Should Schools Reopen?

"I think this is another foul-up on the part of the baby boomers. I am a real baby boomer — I was born in 1947, I am almost 73 years old — but I think we’ve really screwed up. We’ve caused pollution, we’ve allowed the world’s population to increase threefold in my lifetime, we’ve caused the problems of global warming and now we’ve left your generation with a real mess in order to save a relatively small number of very old people. "  Nobel Laureate Michael Levitt from Unherd. com

Weekly Covid-19 Hospitalization Rates/100K: 18:29 years and 65+ years
from https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html Click to enlarge the Chart.

Key talking point: "What does it mean for this age to be separated from their social contacts at high school and college? How do the ~6000 yearly suicides in the 15 - 24 year age group compare to any potential losses from Covid-19? Currently, in hospital Covid-19 deaths for 18 - 49 total 57 for the year 2020."

I have seen the effects of my children living in the world of online education. I think we need to take a deep breath and remember that life is not without risk and that all risk needs balancing.  My concern is that the threat to children and students from Covid-19 is overblown and that we are simply and selfishly attempting to protect the elderly at the expense of the future of youth. This is wrong. Of course, monitoring and infection control has to be done to keep students safe. Protocols and technology will be needed.

Let's hope those protocols for infections control are applied more carefully than they were for US nursing homes. According to the NYT 55,000 or 40% of all Covid-19 deaths (as of July 7) were related to workers or patients of nursing homes: This includes 57% of deaths in WA state. If you wanted to worry about Covid-19 deaths, you could spend your time more usefully worrying over infection control practices in nursing homes because we are not through with Covid-19 in those institutions yet.

As far as I can tell Britain, France, Germany are all planning on reopening (primary) schools. [See links at bottom.] The problem now seems to be FLA, TX, CA which are the three most populous U.S. states. But who really knows what this disease will do: It's one thing, one month and another the next. It reminds me of 'Advanced Persistent Threat' ("APT') which is was originally a state based cyber penetration and data ex-filtration strategy that has functionality that changes the nature of malware in response to the intrusion prevention efforts. Like "APT" Covid-19 has proven fundamentally unpredictable for medicine and virology: transmission, etiology, disease sites, targets, immunity. As I read the 100s of pre-prints and debate/listen to virologist and epidemiologist on Twitter, sometimes it feels as if someone is reprogramming the virus each month. So at the very least, consistent monitoring and flexible solutions are needed if deaths and disease spike.

I am doubtful that young people are being hit hard by Covid-19 based upon any meaningful age comparison. Probably they have been tested more recently, which is something we don't do with most influenza, a disease which also kills ~ 2000 under the age of 44 each year in the U.S. CDC serologic testing has admitted a possible 10x increase in positive serologic results over Covid-19 number of cases. Which potentially means millions of citizens are or have been positive. That number probably isn't fully understood yet. I suspect it is probably much larger. But in some sense, only the death data is quantifiable and real. Lots of people get the flu for all ages for example. As for Covid-19, most or all flu deaths are older Americans. Influenza and pneumonia kill at least 55K (2017) each year without Covid-19. The actual Covid-19 CDC data page for week 27 (ending July 5) summarizes the PIC epidemic status like this:

"Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 6.9% during week 26 to 5.5% during week 27, representing the eleventh week of a declining percentage of deaths due to PIC. The percentage is currently below the epidemic threshold but will likely change as more death certificates are processed, particularly for recent weeks."

The CDC in that same update summarizes hospitalization rates like this:

"Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative COVID-19 hospitalization rate is 107.2 per 100,000, with the highest rates in people aged 65 years and older (316.9 per 100,000) and 50-64 years (161.7 per 100,000)."

In the pdf is a chart and table on page 7,8  with cumulative hospitalization rate numbers. I never trust rate adjustments unless I can review the code myself:

Age Groups: Cumulative Hospitalization Rate per 100,000 Population

• 107.2 # Overall
• 0-4 years 9.4
• 5-17 years 4.4
• 18-49 years 66.7 #  not very granular age group
• 18-29 years 37.8 #  This would be more informative if broken down into specific years
• 30-39 years 66.3
• 40-49 years 104.4
• 50-64 years 161.7

Remember these groups below are going to lose many people to deaths in any year. Much more so that younger age groups:

• 65+ years 316.9 
• 65-74 years 230.6 
• 75-84 years 381.5
• 85+ years 590.3 

If you look at Short Term Mortality Fluctuation, the US definitely have lost a lot of people in March, April, May in the US compared to previous years. Numbers below are totals per year as of week 25 (ending June 14, 2020):

