Unexpected ways COVID impacts lower-income populations: An example from my community.

In true nurse form, I’m going to SBAR this.

[Thread]

SITUATION: I’ve observed something unfold I’ve wanted to outline in hopes to advocate for a large group of children who are at a massive disadvantage and need a voice. While this is happening in Champaign-Urbana, I’ve heard it’s happening in other areas as well.

Basically, we’ve crossed a highly concerning threshold where public schools are keeping kids out of school remote, while private are allowing in-person instruction. Here, private and outlying rural schools have be in session for approx. 7 weeks with little to no reported cases.

Kids who need the support of school the most (lower-income, high-risk) are deprived of this, while parents who can afford to send their kids to private schools enable them to have in-person learning. We’re enhancing inequality exponentially.

“The worst way to promote social justice of any kind is to shut down schools that preferentially target the most vulnerable members of our society.” - @ZDoggMD

BACKGROUND: I live in Champaign-Urbana, IL, where University of IL is located. Population around 200-210K, university has around 44K students during the school year. Because of university, we test approx. 60x more than comparable nearby communities.

Champaign poverty level is 26.9%. Urbana’s 30.8%, well above national averages. We’ve got 2 public school districts (Champaign & Urbana). I went to @cityofurbana my whole life. My husband and I graduated from UHS in 2005.

We assumed that more tests = lower mortality and hospitalizations. In Champaign County, when you compare tests/student with hospitalizations/100k and deaths/100k in the broader county shows an R^2 value of no significance.

(Thank you @OBusybody for your graph!)

For context, I recommend checking out this phenomenal thread by @andrewbostom, comparing the tests taken at major universities vs. hospitalizations.

As of 10/5, despite about 70K test at 50 major universities, only 3 hospitalizations + no deaths. https://twitter.com/andrewbostom/status/1313162488955973634

The WHO, CDC, and Fauci have all repeatedly said that we must look at how this virus impacts our community on a local level. So, let’s see how it’s impacted this smaller Midwestern farming community with a major university, community college, and health system:

ASSESSMENT: No hospital overwhelm at any time. Average of 6.4 hospitalized COVID pts at any given time. Of note, it does not distinguish pts hospitalized “for” COVID and “with”. If you swab + regardless of clinical symptoms or viral load, you’re a COVID hospitalization.

Total of 27 deaths:

26 had underlying health conditions
21 were 70+
13 older than average life expectancy

1 death without underlying conditions was 39 yrs old. Tragic and unexpected, however it is the only one out of approx. 200K people (0.0005% of population).

We use a Ct test cycle of 40 on our PCR test, which many report is far too sensitive. This causes many of our tests to be marked as positive, despite clinically insignificant levels of viral load. This causes needless isolation and public panic.

While this PCR test is accurate, it is not precise. Important to delineate accuracy vs. precision, and active infection vs. case. Just b/c someone tests + does not mean they have a viral load high enough to cause active infection, symptoms, or transmit to another person.

Let’s add in CDC data of Infection Fatality Ratio as of Sept. 10, 2020:

0-19 years: 0.00003
20-49 years: 0.0002
50-69 years: 0.005
70+ years: 0.054

(Please note, average age of a teacher in IL is approx. 40)

To put it into context, kids and teachers are more likely to die on their way to school in a car accident than to die from COVID. Kids are 5-10 more likely to die from the flu, and per the CDC director suicides pose a far greater risk.

“... Available evidence provides reason to believe that in-person schooling is in the best interest of students, particularly in the context of appropriate mitigation measures similar to those implemented at essential workplaces.”

Link: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/reopening-schools.html

(Same article) There was “a 62% decrease in child abuse reporting calls between mid-March and April 2020 compared to the same time period in 2019, but saw more severe presentation of child abuse cases in emergency rooms...

Children who live in a home or neighborhood where neglect, violence, or abuse occur, but who are not physically in school, are deprived of access to trained school professionals who can readily identify the signs of trauma and provide needed support and guidance.”

We have had no "outbreaks" in grocery stores, hospital workers, day care teachers, or any other essential businesses. Throughout, daycares have remained open for essential workers.

Of note, day care has younger kids. While masks are required, they’re off for a lot of the day for snacks, meals, outside, and naps. They touch one another more, are physically closer and harder to contain, yet no “outbreaks” in any daycares.

The rationale for postponing [according to @news_gazette article] was:

#1 - The # of active cases was the same as it was months ago when decided to do virtual.

It actually rose proportionally when 44K people came to town, but was still minuscule when viewed in context.

