On A Safe Return To School Buildings

Post-script: I stopped writing about science in August because I felt frustrated that no one was listening to me, that no one cared what I had to say. I've struggled with feeling like I have a duty to educate people about science at the same time I need to protect my own sanity and not waste time and energy on fruitless endeavors. As COVID cases rise around the country, I've decided to share the letter I sent to the school district I am employed by. 

In-person school resumed in my district on Thursday September 10th. By Wednesday September 16th, the high school needed to switch to fully remote instruction because of six COVID positive students. We resumed in-person instruction on Thursday October 1st. On Sunday October 18th, staff were notified that 3 new students had tested positive for COVID and the district and health department were monitoring the situation. By Thursday October 22nd, we were fully remote again as another 3 students had tested positive. We were scheduled to resume in-person instruction on Monday November 9th, but got an email on Sunday night that we will continue to be remote until at least November 30th. 

There are at least 23 kids who have tested positive in the past two weeks, with no end in sight to cases. The town health officer is reporting that some families are saying they will not keep their COVID positive or COVID exposed children home. There are parents signing a petition to demand 5 day a week in-person instruction. About 150 students marched to the Board of Ed on Monday to protest the halt of the fall sports season. 

Meanwhile, the United States continues to post record numbers of COVID infections - over 100k a day. New Jersey has been reporting more than 2000 new cases a day for a couple of weeks - today we hit over 3800. Union County's case positivity rate is above 7% - the recommendation for opening schools was predicated on low case positivity rates. The last time NJ had that many positives was in April, during the peak of the first wave. This virus is not going to go away with people continuing to act like it doesn't exist or isn't a big deal. How many deaths and permanent health effects will be enough? 

                      

August 13, 2020

Dear Doctor Dolan and Board of Education members,

First, I would like to say that I appreciate the hard work that members of the Westfield School District community have put into trying to develop a plan to reopen the physical school buildings. I understand that this was a herculean task given the short amount of time between when Governor Murphy and the NJDOE released their “The Road Back” document and when tentative plans needed to be submitted to the state. However, I am writing to document my concerns about the Westfield School District plan, as it currently exists.

For those who do not know me well, I have been a teacher at Westfield High School for 13 years and I am the parent of two rising freshmen. A few words about my background: I have a B.S. in biology and a Ph.D. in biomedical science, during which time I took advanced course work in immunology. I spent 8 years working in labs before making the career switch to science communication and education. Therefore, I am looking at reopening through the lens of science. A safe return to physical buildings is predicated on extremely low community transmission (<1 case / 100,000 people) and a robust system to detect community spread¹. Multiple public health experts from around the globe have stated that community spread of SARS-coV2 (COVID-19) is inevitable without the ability to test, contact trace and isolate individuals who are sick and have been exposed^2,3.

In New Jersey and around the country, we have seen delays of a week or more in getting COVID19 test results. Governor Murphy recently opined that the delays may get worse in the near future^4,5. Contact tracing has also been problematic in NJ, with Governor Murphy reporting that only 63% of COVID positive folks responded to contract tracers and then about 45% of those folks refused to provide information about their close contacts^6,7. Throughout the summer, New Jersey has witnessed an increase in the effective reproductive rate of the virus (R_t)⁸. Much of this uptick has been associated with younger cohorts assembling for social gatherings during the summer^9,10. No doubt you are aware of the fact that Westfield made national news in July for a spike in COVID in the under 25 group.

Even more alarming, as summer camps and schools have begun to reopen, we are witnessing unprecedented numbers of infected children^{11,12,13,14,15}. According to the American Academy of Pediatrics, between July 9 and August 6th, 179,990 children around the country tested positive – a 90% increase over previous reports¹⁶. This is likely an undercount, as it is estimated that as many as 40% of infected individuals are asymptomatic¹⁷. We’ve already begun to see southern schools shut down in response to outbreaks less than a week after reopening. One district in Georgia opened on August 3^rd and has already had to quarantine almost 1200 students and staff.¹⁸ We may not have the same COVID numbers as Georgia right now, but New Jersey is not special – the virus is still circulating in our communities and we will see increases in infections if we give it the right environment.

To address specific questions of the feasibility of a safe return to Westfield school buildings in September, I have gone through the district plan and frequently asked questions document to identify areas that I believe need to be addressed before students and staff return.

·       HVAC systems have a fresh air component to their operation. All filters for air conditioning units are maintained as per manufacturers’ recommendations based on the type of equipment.

