You Can’t Screw with Mother Nature- Humility, Transparency, and Patience are Needed to Conquer COVID-19
By Claudia Neuhauser, Ph.D., Associate Vice President of Research and Technology Transfer, Professor of Mathematics, University of Houston; and Brian Herman, Ph.D., Professor, Department of Biomedical Engineering and former Vice President for Research, University of Minnesota and University of Texas Health, San Antonio.
When Texas opened its economy, the number of cases of COVID-19 exploded as Texans began to frequent bars, restaurants, and other businesses, often without facial coverings and with little to no physical distancing. We live in two of the hotspots, Houston and San Antonio, where as many as 1–2% of the residents may currently be infected. And despite the recent mask mandate from Governor Abbott, many Texans continue to ignore the mandate to wear a mask and physically distance. On July 8, the two counties we live in each reported the highest single day death count. The cities of Austin, Dallas, and Houston have exceeded hospital capacity for severely ill COVID patients. As was the case with Memorial day celebrations, Independence Day celebrations saw defiance of Governor Abbott’s orders closing bars and requiring people to wear face coverings in public in much of the state. And the number of daily new infections is still trending upwards. Almost daily, Texas and the counties we live in hit record numbers, whether it’s the number of new cases, the number of deaths, or the number of hospitalizations.
Before opening the state, the number of new cases hadn’t been declining the way they were supposed to before opening would have been deemed safe according to the White House recommendations.
Texas wasn’t the only state that opened too early. Close to 20 states are now pausing their reopening plans and implementing more stringent measures to regain control over the virus. The measures are not nearly as stringent as what Europe did, which, for now, seems to have gotten the virus under control and is starting to experiment with opening their economies. Here, we seem to be content with mostly closing bars or just ordering bars to stop serving alcohol, or limiting capacity in places that are considered higher risk, like restaurants, gyms, and other places where people congregate for extended periods of time.
In Texas, until very recently, we were still discussing whether wearing face coverings should be mandatory. An executive order from the governor now requires face coverings. Some local jurisdictions refuse to enforce even this order, while others would like to go further. But since the governor has final control over what can and cannot be done by local jurisdictions, local jurisdictions do not have the authority to put in more severe measures.
We should have learned our lesson from what happened in the state of New York (NY) in March, namely that pandemics can get quickly out of control, AND it takes a long time to regain control over an outbreak. Take a look at Figure 1: The 7-day averages of new cases in NY went from less than a hundred to over 2000 in 7 days. Within another 7 days, the numbers reached 6000, just about where Florida was on June 28, and Texas and California were on June 30. It took NY another 13 days to hit the maximum of almost 10,000. Recovery was much slower. It took 40 days to go back down to below 2000 and another 20 days to go below 1000. New York City was the primary driver, and, you may recall that it took drastic measures to regain control. It was shut for 100 days, about 80% of the time was spent to get the numbers back down.
Florida, Texas, and California opened their businesses between mid-May and mid-June. Each one saw its number increasing. There are no signs yet that any of them has hit the maximum. At the rate these states are currently going, it’ll take a week or two for the 7-day averages of the number of new cases to hit 10,000. If New York’s recovery is representative of the recovery after an uncontrolled outbreak, we are looking at a minimum of 2–3 months before the numbers are back at a level where the pandemic can be considered under control. That would put us somewhere into mid to late September, or later if we don’t implement effective measures.
Mid to late September? We both work in higher education and have been part of trying to figure out how to open up research safely and how to teach in the fall semester. Fall semester starts somewhere between the last week of August and the first week of September for most colleges and universities. According to the Chronicle of Higher Education, 59% of colleges and universities are currently planning for in-person instruction and another 25% for hybrid instruction in the fall semester, and are hoping to offer a reasonably rich college experience to the millions of students who were sent home last semester without much of a warning and had to take the rest of spring semester online. Many universities plan to send students home at Thanksgiving and finish the rest of the fall semester online to eliminate the risk of having students return infected to campus.
Of course, there is no way to tell what September will look like. The planning is based on being in a location where the pandemic is under control, which increasingly means not at a level where the health care system is overwhelmed.