#2 - Concern about the “long-term ramifications of COVID-19 that might not yet be known”. So, we need more evidence than the 99+% recovery rate to resume school until we know ALL long-term ramifications? ...

What about the CDC’s list of ramifications of postponing in-person learning? Why do we need to know every single thing before resuming? We don’t know everything about sepsis & 270K people die from it annually. It will be years before we know everything there is to know.

#3 - It “puts kids at risks in ways that we can’t even begin to imagine,” said someone - We can not only begin to imagine, we can actually know with a level of predictability by simply looking at all the other schools who have been open that are mere miles away.

Our poverty rate is than national average. We’re talking about “protecting” our kids from 1 possibility or infection with a 99%+ recovery rate for kids in age range, while actively increasing their likelihood of harm from multiple other avenues.

This begs the question: If someone is “protected” from COVID, but put in actual danger for other things… are they really protected?

If a child is at home with virtual learning and lowers their risk level of contracting COVID as low as humanly possible, but has significantly their likelihood of depression, suicidal, poor nutrition, neglect, abuse, and/or losing developmental progress... are they protected?

As a nurse, that would be like not giving a patient a medication they need to live with any degree of quality of life because of the highly unlikely possibility of an anaphylactic reaction…

... or putting the entire hospital on isolation regardless of their clinical picture and risk profile, while putting something dangerous in the room for the most vulnerable/at-risk of them… and locking the door.

RECOMMENDATION: Neglecting members of our community who need in-person schooling the most is a profound disservice. This is not a benign intervention; it carries serious risk to populations that are already at a disadvantage.

We have continually moved the goalposts since April. First, it was preventing hospital overwhelm and ventilator use. Then, preventing any spread. Then, preventing as many cases as humanly possibly, whether or not those cases are clinically significant.

It’s as if we’re looking at today’s data through our lens & perspective from 7 months ago when we were in emergency mode.

It’s like constantly changing the discharge plan. At some point you have to let the patient go home, you can't protect them from every single risk, esp when you don't view them objectively or provide them any autonomy over their own life and decisions.

We have new info it’s not nowhere near as deadly as we thought overall, particularly for kids.

We have data from our community that when viewed in context is encouraging multiple schools have opened, daycares continually open, essential workers working throughout.

We have become substantially better at treating it, have hospital bed availability, and multiple viable treatment modalities.

Again, encouraging.

I realize that nothing is perfect and life carries inherent risk. Balancing that risk has been dizzying over these last 7 scary months. So much research, data, and conflicting info has come out that it’s hard to put it into context and view it in an objective balanced manner.

Any death is painful, but it’s also an aspect of life that we rarely discuss. As a RN, I’ve been at the side of many patients as they left this earth. I’ve there as their loved one died, and helped people process death who had previously never really thought about it.

Knowing a death could have been prevented can be an unbearable burden… but in our tunnel-vision pursuit of preventing every single COVID death, have we:

1. Removed significant QOL for people at the end of their life
2. Robbed people of the dignity of their death ...

3. Caused irreparable trauma that doesn’t compare to a COVID diagnosis
4. And worse - actually caused other deaths in this plight to prevent harm?

I feel empathy for the 27 families in this area who have had to grieve the loss of their loved one. But the problem is that we’ve dove so deep into this empathy that we’re drowning... and aren't making logical decisions because of it. That is the opposite of prudent public health

We went from simply controlling for overextended health care resources to this nebulous goal of no cases, hospitalizations, or deaths. It’s as if the possibility or diagnosis of COVID is the only health problem that matters at all.

We’ve got an opportunity to teach our kids how to responsibility, constructively, and bravely navigate this world we live in that comes with inherent risk.

These children and their families are carrying a devastating burden, and not only is keeping them out of school wrong - it’s not at all supported by data when it’s viewed objectively and in context.

If private schools and daycares have safely re-opened in Champaign-Urbana, allow the public schools to do the same. If parents or teachers feel their actual or perceived risk outweighs the benefit, allow them a remote option.

I have been a nurse for over 10 years. My husband is a professional counselor. We both graduated from UHS, and now have masters degrees. We are parents. Not only do we both feel strongly about opening public schools, many others who are highly invested feel the same.

Please, stand up for our children. I wholeheartedly agree with Urbana Superintendent Jennifer Ivory- Tatum and school board member John Dimit, who both expressed concern about pushing back in-person learning.

The risks simply do not outweigh benefit.

Thank you for coming to my TED Talk.