CareTalk Podcast – Can We Ever Go Back to School?

This week, the CDC issued its back to school guidelines for students. In this episode, John and David put the guidelines under a microscope, while debating what makes back to school in 2021 different than 2020.

David Williams:

Welcome to CareTalk. America’s home for incisive debate about healthcare business and policy. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix.

David Williams:

Hey John, just a few days ago, you told me how Google was so well positioned in healthcare, but Amazon was lousy. And I think pretty much while we were talking, Google said they’re dismantling their health division and that the head of it is running off to become CEO of Cerner.

John Driscoll:

Just because things are a good idea, David, doesn’t mean people are going to do it, particularly large companies that make Titanic amounts of cash doing something else. I still remain correct that Google is the best-positioned facility and organization to organize, simplify and make healthcare data transmissible and shared in a safe way. I am right. Google is wrong about Google being right and you being wrong.

David Williams:

Okay, John, I don’t know if I can follow all that, but what you’re saying is they’re like the Delta variant of information. They can spread it everywhere despite people wearing a mask wherever they may-

John Driscoll:

No, they are like vaccines. If they can engineer it the right way, they can solve a universal problem with a universal solution.

David Williams:

Okay. John, we’re going to relabel you as doctor double down and see how it goes from there.

John Driscoll:

I won’t back down. Tom Petty was right, don’t back down.

David Williams:

I love the summer, John, except the thing is, it always seemed to me like around July 1st or July 4th, they would start advertising back to school. I hated back to school, but now, it’s sort of like back to school and then we didn’t have back to school. So last year, we didn’t have back to school and this year we’re going to talk about back to school and whether we have it or not. You’re ready for back to school, John?

John Driscoll:

Well, I think what you’re talking about is really back to school safely. I mean, we’ve got a challenge right now in that parts of the country are highly vaccinated and parts of the country are still trying to figure out whether they should get a vaccine or mask. And so, the COVID virus is still running rampant and when you think about a vaccine that’s highly effective, but which is not recommended for anyone under the age of 12 and where I think the under 21-year-olds, particularly the under 16s, it’s only a third of the people of students are vaccinated. You’re creating an environment where, unless we sort of have defense in-depth, it’s going to be really hard to open the schools. At the same time, if we don’t open the schools and have people attend schools in person, we know that these are going to be the lost years for a number of students who don’t have great Internet connections and frankly have a hard time, like most teenagers, like I would, staring at a screen all day taking in new information.

David Williams:

John, this is actually the third school year that’s going to be affected by COVID, which is kind of crazy if you think about it. The CDC did issue some guidelines this week about going back to school during COVID and there are nine guidelines. The first one is to take COVID-19 seriously. And the other ones are not specifically related to COVID, although there are some indirectly related mental health matters and routine vaccination saves lives and washing your hands. There’s also a kind of a climate change one thrown in there as well. What did you think of those guidelines?

John Driscoll:

I think it’s sort of missing the point. It’s like the house is on fire and we’re going to talk about electricity and this is all about COVID-19. It’s all about the threat of kids getting sick, of kids getting into the ICU. The vaccine hesitancy in this country is driving hospitalizations in pediatric ICUs through the roof in any area where people are unvaccinated.

The reality is the current MRNA, the Pfizer and the Moderna vaccines are highly effective, 90% plus at preventing serious illness and hospitalization, but the only way they work and protect all of us is if there’s a high level of vaccination. And if there aren’t, what we’re doing is we’re basically making kids vulnerable and when we send them back to school, we’re getting them together, which means they’re going to be more vulnerable. I think we shouldn’t be screwing around with talking about anything other than a simple clear message that this is a threat and we have to defend against it and the way we defend against serious infections and viral infections is defense in depth and agreeing on it. But to be talking about climate change in the middle of the pandemic strikes me as sort of silly.

David Williams:

John, I was seeing different analogies that people are trying to use to describe COVID, pandemic, vaccination, and so on. And one of them had to do with about like a wildfire and you want to take the kindling away, right? One way to do that is to vaccinate people. And then there, it’s kind of like putting water on the tree or something like that to keep it from burning or actually sometimes what they do with a house that’s in the area of a forest fire is they dip the same stuff that they use for, they go in Pampers, these diapers and then they fill it up with water and that protects the house. That’s kind of like what a vaccine is, but of course the kids aren’t eligible yet.