Universities have realized how difficult it is to open a campus and have been preparing meticulously for safely opening campuses in the fall semester. Many are confident that they can manage the logistics of it. Some feel a moral obligation to offer in-person instruction, regardless of the risks. Purdue University president Mitch Daniels thinks the risk is tolerable since a large percentage of the campus population is under 35 and there have been few deaths in this group. University of Notre Dame’s president John I. Jenkins believes that he has a moral mandate to open the campus. For him, the risks are worth taking. He wrote in an opinion piece in the New York Times that not opening “would risk failing to provide the next generation of leaders the education they need and to do the research and scholarship so valuable to our society.” And University of Minnesota President Gabel has stated that “There is not one thing that has been asked about we have not anticipated, planned for, vetted against the science, consulted against, and then included in the plan.”
Despite all the planning, no university can control the behavior of the people in their neighborhood. They also have no control over what restrictions their county or state will put into effect. There is also much we don’t know about the virus. Dr. Osterholm, Director of the Center for Infectious Disease Research and Policy and a renowned public health expert, said in a recent interview on Public Radio that “we all in the public health world have to have real humility right now and just admit that we don’t understand exactly what’s happening.”
Such humility is in place. We have seen now what reopening does to the pandemic. We have also gotten a first taste of what happens when we bring students back on campus even when the pandemic is under control locally. Universities started their athletic programs in June only to learn quickly that student-athletes brought COVID-19 with them, undetected upon arrival, and exposing other athletes and staff to the virus, often for days before the infection was detected.
It should be clear by now that bringing thousands of students on campus will likely invite tens to hundreds of positive COVID-19 cases on campus as well. We can expect higher numbers of infected students in places where the pandemic is uncontrolled. Very few universities will test students before they arrive on campus. Many of the infected students will likely be asymptomatic and will spread the disease quickly to other students in dorms, dining halls, classrooms, and any of the social activities they engage in.
It’s not only other students who are at risk. Faculty and staff interact with students, often for extended periods of time. Even if social distancing can be maintained, the prolonged exposure in confined areas, such as a classroom, may not be sufficient to curb the spread. Cleaning will be a challenge. It is not feasible to clean thoroughly in between classes. Not only is there not enough of a break between classes to do a thorough cleaning but also the number of people required to complete this task would likely exceed the current capacity of cleaning crews.
Testing students for COVID-19 is not really an option either. The CDC currently does not recommend testing asymptomatic individuals without known exposure to a person with COVID-19 before allowing them on campus because it is simply not known whether this would result in “any additional reduction in person-to-person transmission of the virus beyond what would be expected with implementation of other infection prevention measures.” If testing before they come on campus is not recommended, what about repeated testing, something that is done with athletes? Frequent testing of the entire campus community would likely present a logistics challenge. It is also not clear whether sufficient tests would be available. Frequent testing would also be prohibitively expensive for almost all but the wealthiest institutions.
Humility, transparency, and patience are the ingredients to gain trust and get us through this pandemic. Students and parents have the right to know that we don’t really know what to expect. They must gain the confidence that we will monitor the situation closely, follow the advice of public health experts, and put the safety of people before financial objectives. Depending on the location of the campus and the ability to test students frequently and isolate those who are infected, some campuses may be able to open safely, as, for instance, President Kotlikoff of Cornell University claimed in a recent WSJ opinion piece. Other campuses may open their doors in places where they will be unable to keep the virus under control and may have to close the campus within weeks of opening and deliver the curriculum online again. Patience is required of all of us.
We may be living with this pandemic for a good while, perhaps two or three years or more, until we either reach herd immunity or sooner if we have an effective vaccine. An interesting analogy might be how colleges and universities deal with meningitis. Meningitis is a disease that spreads rapidly through contact. A vaccine is available. Some states require students to be vaccinated against this disease before coming onto university campuses. While a vaccine against the coronavirus does not exist yet, the same type of caution must be considered. In these states, a student without a meningitis vaccine cannot attend university classes, where they are surrounded by other vaccinated and protected students, but we feel it is safe to bring back students during a national pandemic where there is zero protection and the infection is even more contagious? Students, parents, and universities will need to adjust and figure out together how to get an education that will give the students the knowledge and skills to succeed in this world. At least in the short term, remote learning may just become the norm, augmented by community service and internships to help students to transition into adulthood and the workplace.