There is growing evidence that SARS-coV2 is spread through certain air conditioning systems and that SARS-coV2 is airborne^19,20. For example, a recent hospital study showed that infectious virus could be found as far away at 17 feet from sick patients – the room had six air changes per hour and was fitted with efficient filters, ultraviolet irradiation and other safety measures to inactivate the virus before the air was reintroduced into the room²¹. How do our current systems compare to that? Does your statement mean that the school building systems are fitted with MERV13 filters that are most effective at removing viral particles? If not, what other systems are being explored to keep air quality as safe as possible (UV lights, etc)? How will you be addressing the air quality in classrooms that may have few windows, difficult to open windows or lack central air conditioning for cooling?

·       Face coverings are required for staff and students while in the building, unless it will inhibit an individual’s health as documented by a physician.

Research shows that cloth masks predominantly work by preventing expulsion of large quantities of infectious droplets into the air; cloth masks are not particularly effective at preventing uptake of particles once they are in the air. How will students and staff be protected from individuals who are not wearing masks in the school buildings? Will face shields be mandatory for these individuals to help minimize their respiratory droplets in the air? Will students not wearing masks have something to identify that they are in compliance with district policy? Will staff be responsible for ensuring that students (other than those with exemptions) are wearing their masks properly? If a student refuses to wear a mask properly and does not have an exemption, what is the course of action?

 ·       Mask breaks will be provided.

How will this be accomplished? Removing masks indoors even for short periods of time defeats the purpose of masking in the first place. If you are proposing students be outside the buildings in large numbers, how are you addressing security? You also reference that students will be able to fill water bottles in school. Will mask removal for drinking be allowed anywhere in the building?

·       Student desks and seating in classrooms, cafeterias, multi-purpose rooms, and other spaces will be placed 6 feet apart. When social distancing is not possible, physical barriers and other measures will be utilized to maintain safety.

How will safety drills be accomplished according to these guidelines? Will there be no more active shooter drills? How will distances be maintained during fire drills?

·       Schedules will accommodate limited mixing or passing of students in common areas such as hallways and bathrooms; cafeterias and gymnasiums may be utilized by small student cohorts to aid in social distancing protocols.

How will social distancing be enforced in the hallways between classes in the upper grade levels? Even with half the WHS student body, there is not enough space to keep all students 6 feet apart in all directions when traveling. How will bathroom usage be regulated so that students are not overcrowding or socializing in there? How will you ensure that enough bathrooms are available for staff so that they may remain apart? Recent studies have shown that SARS-coV2 is present in human waste and flushing toilets creates a vortex of potentially viral containing particles in the air^22,23. How will you minimize the viral particles in the bathrooms? Will the toilets have lids or self-flushing mechanisms installed if they do not already have those features? Will all sink faucets and soap dispensers also be automatic?

·       Staff is encouraged to use telephones and intercoms for interactions with the main office and colleagues in other classes to minimize staff-to-staff interaction and maintaining social distancing.

How will staff access to the faculty lounge and main office (where photocopiers/scanners are located) be regulated such that distancing can be maintained? How often will these high traffic spaces be cleaned? If staff are encouraged not to congregate, where will staff work when they are not teaching in a classroom if it is not possible to keep 6 feet apart in office or faculty lounge spaces?

·       Parents/guardians will be required to take the temperature of their child(ren) each morning no more than one hour before the start of school. They will manually enter the temperature reading into a daily online form that will include a brief health questionnaire regarding COVID-19 symptoms.

Public health officials have cautioned that temperature checks will not avert all community spread, as there are plenty of people who can be infected and not have a fever^24,25,26. However, asking parents and staff to check temperatures daily and report it using the honor system alone is foolhardy. It relies on everyone in the community acting responsibly and being considerate of others. However, we continue to see people all around the state (including Westfield) disregarding public health advice to use masks, keep socially distant and not have large gatherings. We know that students often come to school ill so that they do not miss days. How can we rely on the accuracy of these reports? If a parent does not enter a response for a particular student, how will the staff be alerted to this fact to prevent entrance of that student to the school building? Will students be expected to wait in a socially distanced lines to have staff check if their name is on the digital temperature form?

·       If a student or staff member is suspected to have COVID-19, the district will comply with the CDC and New Jersey Department of Health recommendations that the classroom and work areas where the student or staff member was located should be closed off for at least 24 hours prior to being cleaned, sanitized, and disinfected.

