Let The Children Have Their Way

“Will you make us laugh, will you make us cry?

Will you tell us when to live, will you tell us when to die?

I know we’ve come a long way

We’re changing day to day

But tell me, where do the children play?”

— Where do the Children Play (Yusaf Islam — nee Cat Stevens)

“Let the children have their way
Let the children play
Let the children play”

— Let the Children Play (Carlos Santana)

Hope all are enjoying their Labor Day Weekend.  Today’s goal is to alleviate much of the anxiety all are having about this weeks upcoming in-person return to school.  Today’s audio homework is your spoiler alert as to where I stand on school attendance as a general recommendation.  If you enjoy the Cat Stevens selection, and are in the mood for a dark comedy at some point, might I suggest Harold and Maude, as it features his music throughout.

Coronavirus Update

Case Rates and Fatalities

The pandemic is ongoing, and the daily damage nationwide has remained more or less consistent now throughout the summer.  If 1000 deaths per day from an illness in this country is something you are comfortable with, then this pandemic is under control.  For the rest of us, there is some serious work to be done yet.

Here on Long Island, we have continued to have a low number of deaths over the last month.  Based on statistics presented by Newsday, there have been 12 deaths over the last month.  A bit concerning though is the recent spike in cases.  For reasons that will be discussed later, the relevance of cases reported is debatable, but would not ignore it nonetheless. The other statistic we have discussed in the past that is of concern here in New York is the current R-value.  In New York we have again breached the level where COVID-19 is poised to spread quickly.  The value is currently the highest it has been since the end of March when shelter in place orders were instituted.

Vaccine Update

The CDC recently advised states to plan for COVID-19 vaccine distribution in late October. This is extremely optimistic thinking for a litany of reasons.

There are roughly 170 COVID-19 vaccines in development.  Of these 34 candidates are in clinical trials, with 9 in Phase 3 trials.  None of these Phase 3 trials are currently scheduled to close prior to 2022.  Based on preliminary data, there may be release of a vaccine for use prior, with continued monitoring for both efficacy (how well it works) and adverse reactions.  It is worth noting as well that there are no children currently enrolled in any clinical trials for COVID-19 vaccines.   There is a fantastic review of the trials in the Wall Street Journal this week, though it likely requires a subscription.

The vaccine manufacturers themselves, per a separate article in the Wall Street Journal are preparing a statement pledging to adhere to high scientific and ethical standards in the conduct of their trials and manufacturing process.  Actions speak louder than words, but it is somewhat reassuring nonetheless.  A bit more on this topic a little later.  

Education

“Out through the night

An’ the whispering breezes

To the place where they keep

The Imaginary Diseases….”

— Stink Foot (Frank Zappa)

Bonus listening for all this week.  This album was mentioned previously on a Facebook post as it features Tina Turner as a backup singer.  Classic album from one of the finest and most under recognized American composers.  Most who recognize Frank, do so from his more “popular songs” such as Don’t Eat the Yellow Snow.  However, Frank was a virtuoso on guitar and released albums in genres ranging from Rock to Jazz to Classical and everything in between.  His classical compositions have been performed by the London Symphony Orchestra.  The crux of the biscuit by the way is the Apostrophe…….listen to the tune and you also get to learn the medical name for Stink Foot.

Colleges

Colleges have restarted across the country over the last couple of weeks, and already we are seeing reports of outbreaks on those campuses.  This issue is in part due to “kids being kids” and partying despite mandates to the contrary, though would these outbreaks would not be shocking even despite considering that the students came from all over the country to live in close proximity with one another.  Students may have been screened prior to moving in, but remember that the majority of those without symptoms will show up negative on a COVID-19 test even if they have it (and are contagious).

In New York, there have been several colleges reporting significant numbers of cases, though this week Oneonta managed to grab the spotlight after they suspended five students who had organized parties that are considered the likely source of an outbreak on that campus.  Per the NY Times, more than 500 cases were reported among the students (there are typically about 6,000 students on campus).  Also per the article, students were sent home.  If accurate, this is probably the worst thing a college could do as they are sending potentially asymptomatic vectors to various other locations to contaminate those populations.  This concern has been publicly raised by many, including Dr. Fauci.  

