I haven’t had much of a chance to write lately, but there are so many things that I want to comment on. So here are a few quick thoughts:
The Peter Navarro piece in USA Today about Tony Fauci was a total joke. It reminded me of what a middle school student would have written if forced to take the Con side in a debate where Pro was obviously correct. “Dr. Anthony Fauci has a good bedside manner with the public, but he has been wrong about everything I have interacted with him on.” It’s just nut. USA Today is getting serious grief for running that, as well they should. But Navarro and Trump are the ones who should really take a beating.
COVID-19 is badly increasing disparities. The stock market is rising and high end homes and cars are selling fine. Private school students are being educated and getting specially designed internships. Meanwhile, lower income jobs are getting squeezed, public schools have given up, and summer jobs for teens are hard to come by.
We continue to dig a deeper hole. Massachusetts and neighboring states are doing relatively well –but the South and West are in serious trouble. Eventually they will take us down with them if the fire keeps raging out of control. We can’t even agree on the lowest common denominator –wearing a mask
Speaking of which, looks like Walmart and other retailers have become our new public health department. There’s no national mask policy and some states won’t impose them. So now it’s up to the retailers to step in.
Looks like private companies may have to take over data collection, too as the White House bypasses the CDC for infection reporting
Donald Trump, the CDC and much of the rest of the federal government have demonstrated sustained incompetence on getting testing going…
The obvious answer is to enlist the adult film industry in returning the economy to normalcy. The industry has operated a testing system successfully for years to stave off threats of infections from HIV and other sexually transmitted diseases.
I went on to describe the PASS system that had operated successfully for a decade, with frequent testing and follow-up. I encouraged employers to do something similar.
Employers haven’t really taken this on, but one sector of the economy is not only adopting this approach but taking it to the next level. Some high-end private colleges and universities are determined to return to campus this fall. Online classes are ok but they are a very poor substitute for the in-person experience and are frankly not worth the tuition.
Unlike some of our red state governors, certain college presidents are taking a cold, hard look at what it will take to make it happen. They aren’t relying on science and public health experts, not wishful thinking. And they have come to the same conclusions that the porn kings did.
Here’s what Colby College is doing (emphasis mine). They expect to spend $10 million this year.
Colby’s testing program… will require the participation of all members of the campus community—students, faculty, and staff. Students will be tested prior to arrival with test kits provided by Colby, and all community members will be tested three times during the opening weeks of the semester. Thereafter, everyone will be tested twice per week, a rate that scientific models have demonstrated will greatly limit the spread of the virus by detecting infections in individuals prior to them becoming contagious. To put this in perspective, we expect to administer roughly 85,000 tests in the first semester alone, a number that almost equals the total number of tests administered in the entire state of Maine since the start of the pandemic.
…Test results will be returned to the individual and the College within 24 hours, allowing for any required mitigation efforts to be instituted quickly. We have leased additional housing for quarantine and isolation of students, who will be provided with a range of support services, including facilitating their coursework, attention to medical and mental health, and food delivery.
Brandeis will provide high-frequency, mandatory COVID-19 testing to all on-campus community members…All students living in campus residence halls will be tested upon their arrival to campus, and students living off-campus will be tested at a designated time before the start of the fall term. There will also be mandatory testing multiple times per month for all students, faculty, and staff who either live on campus or who come to campus several times per week, whether or not they are symptomatic. This will enable us to quickly identify and contain any instances of infection on our campus. Those coming to campus less frequently will also be tested, though not as frequently.
Testing is part of broader plans, but it is the core and let’s us know they are dead serious. Both of these schools are working with the Broad Institute for testing.
Interestingly, some other colleges are wavering on testing or throwing in the towel with a move to online only. Good luck with that.
Medicare eligible Americans have borne the brunt of coronavirus. Some of the immediate impact on Medicare Advantage plans is obvious. They are covering telehealth and paying for acute hospital stays.
But there are longer term implications, too. Their risk adjustment scores are thrown off by the lack of visits. Certain supplemental benefits (think gym membership!) no longer sound so healthy, while others (meal delivery) become super valuable.