Where will instruction occur for classes whose classrooms need to be shut down for this process? In the upper grade levels (6-12), where an infected student or staff member may have moved through 4+ classrooms, how will this be feasible to find replacement rooms? Does that mean that all those classes must be taught 100% remote until the classroom is cleared?

·       If a student or staff member is exposed to COVID-19 at home and/or outside of the school building, they should self-quarantine and monitor symptoms for fourteen (14) days from the last date of exposure. Exposure is defined as being within 6 feet of a COVID-19 positive person for 10 minutes with or without wearing a mask.

There is no clear policy on how school community members (students and staff) who may have been exposed to someone who is COVID-19 positive at school will be notified of their risk nor how quarantining will be achieved. This is asking for community spread in our schools.

·       Each building will be cleaned, sanitized, and disinfected on a daily basis.

This was the practice pre-COVID. How will you address the fact that students and teachers in many of the school buildings change rooms multiple times throughout the day? How will classroom spaces be cleaned in between periods, if passing times are 10 minutes or less? If there is not enough custodial staff to sanitize each room between classes, do you believe it is appropriate to expect students or staff to clean work surfaces? Will there be any legal ramifications to staff if a student contracts COVID from a space they are assigned to clean?

·       Families will have the option to choose the A/B Hybrid Model or All Remote Learning.

I applaud Governor Murphy and the NJDOE for making the decision to allow families the flexibility to safeguard their children as they feel is necessary. One of my sons is asthmatic, as well as my husband, so I am grateful to be able to lower their risk of contracting COVID by having my boys do their instruction 100% remotely. However, I have serious concerns about the fact that the same consideration is not being afforded by the Governor to all the staff of school buildings. I am also concerned about educational equity between students who are engaged in hybrid instruction and fully remote instruction. What safeguards will be in place to ensure that equity is achieved between these two groups?

·       Teachers will broadcast live lessons during each of their assigned periods for students to take part in synchronous learning activities.

Teachers will be wearing facemasks at a minimum and potentially other PPE like face shields that could impair the quality of their enunciation for recordings. We have not yet tested the district’s servers’ ability to allow for livestreaming from every classroom. Last spring, there were problems with video quality when streaming through WebEx when we were not requiring every course to be synchronous. What has changed to fix this problem?

·       Per the New Jersey Department of Education, all school districts in New Jersey must resume some form of in-person instruction for September 2020.

This is not what “The Road Back” document states. Instead, it says “Accordingly, absent a shift in the public health data, school buildings will open in some capacity for in-person instruction and operations in the Fall.” It does not say that all students must be inside the buildings, nor does it say that in person instruction must resume in September. Today’s press conference gave further clarification on that point – if all safety guidelines cannot be met by September, districts do not need to open their doors to everyone. Many other districts are following public health authorities lead on this issue and are either remaining entirely remote for all students until later in the fall or opening the doors only to the youngest or most vulnerable students.

This will be my 14^th school year with the Westfield district. I have come to see Westfield as my home away from home and my colleagues as my extended family. I am incredibly proud of the students I have taught over the past 13 years. I have always looked forward to the start of the school year and meeting my next group of students. But this year, I want to keep everyone safe – my colleagues, all the students of Westfield, the families of our school community members – so that we may grow together for many years to come. Right now, I believe that means opening schools with 100% remote instruction in the fall.

Sincerely, 

Dana Philipps

Citations

1.     https://globalepidemics.org/wp-content/uploads/2020/07/pandemic_resilient_schools_briefing_72020.pdf

2.     https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions

3.     https://www.sciencemag.org/news/2020/07/school-openings-across-globe-suggest-ways-keep-coronavirus-bay-despite-outbreaks

4.     https://www.nj.com/coronavirus/2020/08/coronavirus-testing-delay-already-sucks-according-to-murphy-it-could-get-worse.html

5.     https://www.roi-nj.com/2020/07/22/healthcare/lagging-turnaround-times-on-tests-becoming-n-j-s-biggest-problem/

6.     https://www.nj.com/coronavirus/2020/08/most-nj-covid-19-patients-arent-giving-contact-tracers-the-information-they-need.html

7.     https://www.nj.com/coronavirus/2020/07/more-people-are-refusing-to-cooperate-with-coronavirus-contact-tracers-heres-why-that-could-spell-disaster.html

8.     https://www.nj.com/coronavirus/2020/08/njs-coronavirus-rate-of-transmission-is-rising-heres-how-its-calculated.html

