But what you imagine has very little actual evidence behind it.
That said staggering shifts when possible to minimize crowding during peak hours, wearing masks, spacing out when possible, all can further reduce the risk. Never to zero.
Again the key concepts are making major decisions on solid evidence rather than what we imagine or single studies, avoiding one size fits all responses, and considering what the alternatives each risk.
One of the caveats noted in your linked article is that people in Asia, where ridership of public transit is high, wear masks…which is not necessarily the case here.
I don’t disagree that we can’t live in a zero-risk environment - that’s not really why I keep disagreeing with you. I just don’t buy that we’ve done anything remotely approaching what is possible in terms of containment and mitigation, and we’re being repeatedly besieged with misleading, feel-good news that offers psychological justification to go out and live as if we’re not living through a national emergency.
I actually believe that we really could gradually reopen and operate semi-normally…if people would just reckon with reality. That’s the problem - too many people are not. Too many others are needlessly minimizing the severity and risks associated with this virus. The two problems go hand in hand.