John Driscoll:

I don’t know what you’re talking about. Pampers and wildfires. Were you drinking at lunch today, David?

David Williams:

John, I was smoking some of that forest fire smoke that’s been coming in. Well, what’s different this year, John? Because we’re talking about back to school last year and I think we actually thought kids were going to go back to school last year. They didn’t go back to school last year. For a lot of people, it was a remote experience. Certainly, the vaccine is something different. I mean, are we going back to school or not?

John Driscoll:

I think we have to, David. I mean, there’s a combination of serious lifestyle disruption for working parents, low income, working income, single parent, there is not universal childcare available, certainly not and even less during a pandemic. Secondly, you have just the mental health and the long tail of disconnection that a lot of kids feel when they’re not around their peers. It’s not just social development, it’s basic community that kids need. And the third is obviously the disrupted and lost months and years of learning. We have to go back to school, David. We have to find a way to safely go back to school. And the reality is that there are solutions even when the pandemic is running.

You’ve got obviously vaccinations and face masks help. You see the counter example of a school district in California where they have a high level of vaccinations and masking. And you’ve got out of a school different like of about Brentwood. I think it’s 55 people were infected with COVID-19 and a similar school district in Arkansas, you had 800 where they’re low vaccination rate, face masking by choice.

The right solution is probably asymptomatic testing. That is testing while the pandemic is running the entire school district, all the students and the teachers once a week. That works. In Tulsa, Oklahoma, they were able to reduce the number of people who were ill by testing everyone to, I think it’s like 0.10%, which is about 11 per 10,000 students. And that’s a remarkably low number particularly in an area where we’re sort of in the middle in terms of vaccines and face masks. Testing, which was widely available towards the middle of last year, but was not universally done, particularly around asymptomatic, those folks who don’t have symptoms. It could be very effective as a surveillance and managing tool. If you can catch things early, people can opt out, you can keep the schools open and sort of manage your way, navigate your way through the pandemic. It’s doable. And we have examples like Tulsa that prove it.

David Williams:

John, I liked what you said before about defense in depth. So let’s just tick off some of those things. And the idea is that it’s not just… One thing alone, isn’t going to work. There’s not one magic bullet. The vaccine is the closest actually, but we’re talking about masking, so wearing a mask indoors, a decent one, not just a cloth one, getting vaccinated, testing, certainly routine testing. The pool testing was working well where you take a bunch of samples and you put them together and see if anybody has it, and then you do a followup if you need it. Contact tracing, we haven’t talked about in a while. What else is there in the defense in depth?

John Driscoll:

Well, I think that it’s every step of the way. It’s vaccinations, it’s masking, it’s personal hygiene, it’s asymptomatic testing, and then when you’ve got that testing of the entire population either through pooled testing or through testing everyone, which is what MIT did last year to keep in person, a lot of colleges are doing, or you do pool testing which some school districts in Boston are doing, to sort of identify smaller groups and it’s highly efficient. We talked about that on one of our other podcasts and then contact tracing is just simply quickly following up on those folks who were identified. I think the early approaches to contact tracing where we were the sort of Singapore approach, we’ve blown well beyond that now that we’ve got the pandemic adept where everybody’s being monitored by the state and documenting everything. If we simply mandate testing of one sort or another for the entire population, asymptomatic testing, that’s about as much contact tracing as you’re going to need.

And again, we can… and this is an area, David, keeping schools open where the president’s been very clear and very consistent. And I think honestly, taking a courageous stand because there’s obviously a lot of unions that are inconsistent about whether they support mandatory vaccines. There are different school groups that are uncertain about whether they want their schools open and masks or vaccines and the president has been very consistent that the federal government’s going to stand on the side of protecting kids long-term by providing school districts the resources they need to keep schools open.

David Williams:

John, another one that you didn’t mention, one of my favorites for defense in depth is actually ventilation. And I hope the schools take the time to get the proper ventilation in place because that makes a really big difference. It’s something that’s hard to see, but is pretty serious. It’s interesting how-

John Driscoll:

Do you want to just talk about that David?