9.     https://www.nj.com/coronavirus/2020/08/murphy-reverses-indoor-gathering-rules-in-nj-after-a-spike-in-the-spread-of-coronavirus.html

10.  https://www.nytimes.com/2020/07/30/nyregion/coronavirus-cases-nj.html

11.  https://www.wired.com/story/a-summer-camp-covid-19-outbreak-offers-back-to-school-lessons/

12.  https://www.businessinsider.com/covid-broke-out-at-our-kids-camp-this-is-what-school-will-look-like-2020-7

13.  https://www.nytimes.com/2020/08/04/world/middleeast/coronavirus-israel-schools-reopen.html

14.  https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.29.2001352

15.  https://www.wired.com/story/some-countries-reopened-schools-what-did-they-learn-about-kids-and-covid/

16.  https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/

17.  https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html

18.  https://www.nytimes.com/2020/08/12/us/georgia-school-coronavirus.html

19.  https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article

20.  https://news.harvard.edu/gazette/story/2020/06/air-conditioning-may-be-factor-in-covid-19-spread-in-the-south/

21.  https://www.nytimes.com/2020/08/11/health/coronavirus-aerosols-indoors.html

22.  https://www.nytimes.com/2020/06/16/health/coronavirus-toilets-flushing.html

23.  https://www.nationalgeographic.com/science/2020/06/could-flushing-public-toilet-plume-spread-coronavirus-cvd/#close

24.  https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/non-contact-temperature-assessment-devices-during-covid-19-pandemic

25.  https://www.statnews.com/2020/07/02/smell-tests-temperature-checks-covid19/

26.  https://www.businessinsider.com/temperature-checks-flawed-coronavirus-cases-asymptomatic-no-fever-2020-5

Calculating and Interpreting R Values

https://www.nature.com/articles/d41586-020-02009-w

https://www.cebm.net/covid-19/when-will-it-be-over-an-introduction-to-viral-reproduction-numbers-r0-and-re/

Airborne SARS-coV2 and Ventilation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182754/

https://jamanetwork.com/journals/jama/fullarticle/2766821

https://www.epa.gov/coronavirus/indoor-air-and-coronavirus-covid-19

https://www.wbur.org/hereandnow/2020/07/15/coronavirus-indoor-air-conditioning

https://www.forbes.com/sites/brucelee/2020/05/14/here-is-more-evidence-for-face-mask-use-with-covid-19-coronavirus/#4e6233671060

https://www.ashrae.org/technical-resources/reopening-of-schools-and-universities

https://www.epa.gov/coronavirus/air-cleaners-hvac-filters-and-coronavirus-covid-19

https://www.energyvanguard.com/blog/can-your-hvac-system-filter-out-coronavirus

COVID19 in Children

https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e3.htm?s

On Loss, Personal and Collective

Written May 7, 2020

Separation 

by W.S. Merwin

Your absence has gone through me 

Like thread through a needle. 

Everything I do is stitched with its color. 

Let me preface this post: I won't pretend to be a mental health expert. I'm merely speaking as someone who spends a great deal of time observing the world and has had direct personal experience with both loss and mental illness. 

On March 12th of last year, just around 1 AM, my mother in law's courageous 20+ year-long battle with breast cancer ended. I was 8.5 months pregnant with my youngest son, the grandchild she first asked me about on my wedding day. The baby we were anxiously awaiting after 3 miscarriages in a row. For two years straight, my personal life was tinged with death. When Griffin arrived on March 30th of last year, my husband and I were still deeply mourning the loss of Mom, but we finally felt there was something to look forward to after so much sadness. Fast forward to this March. We were planning a celebration of Griffin's first birthday - the first time we'd see many of our large extended family since Mom's funeral. The pandemic threw a monkey wrench in those plans.

The scale of collective loss is something we haven't experienced in my lifetime. Over 70,000 Americans dead in a month, over 8000 in New Jersey alone. We've been fortunate thus far. No one we love has died. We still have enough income to pay our mortgage and food bills - I can work from home, though my husband has to go to work where he is risking exposure to the virus weekly. So far we are healthy. I know that not everyone has been so lucky. My heart breaks a little more with each death I read about and each family thrown into chaos by loss. I also worry for the small business owners like my father and employees who have been let go and can't find work or get enough unemployment to pay bills like my eldest son. It's easy to get sucked into a spiral of anxiety and depression.

