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Covid-19 in schoolchildren – A comparison between Finland and Sweden [pdf] (folkhalsomyndigheten.se)
48 points by mrfusion 31 days ago | hide | past | favorite | 95 comments



Here is a big problem. The children need to go somewhere. Parents need to work, bills need to be paid and tax incomes need to continue to flow. So what to do with the kids?

Right now, the options are either send them to school, where there are (in the US) government employees making sure they are safe. The workers are well represented by a strong union, have good healthcare and reasonable wages. The other option is to send them to private day care, where private citizens with no oversight, very low pay and no worker protections are being asked to shoulder the risk. It seems like we have no problem hoisting even more responsibility upon the poor and least represented in society.

Teaches are essential workers, much like firefighters, DMV workers or court clerks. We expect a girl making minimum wage at Kroger to accept that she is an essential worker. Why do we not expect the same from school staff?

Disclosure: I have siblings and other close relatives that work for and in school in the US. I am not externalizing the risk.


> The workers are well represented by a strong union, have good healthcare and reasonable wages.

My spouse and sister are both schoolteachers. Sister's situation: laid off from a private school where enrollment will drop significantly this year. Spouse's situation: works for a well-funded school in one of the most populous states in the U.S., where there is no strong union, the pay is below the poverty line after mandatory deductions, and the healthcare is so bad (no out-of-network benefits and in-network only applies within the county, basically) that most people have to expand their view of what "health insurance coverage" is in order to understand it. A number of the teachers in their network are considering teach 5 kids in a private daycare group (working 30 hours a week) instead of teaching 30+ kids working 50 hours a week under very constrained public school conditions. These are anecdotes, of course, but what we're seeing from over here is that teachers don't feel safe reopening schools, and aren't overly committed to their benefits since they're not particularly well taken care of by the standards of the average American worker. Just a different two cents.


I appreciate your perspective and I am sorry that that is the situation in your state. I admit I can only speak for my state, and as such should limit my opinions to that context.

Thank you!


Non-US tenured teacher here. I'd have to do something very, very, very wrong before I'd ever have a snowball's chance in hell of getting fired.

Most if not all of my colleagues and I have worked incredibly hard teaching remotely when that was the only option. We've been expected to use self purchased electronic equipment for that. When limited on-site teaching became possible again, we took the opportunity. Yes, older, overweight teachers most at risk also did.

We saw our bosses cared. We saw a fairly competent chain of command up to the prime minister, very much guided by the scientific approach. My guess is that made a large difference. At least with me it did.

Would we have done the same in the US? I don't think so. The scientific approach has been disregarded so badly, not to say ridiculed, at so many levels. Individual students, parents, school district leads, governors, the president. Don't expect me to voluntarily take the risk they've created.

Here are some of the important questions that need to be answered before I'd consider going back to teach on site:

- Will sufficient personal protective equipment be provided?

- Will elementary technical precautions like distancing, natural ventilation etcetera be taken?

- Will parents and students over 12 years old be required to use a facial mask in any physical proximity situation?

- Will my obese colleague with a heart condition be shielded from teaching in direct physical contact with students?

Also, it would be nice if government showed some appreciation for our hard remote work, by way of a budget for electronic equipment for remote teaching for example.


> there are (in the US) government employees making sure they are safe. The workers are well represented by a strong union, have good healthcare and reasonable wages.

What country do you live in? Most teachers are employees of the local school district, not directly of the government. (When I was a Title I teacher, I was a federal employee, but that's not very common). I was never in a union, because there weren't any in the Detroit charter schools I worked at. And I only made $27,000 a year. Does that sound well-paid to you? Even though we had decent health care, with student loans I couldn't afford the copay, so I forwent any health care unless it was an emergency.


The problem with this kind of framing is that it accepts the status quo as a sane premise in the face of a pandemic with largely unknown long term consequences.

Having public schools function as de facto daycares when there’s not a pandemic makes a certain amount of sense, but in the circumstances of the US, where we have uncontrolled spread and a dysfunctional healthcare system on many levels, it makes little.

The sane thing to do would be to implement some form of short term UBI that allows one parent or a designated caregiver to stay home and attend to children’s needs and do everything we can to get the situation under control (universal mask orders, regional lockdowns, replenish PPE, etc.)


Three questions:

1. What makes you think we _can_ get this under control without herd immunity or a vaccine? I am of the belief that there is a certain level of latent immunity via t-cells in a large portion of the population and thus effective herd immunity is around 25-30% infected. But for arguments sake, lets say it is around 70 based solely on Rt.

2. Who would pay for the UBI? My state is already running low on money. We are already having to cut programs. Raising taxes doesn't count, that would take a year to pass, a year to implement and collect and probably a few years in court litigating. So how do we pay for it?