David Williams:

Sure.

John Driscoll:

Because I do think that, if we could dig into that, because it’s sort of a broad category. It’s like when people talk about infrastructure, what does that mean to you? Because one of the things we learned early on in Hong Kong or in the Asian research is that well-ventilated spaces, people could congregate and there would be a low infection rate. And in poorly-ventilated places, particularly restaurants without open and ready air flow, there was an extremely high level of cross infection because of the aerosolization, the air-based nature of this virus. What does that mean? How do you translate that into a to-do for US schools?

David Williams:

Sure. John, with the pandemic, we got off to a bad start with our understanding of how it was transmitted because there is a belief that it was being transmitted through surfaces and you still see this where people talk about this cleaning and they’re putting all sorts of chemicals on surfaces and so on, but really almost all the transmission is occurring through the air. And unlike with a mask where you can see if somebody has a mask or vaccination where there’s a card and you can check it. With ventilation, it’s harder to see and it’s ventilation plus filtration. Basically, you want to avoid having a big concentration of virus particles that you breathe in. And one way to do that is just to be spread out like outdoors, where it dissipates or the virus is killed by the sun or indoors having a lot of flow of air, so the air is being re-circulated in the room frequently, and it’s going through good filters as well.

A lot of schools are not very well-ventilated. The easiest way to ventilate them is actually to open the windows, but not all the classrooms have windows. And so, having fewer people in them so that the air not be as contaminated and then having ventilation systems that actually are filtering the air out, filtering the virus out of the air are very important. And these are shown to work. You’d also saw in some of those early examples in Asia where somebody could be in the path of a ventilated, but not well-filtered air and they might actually be having the virus blow on them. This ventilation is just absolutely critical. It’s hard to measure.

John Driscoll:

It’s not a new thing, but I think that something just under 50% of all of the facilities that kids are in schools are very old structures where I would not expect the ventilation or filtration to be strong, but if you go back to the pandemic of 1918, when you were in school, David, you actually can see pictures-

David Williams:

I was in first grade, John. Let’s face it. I wasn’t in my later years. Let’s not get everybody the wrong idea about how old I am.

John Driscoll:

There are actually a number of pictures, for example, from Philadelphia of elementary and middle school kids taking classes outdoors where they’re all wrapped up in blankets. And I think we’ve got to take the issue of ventilation and filtration really seriously that if you’re sending your kid to a school that’s really in a building that is either old and has poor ventilation or new and doesn’t have windows that open or poor ventilation, that we should be looking for hybrid, not at school and not at school, but outdoors and indoors learning because we’ve done it before and it worked.

David Williams:

So John, let’s get a little political here for a moment. Now, you see these mask mandates. You’ve got some of the so-called conservatives from the GOP who previously talk about kind of local control and so on now telling a locality they can’t have a mask mandate. And I’ve actually gotten emails about this from congressional candidates who must think I’m on the other side of things saying, “Hey, they’re taking away our freedoms or doing un-American things, stifling the kids, by the way, trying to slip a little critical race theory into the discussion as well.” How does all this wrap up?

John Driscoll:

Well, I think what we have found is in this country, there is an almost unlimited market for contrary opinions regarding whatever freedom is. Freedom is a practical matter. Those who are wrapping themselves in the flag of don’t tread on me are also infringing on the freedom of others to live in a free and open society that’s safe. And I don’t really understand the attraction of attacking science, embracing nut jobs on Facebook and Twitter who are pretty consistently getting very sick and in some cases, dying of COVID-19 while they’re arguing about everything from taking horse medicine to not masking and not following what the current medical establishment believes is the best treatment, but I would not underestimate the political attractiveness of this. The reason why you’re getting that email, David, is not just because of your peculiar political habits, but also because it is a consistently sort of attractive American attribute.

As one friend of mine said at one point, in the middle of New York Harbor, they don’t have the statue of community, we have the Statue of Liberty. In the 1918 pandemic, when San Francisco was trying to get folks to wear masks and socially distance, and actually find people who did not wear masks, the mayor of San Francisco proudly paid his fine and fought the mask mandate. We are a peculiarly contrary country when it comes to anything that approaches even the idea of a threat to individual choice and that’s dangerous. And so, I think we just have to consistently try to tie the conversation and the arguments around health to protection of us all and providing, and basically along for all of our freedom to live and work and go to school in a safe environment because this isn’t like a tetanus shot.