Full Poem Source: Jay Hulme

I've heard several people say "The cure can't be worse than the disease", as though repealing shelter in place orders will fix what is ailing us. I've heard people claim that more people will die due to alcohol and drug addictions or suicide because of the shelter in place than will die because of the virus. As a person who has dealt with suicidal ideations since childhood, I reject both of these statements.

Hardship is not worse than death. Hardship is temporary, death is permanent. Suicide doesn't end pain; it simply transfers it.

Source: VailDaily

I'm not naive. There certainly will be people who die from addiction and suicide because the pandemic has impacted their mental health - the 1918 pandemic taught us that. Some tragic stories like that of Dr. Lorna Breen have already been reported. However, we now have tools to help people cope with their demons. We can be proactive to minimize risk. 

Need a lifeline? Call 1 800 273 8255.

So what do the mental health experts say we should do? A consortium of psychiatrists and other mental health professionals developed a short position paper about the steps we can take.

Lancet: Strategies for Mitigating Suicide Risk

They recommend that we implement universal interventions that will support individuals not previously known to have mental health challenges at the same time we are applying specific, selective interventions for people known to be facing a crisis. The general interventions recommended...

1. Government provided safety nets to help deal with pandemic related financial stressors
2. Government provided support for individuals needing to escape domestic violence
3. Public health education about alcohol consumption 
4. Find creative ways for community members to remain engaged with each other when person to person contact is not possible
5. Monitoring access to means and reporting suspicious behavior
6. Reinforce guidelines on responsible media reporting, in order to not encourage suicidal behavior

I understand the desire to return to "normal". But right now, that's not possible. I understand grieving for what we've lost and what we are missing. Now is the time to think outside the box, to figure out new ways of doing the business of being human, in order to keep as many people healthy as possible. If we take away nothing else from this global crisis, it should be that people need other people (even if that means keeping apart) and that both individuals and society as a whole are better when we work together. So let's be careful out there...

Why Facts Should Matter But They Often Don't

Note: I wrote this post on May 15, 2020, but forgot to share it. In light of everything that has happened in the past few weeks, I think it is still timely.

We, humans, take for granted our ability to reason - that is to make sense of the world in a logical fashion, to easily separate fact from fiction - and erroneously believe that we are correct in our beliefs most of the time. Cognitive scientists and evolutionary biologists suspect this ability to accept false beliefs begins around the age of 4 to 5 and helped our species survive.

Since we are hardwired to look for patterns that match with the mental maps that formed during our own development, we often seek out information that appears to reinforce our pre-existing beliefs about how things work. This is known as confirmation bias (*NOTE: there are many other kinds of bias).

More than four decades ago, researchers at Stanford found that even when people were told they were intentionally misled about their ability to assess information, those people's initial impressions about how accurate they were at the task remained. In other words, if the research subjects thought they were better than average at a task, they continued to believe that even when provided evidence that they were not.

This is why in large part giving someone with an erroneous false belief the evidence necessary to reject their thinking, they often don't change their minds. And this is why conspiracy theories are also hugely popular.

So how can you help convince someone to reexamine strongly held beliefs? The first thing to do is to identify the other person's major concerns and shared values. People are more likely to consider what you have to say if they believe you have some common ground. 

It's important to be aware of these brain tendencies because if we aren't and we act irrationally, we can make mistakes that have significant, long-lasting impacts on society. Like rushing to pull NIH funding from EcoHealth Alliance, a leader in surveillance of zoonotic diseases including coronaviruses in the middle of a global pandemic because of a conspiracy narrative...

More videos on these topics:

12 Cognitive Biases Explained

Why You Think You're Right - Even If You Are Wrong

How You Can Change Someone's Mind

Science 101 or How to Spot A Grifter

Right now there's a barrage of conflicting information regarding SARS-coV2 swirling about the internet.  It can make it challenging for people without a solid science education to know how to interpret what's out there. I will admit, typically when I read pseudoscience conspiracy theory mumbo jumbo, I roll my eyes and ignore it. I even think to myself "How ridiculous!" Or more pointedly "How farcking stupid can you get?" It's easy if you have the tools to interpret scientific BS to get frustrated and overwhelmed by the ignorance and charlatanism that is freely propagated on the web and dismiss it offhand. But now that it's misinformation about a deadly infectious disease, I feel some sort of obligation to speak out. 