Purposeful –aiming to meet the objective of educating children in person while keeping them and staff members safe
Timely –coming at the end of the school year, with updates promised over the summer
Evidence based –relying on the latest medical and public health guidance and the experience of schools abroad
Appropriately detailed –with enough specifics to guide decisions that need to be made now without being overly prescriptive
Circumscribed –acknowledging and accounting for issues of racism and disparities without purporting to solve every problem
Balanced –recognizing that we are living in the real world (such as it is!) and that COVID-19 is part of it. None of the measures (hand washing, masks, staying home when sick, social distancing) on their own will prevent the spread, but taken together they have and will
I’m not an easy grader, so my A for this assignment is real. I have publicly criticized Massachusetts’ reopening plan and its testing plan for being vague, non-evidenced based, and irrational. Privately, I’ve admonished the local school system for its defeatist attitude toward COVID-19.
The plan doesn’t set a cap on the number of students in classrooms
COVID-19 testing is not mandated
Daily temperature checks are not required
It mandates only 3 feet of social distancing even though officials have been telling us 6 feet
Superintendents need to develop 3 sets of plans (in person, hybrid, virtual)
No clear guidance on whether state should go back to in-person classes when school reopens
Doesn’t adequately address challenges of urban schools that serve children from disadvantaged backgrounds and have limited space
Racism is not connected to students’ mental health in the plan
It doesn’t say how many students can ride the bus
People don’t like the idea of wearing masks all day
The report itself anticipates and addresses these criticisms. The Globe notes some but not all. Here is the reasoning
Number of students isn’t capped because the relevant constraints are adequate space between desks and proper behavior. If a room is larger it can accommodate more students. The report encourages use of new spaces like libraries and cafeterias
No one in the country (or world?) is seriously suggesting testing all school age kids. It’s expensive, slow, unpleasant, impractical and unnecessary. Maybe there will be cheap, spit tests at some point. They can be used if the need is real
Daily temperature checks produce too many false negatives and false positives, offering a false sense of security and causing students to miss school when they don’t need to. These checks are good for other illnesses, like the flu where fever is a good indication of active infection, but it’s of limited use for COVID-19
There’s no magic in 6 feet. Three feet seems to work fine in other countries’ schools, especially in combination with other measures, like wearing masks. Schools with 3 feet of distance abroad have not had outbreaks. Kids aren’t going to be safer out of school
Superintendents need to develop plans for different scenarios. Of course they do! If they just developed one plan it would have to be for remote instruction only. Is that what we want?
Of course the guidelines can’t be definitive in June about whether students can go back in September. But the goal is to get as many back as possible. To make that happen requires everyone to behave well over the summer (adults, especially!)
Although the plan isn’t going to eliminate disparities or solve racism, there are extra funds to help all schools and especially those with extra needs. And the best way to reduce disparities is with kids in school. Disparities widen (as I’m sure they did this spring) when normal routines are thrown off. For extra space, the guidelines suggest working with local community centers, libraries, etc.
Kids will need to wear masks on the bus. If the bus is crowded then buses will need to be added or kids will need to get to school in other ways. They can keep windows open, too.
It’s true that people don’t like wearing masks all day. The guidelines call for mask breaks and make special mention of how to work with people with breathing or communication problems. If we all behave there’s a good chance we can take our masks off sooner rather than later.
Notably, these guidelines are endorsed by people who know what they’re talking about and have children’s interests at heart. The healthy approach is to work within the guidelines to plan a return to in-person classes this fall. We should continue to challenge the guidelines and expect them to be updated as we learn more and as the situation on the ground evolves.
Meanwhile, we can all contribute to a safer back-to-school scenario by continuing to follow public health guidelines that are knocking the virus down in Massachusetts. The lower the level of community spread, the safer any reopening plan will be.
Thanks to COVID-19, the era of decentralized trials is now upon us. In this podcast interview, Adaptive Clinical Systems‘ Temitope Keyes and I discuss how trials are changing and what clinical data infrastructure is needed to make them flow smoothly.
Changes are underway in clinical trials right now as a result of COVID-19
The imperative for “frictionless clinical data.”
Ensure optimal performance in the new environment
New data sources and endpoints that will be employed