3. How do you equitably select a parent to stay home? And how to do reimburse their employer for lost productivity? Do you guarantee their job upon the end of the pandemic?


>1. What makes you think we _can_ get this under control without herd immunity or a vaccine? I am of the belief that there is a certain level of latent immunity via t-cells in a large portion of the population and thus effective herd immunity is around 25-30% infected. But for arguments sake, lets say it is around 70 based solely on Rt.

New Zealand, Taiwan, Vietnam, South Korea, and Germany have done it without herd immunity or a vaccine with a variety of strategies. We should follow their examples and stop using various forms of “American Exceptionalism” as an excuse to not learn from them.

>2. Who would pay for the UBI? My state is already running low on money. We are already having to cut programs. Raising taxes doesn't count, that would take a year to pass, a year to implement and collect and probably a few years in court litigating. So how do we pay for it?

Print the money. It’s short term and there’s already massive demand and supply shocks that will only get worse if the pandemic isn’t curbed.

>3. How do you equitably select a parent to stay home? And how to do reimburse their employer for lost productivity? Do you guarantee their job upon the end of the pandemic?

I believe Canada and some countries in Europe are doing this through an employer-based grants, where the government subsidizes wages to keep them on the payroll. Whether this is ultimately desirable is up for debate, but the companies are going to be screwed in terms of productivity (and everything else) if this ravages the US labor force. How to do it equitably? Just let the parents/caregivers decide for themselves.


> New Zealand, Taiwan, Vietnam, South Korea, and Germany have done it without herd immunity or a vaccine with a variety of strategies. We should follow their examples and stop using various forms of “American Exceptionalism” as an excuse to not learn from them.

Two of those are islands, one might as well be and the other two are Vietnam and Germany. Vietnam is very interesting. There is a strong chance of Vietnam being a prime area to study the cross-reactive T-cells due to the previous experience with SARS. Furthermore, besides dickhead in chief, I don't believe most people made any sort of exceptionalism claim. The USA is a massive nation experiencing several outbreaks at once. The EU just happened to all have their outbreaks around the same time. We can't compare _just_ the results of each nation and rank the response. We need to look at demographics, density, cultural aspects, interconnectedness etc.

>Print the money. It’s short term and there’s already massive demand and supply shocks that will only get worse if the pandemic isn’t curved.

No. This has never been, and never will be, a sound economic strategy in anything but the most extreme of examples. Also, the pandemic _is_ flattened. Remember we were supposed to have millions dead by now had we done nothing. We did flatten it (too much, probably) and now it is curving up, but still not at the rate that was first feared. But this gets in to a different debate. I have made this point elsewhere in my comment history if you are interested in my opinion.

> believe Canada and some countries in Europe are doing this through an employer-based grants, where the government subsidizes wages to keep them on the payroll. Whether this is ultimately desirable is up for debate, but the companies are going to be screwed with in terms of productivity (and everything else) if this ravages the US labor force. How to do it equitably? Just let the parents/caregivers decide for themselves.

Most relationships are not like that. This would almost universally fall upon women to put their careers on hold. This has been researched and reported widely. We did a similar thing with PPP and it saved many jobs. It was a terrible implementation and corrupt as fuck. But it did save many jobs. But again, someone has to pay the piper and don't keep swooning over the nonsense that is Modern Monetary Theory.


I don’t know how to respond to this because a lot of it is simply counter factual. We haven’t flattened the curve, we have several uncontrolled outbreaks raging in the US, no reasonable forecasters were predicting millions dead by this time, instead of speculating about special Vietnamese immune characteristics, we can just do what they did with mask wearing, lockdowns, contract tracing, etc and see if it works. I see also no consideration of Germany.

Ideological opposition to MMT is fine, I guess, but that’s not really a rebuttal or explanation of how allowing the disease to ravage the labor force won’t be worse, let alone in anyway moral, given its disproportionate impact on the poor and minorities.

There are always tough choices with caring for kids, but even paying a caregiver to stay home would be more equitable than the status quo (where this already happens as largely uncompensated labor).


It isn't counter factual. We flattened the curve! Why did we not have outbreaks in Florida three months ago? Because we had flattened the curve! The naughty truth that the brigade of curve flatteners failed to mention early on is that as soon as mitigation strategies are let up, the cases would skyrocket. This is exactly what is happening. Flatten the curve is, was and will continue to be a pipe dream. The virus will win. It will infect _n_ people until it reaches _x_ saturation and burn out. Or we get a vaccine and distribute it to artificially help it reach _x_ faster. That is the only way out of this. What did you expect when a population with little prior exposure locked down for three months and then unlocked? They would be protected by their good intentions?