Consideration towards closing campuses to the outside world for the semester is likely a better solution.  While the students may spread COVID-19 amongst themselves, based on the statistics to be presented shortly, they are more likely to kill themselves via alcohol poisoning than die from COVID-19.  These kids need their education, and we have a responsibility to make sure they get one.  Remote learning is not the solution, and spoiler alert – they are going to party at home too.

Compulsory Education (K-12)

Over the next few days, schools on Long Island will reopen for business.  While some parents opted for remote learning options for their children, the majority will be attending in-person classes either full-time or with a hybrid model.  Preparation has been extensive though to many it will be viewed as not sufficient.  Anxiety is peaking for many students and parents.  We are going to have some fun with numbers now in an attempt to alleviate much of that for you.  We will walk through many of the common statistics cited in the media when discussing the severity of the pandemic and apply to the issue of reopening schools.

“Number of Cases”

Definition:  The number of individuals that have tested positive for COVID-19

Use:  The number of cases reported is indicative of the minimum number of individuals that have had COVID-19.  It is the minimum number as not everyone gets tested.

Often when reporting the number of cases, there are conditions in effect as well.  This is where the data can be manipulated to reassure or instill fear depending on which network you like to watch.

Misleading Example #1

The number of cases of COVID-19 among those older than 120 years of age is zero.

Sounds great!  Not one case.  Issue is that Jeanne Calment is the only person on record to live past 120 years (excluding biblical references) and died of unspecified, but not likely COVID-19, causes in 1997.

Misleading Example #2

Relative to the population, there are very few cases of COVID-19 in school age children.  Below are graphs from New York and Massachusetts respectively and both show a much smaller number of COVID-19 cases amongst school age children.   

So do kids really get infected less frequently?  Maybe to some extent if there is some cross protection from other human coronaviruses that are common to children.  More likely though is that they are less symptomatic and less likely to be tested for several reasons.  Among the reasons are they are not required to do so like many adults for work, many parents are not inclined to have a child swabbed due to the discomfort of such if not required, and many parents will “take one for the team” to see if the infirmary they call home is infected with a common cold or COVID-19.

Take home message:  While I would love to tell you that based on the number of cases reported that kids are in a better place than the rest of us, it may not be a true assessment.

“Percent of Tests Positive”

Definition:  The number of positive tests divided by the number of people tested and expressed as a percentage.

Use #1:  If testing members of a population randomly you can assess a prevalence rate.  Prevalence rate is the percentage of a population with an active issue, in the case of this discussion COVID-19.

Misleading example:

The prevalence of a heartbeat among the living population in this country is 100%.  That number has been recently debated as it pertains to our Commander in Chief, though as a betting man, even he has a heartbeat.  If he keeps walking around without a mask though, he better hope that the rest of the scientific world is wrong about hydroxychloroquine.  Or injected bleach for that matter.  

Use #2:  To assess whether a situation is getting better or worse.  This is a great use for the statistic but it is predicated on consistent testing.  That means you need criteria for who gets tested, have the materials to test when folks meet those criteria, and utilize testing methods in a consistent manner.  Currently we meet none of those criteria.

Misleading example:  In the beginning of the pandemic, the vast majority of those tested were those hospitalized for respiratory infections.  The percentage of those patients who would test positive would be high.  If you used that number as a means of comparison with testing the same number of people who hang out with Snoop Dogg or Willie Nelson you would not find such a high number of percent positives despite most of those folks being high themselves.  Conversely, cannabinoid testing on both the above populations would yield exactly the opposite results.   

Take home message:  While many are looking at this statistic as a method to determine whether to keep schools open or not, it is very misleading and easy to create skew based on changing the criteria of who you test and how you test them.

“Number of Hospitalizations” and “Number of Deaths”

Will combine these two measures for this discussion because they tell a very similar story.  These are the numbers that should be driving our decision making as they are less susceptible to data manipulation.

Definition:  These statistics are self explanatory, but just for completeness sake, they are the number of patients hospitalized due to COVID-19 and the number of deaths due to COVID-19 respectively.

Use:  Can track true active severity of the issue in a location or a nation as a whole.

Limitations:  They are lagging indicators.  That means that by the time you are seeing hospitalizations and subsequent deaths increase, you are several weeks past the events that lead to the increase.