So let's start at the beginning - the nature of science. This is the first unit I do with my Biology 1 students each year because I really do see teaching them scientific literacy my primary goal - all the cool facts about how life works we talk about are just icing on the cake. Science comes from the Latin word scientia meaning "to know". It is a process of inquiry designed to help us understand how the natural world works. It is cumulative in nature, meaning that scientists are constantly revising their explanations of how and why things happen as they gain new knowledge. I always tell my students changing your mind in science isn't "flip-flopping" - it's good science. If you refuse to change your understanding of a phenomenon when presented with multiple lines of evidence showing you that your original idea was incorrect, you've failed. 

It's also important to note that scientists who are being ethical don't speak in absolutes. They don't tell you they are 100% certain of anything because they are smart enough to realize it's impossible to know everything we don't know and it's impossible to avoid making mistakes. To be a scientist or at least think like one, you need to be open to critically evaluate all information you come across and be aware that we all have biases that color our interpretations. And most importantly, it's OK to say "I don't know" and be willing to ask for help to find an answer to a question you have.

Source: Berkeley's Understanding Science

In the process of doing science, we ask questions about the world around us and we develop hypotheses - that is testable solutions or answers to our questions. In order for something to be a scientific hypothesis, it must be testable and those results must be replicable by others, in order to verify whether we should support or reject the hypothesis. Science is a collaborative effort and communication between researchers is critical to developing solid understanding. Typically, scientists work in relatively small group collaborations - a lab group - focused on a small subset of scientific questions or problems. They become a sort of expert unit - all discussing and sharing knowledge of the topic they are examining. The reality is that research is expensive and that solving big questions requires different perspectives and talents. So labs that are interested in the same topics often work together to share resources and sometimes they compete. 

When a sufficient amount of work has been completed to make a cogent argument about what the data means, scientists will write up their findings and submit them to scientific journals or professional meetings. Usually, to have work published means that research has been subjected to peer review - meaning other folks with the training to allow them to evaluate the claims being made by the authors have already critiqued the paper before it was published. And the peer review process doesn't stop once a paper is published - other scientists will try to replicate and verify the results based on the reagents and methodologies presented in the paper. If other labs cannot independently verify the claims, the paper is retracted. So is this process of vetting perfect? Absolutely not. Scientists are human after all - they make mistakes. But generally, bullshit is eventually detected and routed out.

Source: Berkeley's Understanding Science

Because of the seriousness of the COVID19 pandemic, non-scientists are getting to watch the process of science in real-time in a way they haven't before. Results are being released without traditional peer review (see my previous blog post for more details). Scientists who aren't accustomed to presenting data to the general public are finding themselves thrust onto the media. I'm sure this can make it look like scientists don't know what they are doing. But the truth is, you're just witnessing the sausage being made, rather than just enjoying how it tastes in the end. 

Another rather disturbing trend that has been going on for a while is the disregard of expertise. That's not to say that authority reigns supreme in science - paradigm shifts can be generated by up and comers and established scientists can be shown to be wrong. But everyone seems to think that their 20 minutes of Google "research" is equivalent to entire professional lives dedicated to the careful study of something. Isaac Asimov, the great biochemist and author, was quoted in 1980 as saying:

The availability of information on the internet, the ease with which people can make a source look reputable, the staggering amounts of money people can make by sharing their modern snake oil... It's a toxic mix. 

The latest malarkey I've seen shared by multiple friends, acquaintances and community members is a video claiming Anthony Fauci and others in infectious disease masterminded this pandemic. No, I'm not sharing the video nor am I wasting my time to individually break down each false claim it purports. Not because I'm a corporate shill (I have no connection to any pharmaceutical company) or because I'm a sheeple (pretty sure my PhD level education has actually taught me to be more critical than the average bear). But because I refuse to be a part of the misinformation machine that contributes to people's deaths. I will, however, call out the disgraced scientist who features prominently in it. Because people like Judy Mikovits are arguably the worst - people who earn degrees in science and medicine and then use that degree to grift others. Mikovits is not some hero or influential researcher; she was a mid-level scientist whose own decisions tanked her career (after her work on chronic fatigue was disproved she was fired from a private lab in 2011 and arrested for stealing intellectual property) and now makes a living off of writing books and pushing conspiracy theories. She's a shameless self-promoter. F*ck Judy Mikovits and others of her ilk.

So what's an average Joe or Jane to do? First, if it sounds too good to be true, it's probably not true. Recognize that the "I'm just fighting the establishment on your behalf" narrative is just that - a narrative to elevate someone's importance and gain your trust. Avoid sensational headlines - they are designed to capture attention and generate revenue. If you must read or watch something that seems like it is dancing into pseudoscience or conspiracy territory, do so with a healthy level of skepticism and critical thinking. I teach my students that if they make a claim, they must support their claim with verifiable evidence and be able to clearly explain their reasoning - in other words can you show the link between that particular evidence supporting your claims? Astronomer Carl Sagan is oft-quoted about the need for evidence:

Click here to hear Sagan speak on this in 1995.