Year USA total deaths through week 25

• 2018 1412542
• 2019 1398647
• 2020 1492576

But you can see also the rapid declines in deaths in the last few weeks in the table below. This could mean some serious number of those previous Covid-19 deaths would have been deaths this year anyway from other illnesses. Covid-19 is presumably catching them before generic pneumonia, flu, stroke, heart attack, stroke, etc.:

         Wk 2018  2019    2020 through week 25

• 23 51998 53126 51565
• 24 51383 52626 45912 #decline
• 25 51043 52266 33577 #decline

So I wouldn't belittle the threat of Covid-19 to any age group. But life is full of threats. At some point, one them is going to kill you. Death is much more eminent over 44 in the US than under because of clinical disease. Under 44, you are most likely to die in an unintentional accident, usually from MVT or drug use (motor vehicle trauma, drug overdose). Over 44, there is just all manner of diseases that will kill us. For example, the 'new cancer case' rate is 435/100K in WA. Nearly 38K get cancer every year in WA. https://gis.cdc.gov/Cancer/USCS/DataViz.html. For more on deaths under 44 see https://www.cdc.gov/injury/wisqars/animated-leading-causes.html

Many of us are following Nobel Laureate Michael Levitt's HIT (herd immunity threshold) work (http://med.stanford.edu/levitt/research.html) which uses a modified Gompertz function to show that herd immunity starts as the SARS-CoV-2 virus nears infection rates of 20% of a populace. See https://www.medrxiv.org/content/10.1101/2020.06.26.20140814v2 . This reputedly leads to about 500 - 600 deaths per million [see M Levitt comment here]. whereupon the virus cases and deaths drop precipitously because they "run out of easy to find targets". This is what appears to have happened in Sweden and elsewhere. By this math, the US is still short of that 500 - 600/million death rate:

330M * 500/1M
165,000

330M * 600/1M
198,000

Professor Levitt had some choice and controversial words for the rest of Nobel, epidemiological and science community recently. He thinks the lockdowns may have hurt more than they helped and resulted from poor data analysis: https://www.youtube.com/watch?v=AOUnO0cbhTA .  I have charts of deaths and cases for states with over 7M populations for July 14 here: https://www.ncovd.org/2020/07/us-states-over-7m-in-population-covid.html

Outside of nursing homes and select essential workers (e.g. hospital, agricultural, line workers), I just don't see Covid-19 ripping through our population killing people like it did in March. Maybe another 60K for ~ 200K total Covid-19 deaths this year. Even if Covid-19 begins to reach higher numbers, do we really want to shut down our lives, our economy or especially the lives of the young over such a relatively small number of deaths? We lose 2.8M in a normal year ((7700/day, 235K/month) : https://www.cdc.gov/nchs/fastats/deaths.htm .

With Covid-19, we are talking about one month's worth of additional deaths, mostly from 65 plus. People my age or older aren't going to solve the great technical problems of our age. We need lots of youth in the body shops of high speed computing, genetic analysis, virology, mathematics,etc. to solve/prevent the next viral threat. Without the social contact and resources of a school, I think some number of students will just get lost and drop out. And this apparently is a real concern: https://www.insidehighered.com/admissions/article/2020/04/29/colleges-could-lose-20-percent-students-analysis-says  Suicides are very high and the second leading cause of death now for the 15 - 24 year age group in America. What does it mean for this age to be separated from their social contacts at high school and college? How do the ~6000 yearly suicides in that 15 - 24 year age group compare to any potential losses from Covid-19? Currently, in hospital Covid-19 deaths for 18 - 49 total 57 for the year 2020.

We may have a vaccine(s) or anti-viral(s) at some point.  There is a  lot of money being pumped into solving Covid-19. See here:

• https://clinicaltrials.gov/ct2/results?cond=COVID-19  
• https://catalyst.phrma.org/new-report-shows-nearly-260-vaccines-in-development-including-dozens-for-covid-19 
• https://phrma.org/coronavirus.

But remember, no one has ever created a vaccine for any Coronavirus to date.

School opening (probably non university) links for Britian, Germany, France:
https://www.startribune.com/the-latest-india-s-virus-cases-jump-by-another-28-000/571755882/
https://www.cnbc.com/2020/07/14/schools-coronavirus-infection-rate-low-german-study-finds.html
https://www.medscape.com/viewarticle/933244