Now I promised some reassurance to all today, and here it comes….

Below again are data from New York and Massachusetts.  In both cases, the hospitalization rate for those under the age of 18 is nearly nonexistent relative to the population as a whole.  The rates for those of ages common to the parents of school age children are also quite low relative to the population.  It is clear that the older you get, the higher your likelihood of being hospitalized with this illness.  This is especially the case for those older than 70 years of age where the age related difference start to increase sharply.

The data regarding the number of deaths demonstrates and even sharper age related risk ratio.  There were zero deaths in children under 20 years of age in Massachusetts as of August 3rd.  There were 143 deaths among those under the age of 50 years of age.    When simply looking at the number of deaths for those between 20 and 50 (the parents), the rate of death from COVID-19 is less than 6 per 100,000 of the population.  To put it in perspective, the current rate of death by car accident is 12.0 per 100,000 of the population.  Yet you don’t think twice about hopping in your car just for a drive to get out of the house. Wondering why I don’t have more up to date numbers for Massachusetts?  Me too.  They stopped reported the age distributions, possibly because it doesn’t tell the story they want it to?  Looking at the numbers in New York, you get the same story.   Thinking this may just be a northeastern phenomena?  National numbers are quite similar and are summarized in the table below.  

Here are some plain English conclusions from the data to really drive home the message:

The odds of a child 5-14 years of age dying from COVID-19 to date is less than 1 in a 1,000,000 of that population. 

How often do you concern yourself with a one in a million chance?

The odds of a teenager/young adult between 15 and 24 years of age dying from COVID-19 is 7 in 1,000,000 of that population. 

There were 300 deaths in that age band from COVID-19.  And 19,318 deaths for other reasons.   

The odds of a parent dying from COVID-19, assuming they are between the ages of 25 and 55 years is more significant at nearly 330 deaths per 1,000,000 of that population. 

More than 2/3 of these deaths are among those parents 45-55 years of age.   In total for 25 to 55 age bracket, there were 13,815 deaths from COVID-19 and 201,539 for other reasons.

Bottom line is, while there are no guarantees in life, your children, as it pertains to COVID-19 should be quite safe back at school.  Furthermore, while we as parents have more risk than they do, we too should be quite safe with them back at school. 

It’s not all roses though.

From the number of cases present in all groups, there is significant disease burden in children and young adults.  They simply survive it.  Sending children back to school, no matter how much we implement strategies to minimize spread of infectious disease amongst them, is going to result in an increase in the number of cases.

What does this mean?  You better be VERY CAREFUL with the grandparents and other elders.  This illness is a totally different ballgame for them.  If you have such folks living with you, you should seriously consider remote learning options for your children or devise some way to insulate those at risk in your home which is not easy to do.

Another issue that I did not address, and we will not know the answer to for decades, is whether or not there is some damage done by this virus that will not rear its ugly head until many years later.  Could there be mild heart damage or lung damage that does not affect a child but leaves them more vulnerable at 70 years of age?  The answer is yes.  They may also be able to grow you a new heart by then, so my focus is more on the here and now and what is known today.

What is known today?  Children require a proper education to become productive members of society.  Young adults need to work to take care of themselves and society as a whole.  If you are not working, you are not paying taxes.  If there are no tax revenues, there are budget cuts.  Those budget cuts disproportionately affect those less well off financially, those with special needs, and the elderly.  There is no amount of printing money that can change that.

We as a society need to aggressively protect those at high risk while permitting others to go about their business as that business is critical for all.  We need to provide the resources to help our elderly especially stay safe and to work towards both a cure and a vaccine.  On a side note, vaccinating elderly folks does not work nearly as well as vaccinating young folk.  Since young folk are not at the same risk, they are most likely to wait for true completion of clinical trials and adverse reaction data before taking the vaccine.  This is not happening next month.

And as been stated weekly, while you might not like it, wear your masks and social distance!  Not wearing your mask is not as bad as removing your blindfold when the entity from Bird Box is around, but it really does help.  Try to work with it rather than find reasons not to.  Your elders thank you.

Enjoy your Labor Day!!!

One parting song for all today since it is somewhat on topic, and lets me throw some love Lou Reeds way…..