Perhaps the most important thing you can do is to NOT SHARE INFORMATION THAT HASN'T BEEN FACT CHECKED. You cannot control the deluge of preliminary or shaky science, alternative facts, and fake news. But you CAN and should prevent the spread of misinformation. Remember the old Smoky the Bear campaign - only you can prevent forest fires? Well, folks, only you can prevent misinformation dumpster fires. You can quote me on that.

For more information on pseudoscience, battling bunk and why people believe weird stuff: here, here, here, and here. You should also probably check out the two infographics below:

Source: Compound Interest

Source: The Skeptical Cardiologist

School's Out (Sort of)

As of 3 days ago, CNN reported that 44 states as well as DC had chosen to close their schools for the remainder of the school year. Today, Governor Murphy announced that NJ will follow suit.

Of course, closure of the physical schools does not necessarily mean no instruction. Still, a lot of people are upset by the closures and I've seen a lot of refrains like "No children have died from COVID19" (not true) or "Kids can't even spread COVID19" (also not true). So let's look at some facts about children and COVID19.

According to the CDC, as of April 2nd, 22% of the US population are children under the age of 18. Among the positive COVID19 tests we had on that date, 1.7% were children under the age of 18. Data from Italy also suggested about 1% of their COVID19 positive patients were 18 or less. At face value, this seems to indicate the children catch COVID19 less frequently than expected. However, keep in mind that access to testing has been difficult in many places and that a lot of folks were not being tested even if they had obvious symptoms. 

A recent article out of Iceland that did random testing of almost 10k high risk people (with known travel to areas with outbreaks or potential contact with sick folks) found that children older than 10 had a 13.7% infection rate, which was comparable to all age groups classed together (13.3%). Children under the age of 10 were positive at a lower frequency (6.7%). Another new study from China showed that 7% of children with close exposure to others with COVID19 became infected, which was similar to the other age groups. Children with COVID19 were also more likely to have less severe symptoms or no fever.

Source: Lancet

So right now, at best we can say children MAY be infected at lower rates than older people, but the most likely scenario is that children who are infected are simply more likely to be asymptomatic or have less severe disease and therefore not be tested in the first place. Assuming your child doesn't have other underlying medical conditions, the data seems to suggest that most kids who get sick won't require hospitalization and the vast majority of them won't die. This is great news for parents worried about their kids. 

So why keep the schools closed? There's no evidence to suggest that infected children are less infectious than adults. In fact, a recent study out of Germany suggests that in spite of less clinically severe disease, children appear to have viral loads comparable to other age groups studied.

Source: Article Pre-print from Christian Drosten

So it's very possible that although children have less severe disease, they could be a major contributor to COVID19 spread to more vulnerable populations (read: everybody above 18). In a 2011 study from France, it was estimated that each elementary school age child has 323 contacts with approximately 47 individuals throughout the school day. 

Source: PLOS ONE

The school I work in has nearly 2000 students plus 200 staff members for a building that was designed for a population of 700 in the 1950s. It is simply impossible to use social distancing in this sort of environment. (And I'm certain our school building isn't the only one with a similar logistics problem.) Young children cannot wear masks and even asking older children, like the teens I teach, to wear masks for 6 to 7 hours a day is not really viable either. Combine that with the fact that a recent CDC analysis of Chinese outbreak data suggests that the R0 (reproductive rate of the virus) is probably closer to 5 to 6, than the initial 2 to 3 reported, one should come to the conclusion that asymptomatic children + open schools = massive disease spread.

Let's use my school as an example. Assume that shelter in place and social distancing rules are either relaxed or ignored and that 7-13% of the student population becomes infected. That's about 140-260 students. Each one of those students is then likely to infect 5 people. That's another 700-1300 people infected within 2 weeks or so. And another 3500-6500 people in the next two weeks... And so on and so forth. You get the picture.

So while it may be frustrating for families and educators alike and even heartbreaking for many students for physical schools to be closed for the rest of the 2019-2020 school year, Governor Murphy and other governors making this call are doing what they can to save as many people as possible. And I, for one, am thankful.

For more information on pediatric COVID19, check out this review.