You are making an assumption that this would ravage the labor force. Not to be glib, but unless your country has a labor force primarily comprised of 75+ year old workers, no labor force is getting ravaged by this disease. Yes, people will get sick. Some will die. Some will die from loneliness. In the time it took me to write this, hundreds of children died of preventable disease the world over. Some died of starvation. Some of lack of access to clean water. A woman was just murdered and another killed her lover, probably, somewhere. We can't ever have zero risk and to advertise otherwise is irresponsible at best.

Also please note, the poor and minority people that you are claiming to protect through blunt force lockdowns are actually the ones still working. Still butchering your meat, picking your fruits, delivering your Amazon order and washing your apartment complex. And the poor who aren't lucky enough to still be in work and in debt, falling further behind and face the least amount of economic security in 100 years. Let people decide what is best for them, you have no moral authority to claim righteousness in your cause and disparage mine.

Please, don't accuse me being counter-factual unless you want to counter my facts. Yes, I left Germany out. Germany is interesting. There are some theories around about that, but I am not well versed enough on them to comment, so I didn't include it. Well caught. I apologize for not blindly speculating and instead passing it over.

Finally, we were already told that mitigation saved two million lives: https://www.cato.org/blog/did-mitigation-save-two-million-li... so the corollary is that had we not mitigated, two million would be dead. And the Imperial College model really did estimate that much. Though they didn't give such a precise timeline: https://www.cato.org/blog/how-one-model-simulated-22-million...

And lets not forget the folks at the UW: A different, data-driven model from researchers at the University of Washington predicts “about 1 million cases in the U.S. by the end of the epidemic, around the first week in June, with new cases peaking in mid-April,” said UW applied mathematician Ka-Kit Tung, who led the work. “By the first week of June, we project that the number of new cases will be close to zero if current social distancing policies are maintained.” That model predicted two weeks ago that the number of new daily cases would peak around now, as seems to be the case. (https://www.statnews.com/2020/04/17/influential-covid-19-mod...). Again in that model, nobody ever talked about what comes next. I will tell you. More cases. Or immunity. One of those two.


National deficit spending is the appropriate and correct tool to finance national emergencies. This is not "Modern Monetary Theory," it is basic government finance. We financed every war in the 20th century this way, as well as the responses to major financial shocks.


The parent said "print the money" which very much is MMT. Bonds/other debts are a different discussion and we very much are deficit spending right now to combat this.


If you understand how deficit spending works to counter emergencies, then why did you even ask your question #2 above? It seems like you are moving goalposts.


Because UBI is fundamentally different than most deficit spending. It actively injects cash into circulation as opposed to kick-starting economic activity which leads to increased spending/circulation.

UBI has not ever been tested at a large scale, and we have no reason to believe it will work. The last thing we need in this fragile economy is inflation. And UBI without increasing revenue will cause inflation, no way around that.


Maybe the issue lies more in your first statement that children need to go somewhere. That's a fairly modern notion. If we've created a society where we rely on strangers to care for our kids, then maybe that's something that needs to be looked rather than creating additional covid hotspots?

While we're doing that, maybe a compromise with A/B school days to limit student numbers, with online participation for whichever group is at home. Schools also need to create strict rules as far as cafeterias, masks, etc... With clear consequences for violations.

The school I am at has dividers in the cafeteria and staggered lunches with no talking while eating. Masks at all times. Temperature checks at the doors and such. This is countrywide (not US) and there has been no spread in schools.


Well the issue may well lie in my first statement. I am not disagreeing in principle with you. But we a day late and a dollar short to actually make large scale societal change in the time needed to respond to _this_ pandemic. The children need an education, parents need to work. That is the fact of the times.

Should this be an ongoing conversation to prepare for the _next_ pandemic? Certainty. But we lost the benefit of time on this one.


Respectfully, this is a sunk cost fallacy. The idea that we’ve already screwed up so there’s no way to radically change course is a recipe for disaster. Even the UK, who foolishly tried to go the probably-nonexistent “herd immunity” route realized their error, turned things around, and is now doing much better than the US (although worse than Europe, because of their early mistakes).


It is only a fallacy if incorrectly applied :D

In some cases, it is better to continue course with known variables.

Also, I wouldn't say it is non-existent. As I said in another response, I currently see a lot of evidence for the cross-reactive t-cell immune response causing the virus to burn out after around 25% infection rate.


There are no “known variables” under the circumstances you describe in a novel pandemic because we don’t know the long term consequences of the disease.

There’s likewise no firm understanding of the duration or quality of immunity, nor will there be for probably years, making every appeal to herd immunity little more than dangerous speculation.


