Some observations, analysis and opinions on COVID-19 and "reopening. I appreciate any of my former colleagues and current friends correcting anything I got wrong.
-- Warning, it's a bit long --
I favor a hazard reduction approach to protecting yourself and others from COVID-19.
It appears, now, that fomites (inanimate objects) aren't a very efficient route of transmission. That's not to say they can't be, just that it isn't likely relative to droplet spread. There hasn't been much published on the risk of fecal oral or fecal face spread but I suspect it plays a larger role in institutional spread than fomites and may come close to droplet spread. I think in a classroom of young children it may be an understudied risk.
One thing to keep in mind about asymptomatic or pre-symptomatic carriers is that they are probably not efficient carriers. By that I mean because they aren't coughing or sneezing they aren't propelling a lot of virus into the environment. They are capable of spreading the virus, but not particularly well.
When you hear or read about fomite spread you need to differentiate between very brief intervals between the object being contaminated and someone getting exposed, versus an object being contaminated and then being undisturbed for several hours. Or, several minutes if outside and exposed to UV, high temps (>90F), or wind. Almost all studies showing SARS COV-2 surviving for hours and days on surfaces or in the air reflect lab conditions, not real world/real environment conditions; and literature that report those studies make that distinction.
So, the significant danger for most of us is droplet spread from people expelling virus contained in particles usually 6 to 12 feet away from us, farther if forcibly expelled by an explosive sneeze, forceful cough or spitting. Or if you're in a crowded area with a lot of people expelling the virus by singing, talking loudly to be heard over a lot of background noise, etc.
There is definitely a time-dose relationship between who gets COVID-19 and who doesn't.
So what do I mean by harm or hazard reduction: the simplest thing is wear a mask (which depending on the quality -- assuming it's not N-95 -- reduces your exposure chances 20-50%. Your mask also reduces risk to others around you up to 90% (source control)). If you encounter someone not wearing a mask give them a wide berth, maybe 20 feet.
Spend as little time as possible in indoor facilities; if you go to the store get what you went for, pay and get out. There is no need to walk the aisles looking for that impulse buy you know is waiting for you, or to socialize with neighbors.
Keep hand sanitizer with you and use it liberally after you've been in the store or bought gas, etc.
These suggestions are for people who may be incidentally or casually exposed, who aren't in high risk situations or occupations. And, of course, who aren't physiologically at higher risk.
People who face institutional exposure need to understand the mechanics of exposure in their particular environments. Most concerning are people who work directly with COVID-19 patients; most are already trained and educated in how to work in such a high risk environment. As long as they have sufficient personal protective equipment (PPE) and are able to follow the buddy principal and other safety protocols, they can operate safely.
Front-line responders, ER workers, primary care clinic workers face greater challenges because they don't know who is a carrier and who has hay fever or a simple cough or cold until they have done a preliminary exam. They have to take as many precautions as they can without making it impossible to do their jobs.
The people I worry most about are service workers who deal with an unending stream of the public, some of whom refuse to wear masks or wear them improperly, or think their constitutional rights include close, loud berating of the person trying to get their coffee or check out their groceries. I don't understand why stores don't refuse admission to people who won't mask or mask properly. Through such neglect, they put their employees and customers at risk to mollify selfish ignoramuses. It seems like such a poor return.
And then we get to reopening schools and assessing risk to students, teachers, administrative and support staffs.
Studies indicate that young children (think K-5) are at a significantly lower risk of getting infected. It may be their respiratory systems don't, at that age, retain particle in the lungs long enough, or pull them in deep enough, to cause infection. (I hypothesize that may be an evolutionary advantage to protect the species' young from some of our ancient diseases, tuberculosis among others.) However, starting around age 10, children do appear to become exposed and able to spread the virus at a level approaching that of adults. Since children are physiologically different, some have stronger immune systems than others and some are more heavily exposed at home and in their non-school environment (remember, it's a time-dose relationship) you can't draw a hard fast line at age 10 and say that those on one side are okay and those on the other side aren't.
The school reopening proposals I've looked at tend to be similar; reduced class sizes and somewhat reduced contact hours for K-5 with increasingly reduced contact hours for children in intermediate and secondary grades. Many are offering blended and 100% online options. If school districts are able to ensure good ventilation in their buildings, sufficient distance between students in the classrooms, enough teachers to staff classrooms with half the students they're normally staffed for, it might work. But that's a big if, considering our public schools were strapped financially for decades before the current fatwa against public education was issued by our current administration and Department of Education.
So now that we're talking politics and policy, let's jump right in. The United States has a lousy primary health care system and -- thanks to COVID-19 and serious incompetence at the federal and (some) states' level -- a tertiary care system that is in deep trouble. We also have a lot of children who live in poverty and suffer poor health and malnutrition and, consequently, have compromised immune systems. And many of those children live in dire circumstances that are invisible to their communities. In short, we know who, theoretically, is at risk but can only grasp at who is really at risk. And, our government(s) propose to put those children and their teachers and families together in an extended "grand experiment," to what end?
Yes, other countries have seen their kids back to school and appear to be pulling it off. Those countries did the hard work, made the hard choices and made the sacrifices needed to get them to the point that they could. At our national and (some) states' level, our leaders deluded themselves or outright lied about the disease and its dangers. They tanked the economy, and political futures, in doing so. Now they want to "reopen" and "get America working again," and they want our children and grandchildren to be their cannon-fodder.
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