Facts Matter: A Twitter Thread

There's a saying that there are 3 sides to every story. What you think happened, what "they" think happened, and what actually happened. Right now there's a story circulating on conservative media about funding of the Wuhan Institute of Virology. Begin thread to get to the truth.*

The claim circulating is that WIV was awarded a $3.7mil grant from NIAID under President Obama's administration and that illegal viral research was the reason we have #covid19. I was first made aware of this story on April 21 by my father who texted me about it.

I didn't know the specifics of where he was getting that idea, but I did my best to explain BSL4 labs and that any funding to WIV was likely a response to the knowledge that Sars-coV1 emerged in a bat populations in 2003. And that research on viruses wasn't illegal.

I will admit that after that conversation I didn't think about the narrative much. But now I see that Rudy Guiliani and others are actively trying to amplify this narrative to discredit Dr. Fauci's expertise and cast another shadow on the Obama administration.

Make a claim, you have to evidence to back it up.

So let's breakdown these claims. Aside from the glaring mistake that the Obama administration couldn't have awarded a grant in 2017, did the NIAID award money to WIV at any point in time? The short answer is yes - sort of. But then again so did the Trump administration.

Background: some of the first sources to make the claim that Obama era NIAID funded WIV were FL rep Matt Gaetz and the UK Daily Mail. They cited a Nov 2017 paper from researchers at WIV on coronaviruses as proof. Just a reminder that Gaetz showed up to work like this on 3/4.

Very subtle.

The paper in question can be read here: https://tinyurl.com/vp8vwbk

The funding in question is highlighted here. NIAID is the NIH institute that focuses on infectious disease. It's pretty easy to look up grants using R01 numbers. So let's see who the money was awarded to.

All research papers disclose the source of funding.

The grant was for a project entitled "UNDERSTANDING THE RISK OF BAT CORONAVIRUS EMERGENCE" and it was actually made to a non-profit in NY called EcoHealth Alliance. Their stated purpose is to aid scientists around the world to prevent pandemics.

EcoHealth Alliance Mission Statement

You can learn more about them on their Twitter feed. https://twitter.com/EcoHealthNYC/

So in 2014, the NIAID awarded $666,442 to EcoHealth Alliance for a project to study bat coronaviruses. This project was renewed in 2015, 2016, 2017, 2018, and 2019. The total money awarded to date is where the $3.7mil figure comes from.

EcoHealth Alliance distributed funds to researchers in multiple labs globally studying bat coronaviruses, including to WIV. Quite a few papers have been published that cite this R01 grant. A lot of work does center in China because that's where the bat reservoirs are.

One recent paper partially supported by R01AI110964

So the first part of the claim - that all $3.7mil went to WIV - is false. The funding was spread over 5 years, which spans both the Obama and Trump administrations. Let's consider the second part of the claim - that such grants were prohibited in 2014.

In October 2014, the Obama administration announced that they were pausing new funding related to gain-of-function research for influenza, SARS, and MERs. Gain-of-function is the key phrase here.

2014 White House Announcement

There was definitely a bit of debate about this type of research - engineering viruses known to cause human disease - because of mistakes made in certain labs. Here's an NPR piece from Nov 2014 about the moratorium.

So does that mean that research funded by R01AI110964 was prohibited? No. The research funded by this grant has centered on tracking and identifying naturally occurring coronaviruses - not engineering them. The research was carried out in facilities equipped to do that work.

Additionally, EcoHealth Alliance earned the initial grant award in May 2014 before the moratorium. The subsequent renewals indicate that the research funded by the grant money did not violate the moratorium. Otherwise the grant would not have been renewed.

For those of you who are curious, the US moratorium on funding for research into engineering viruses was lifted in December 2017. Who was president then?

HINT: Not President Obama

Rudy's claim #2 is false as well. So what's the truth? In 2014, EcoHealth Alliance applied for a grant to study coronaviruses because they posed a risk to human health. The funds they were awarded by NIAID were given to multiple research partners including those at WIV.

The grant was renewed for 5 years during both the Obama and Trump administrations. None of the published work funded by the research grant was gain-of-function experiments. However, it has been "legal" to do that work since Dec 2017 under Trump's administration.

The reality is that to prevent future global pandemics (and to deal with this one for that matter) we need all experts to be able to study emerging viruses, their reservoirs and collaborate. It cannot be an US versus them approach (pun intended).

And with that, I'm done.

* This post was previously a thread on Twitter.

get to the truth.