Let’s just talk about the vaccination specific. If I don’t take a tetanus shot and I get an infection, I’m going to die. I’m not going to make you more likely to die of rabies, David, unless of course I’ve got… but this vaccine and vaccines around viruses that are as communicable as COVID-19, by not taking the vaccination, you’re actually making other people more at risk and there’s a huge chunk of the society that because of their immunocompromised systems, they can’t take the vaccine. There are children in the ICU today who are, I’m sure, very sick and some are going to die because people in their community didn’t bother getting vaccinated and they, by accidentally, got very sick and some of them are going to be crippled because of it. It’s just the claim of one form of freedom is actually infringing in other people’s basic freedoms to live a healthy life.

David Williams:

John, it was interesting that the other day, the former president was out giving kind of a half-hearted endorsement of vaccination, but an endorsement nonetheless. And he started to get booed and heckled by people that were sort of against him, even though they were sort of following him before. I think what it says, John, is that sane people like you and I maybe need to become a little less articulate and a little more rabid and a little bit angrier and more vocal, and not just let this sort of the loud-mouth crazies drive people along.

John Driscoll:

Well, I think the biggest failure right now is of the Facebooks and the Twitters not taking more aggressive action against people who were sort of pushing out bald-faced lies, whether it’s the vaccine is unsafe or is going to affect fertility or any other nonsense, sort of people should be taking horse medicine or hydrochloric, for that matter bleach. We need to shut that stuff down and the second thing is I think we are going to have to have a society that’s going to require mandates because ultimately, if your freedom is going to infringe on my kids’ health, well screw it. I’m going to put some mandates in place and you’re either going to participate via that mandate in a conventional communal society, school, work, play, or you’re going to be excluded, and that’s your choice, but we’re going to have to be much more rigid and aggressive about mandates, David.

I don’t think you’re going to convince the country. If you look at the industrialized countries, Russia, China, and some of the conservative crazies have exploited this and really built the largest base of vaccine hesitancy in the industrialized world. I think it’s north of 30% of America. The claim is not to be willing to take the vaccine under any circumstance. Well, if they can’t travel, they can’t send their students to school, they can’t go out to eat and they can’t go to a lot of places to work or to worship, I think that that’s the way we’re going to be able to crack that vaccine hesitancy. It’s not by conventional conversation, but it will be helped if we could shut down things that are demonstrably untrue and that are going to hurt people that honestly, the Twitters and the Facebooks are making plenty of money on by sort of feeding and fueling that controversy by being contrary to conventional public health.

David Williams:

All right, John. That’s what I like. Get that spirit up. You’re not quite at the rabid level, but you’re pretty strong. Last question for you, John, what’s back to school going to be like in August to September of 2022, routine, or where will we be?

John Driscoll:

The reality is we get better at managing COVID-19 every month with all of the problems and we’ve stopped testing, which is dumb of asymptomatics, but other than that, more and more people are getting vaccinated every day even with all of the suffering in those folks in the unvaccinated states. We’re getting smarter about mandates. We’re getting better about therapeutics and I think we’re going to be wiser about testing. I think 2022, I’m much more optimistic than this year, but I think we could also be in for a pretty rough winter, David, as more and more people are inside. It’s not just those schools that need to be ventilated. There’s a lot of places of work that you really need to be, we need to have standard measures of whether they’re safe to visit in work or not. And those aren’t available right now.

A lot of modern buildings, the way their HVAC is set up is they have no open windows. And so, I think we’re going to have to rethink our approach to work and school and space, but we’ll learn a lot in this winter, but once we’re through that, the incremental improvement on our ability to manage this virus while it’s endemic in our population, we get better every month. So I’m super optimistic actually about 2022.

David Williams:

Good, John. I’m looking forward to just having to worry about like did the dog eat my homework or are you going to steal my lunch money out on the playground. With that, let’s wrap up yet another edition of CareTalk. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. Thanks for listening and please subscribe.