We don't know the long term consequences of completely shutting down a majority of society for an unknown period of time, including depriving children of an education. So let's not compare unknowns. This whole thing is an unknown and we need to accept some risk in each direction or be motionless.


But the variables in the other direction aren't firmly known either. We don't know that suppression can be maintained in the medium term, and we don't know that a vaccine will be able to eliminate the virus in the long term. We have no option but to make choices based on dangerous speculation.


> We expect a girl making minimum wage at Kroger to accept that she is an essential worker. Why do we not expect the same from school staff?

I wish that as a society we could decide that anyone we're going to call an "essential worker" and draft to the biohazardous front lines should bloody well be paid at least as much as the rest of us who can be gone for a week with little ill effect to society at large.

Not just during an emergency either - they're essential the rest of the time too.


Over here in Asia where we live in joint families or our parents/grandparents live in the same house as us for our entire lives this is a non-issue, I always found it weird how people in the west headed out to live independently as soon as they turn 18 or go to college. I knew a guy in Germany who was working a job and said he was peer pressured to leave his parents home because it was seen as something negative, that he was still "freeloading" by the time he was ~24.


It could be argued that the multi-generational home is one of the cultural ingredients for such a bad outbreak in Italy. That is a lot more common in that country than in some other parts of Europe.

It is also somewhat common in immigrant groups in western Europe and the US (though somewhat out of economic necessity rather than cultural norms) and those groups are also the hardest hit in the US (apart for retirement homes).

Causality is hard to prove, but it is something worth looking at.


The teachers don't expect the same, because they are still getting paid.

I'm not saying they don't have legitimate questions about how schools will reopen safely, but to be frank, it's really easy to argue that it's "just not safe enough", when you're still pulling a paycheck sitting at home and the closing of schools is felt by working parents who are SOL -- not by yourself.


Most teachers would rather be in the classroom than do online learning. They'd also like people to be safe.

The issue comes with trying to force kids to wear masks when so many parents are against them in many places, maintain social distancing, and keeping things clean and sanitized.

Keeping kids focused and learning has become difficult enough, but add on all those measures plus the possibility of contracting covid, just means you will lose a lot of experienced teaching staff.


"Most" is doing a lot of heavy lifting in that sentence. And lets also be real, there is a self-reporting bias there, where I doubt very many people (myself included) would admit to _wanting_ to not work and still get paid, even if that is the motivation.


Most teachers are still working doing online learning though, which why I stated they'd prefer to be in the classroom. Online learning is all the worst parts of teaching with very little of the joy.

Sure, if someone wanted to pay me to do whatever I wanted I'd take it no qualms whatsoever. But yes, I may not admit to it.


I think that like most things in the states, this is super dependent on where you are. I know in my area, teachers were _not_ working every day, despite still doing online learning. They were supposed to check in with the kids every few days. In fact, most went on unemployment (at the request of the district) to be able to make the lower work scheme work without impacting district budgets.


Are you kidding? Every teacher I know has had to radically reinvent their classrooms for fully remote learning on the fly with minimal support and are working around the clock to do so.


Ding ding ding.

I heard of teachers outright disappearing, claiming "technical issues" during this time.


In my city all sports teachers were suddenly ill for several weeks. they had the lowest risk, but apparently also the smallest brains.


Lol. Nice work if you can get it


Of course there will be people like this. Do you think they are anywhere close to the majority?


No but it's unacceptable.


Case counts in children is irrelevant. For an infection to become a case it has to be diagnosed, and that typically only happens with symptoms. But we know young people rarely have symptoms, so obviously they rarely count as cases.

INFECTIONS, however, matter a LOT. If you're infected you can pass a virus on without ever being counted as a "case." And we have zero reason to think children can't be infected. Hell, tigers and mink can be infected. Of course children can be infected. This thing is crazy infectious.

Children will spread the infection to their teachers, school staff, and families. There is no question about that, regardless of whether children's infections count as "cases."


The report mentions this and for Sweden there was a study that found that school staff had no increased risk of exposure.

In that report (see reference 6) for example taxi drivers had 4 times the increased risk of exposure compared to teachers of primary school.


And yet, in other cases (e.g. Israel) infections have spiked after school reopenings. The evidence is highly mixed, so it's very important not to cherry-pick cases that only support one's hoped-for policy outcome.


> Children will spread the infection to their teachers, school staff, and families. There is no question about that, regardless of whether children's infections count as "cases."

Actually this is exactly the big question right now -- ignoring "cases", are children as infectious as adults?

We don't know, signs point to "not as infectious, but probably nonzero".


So in a classroom with 15 kids breathing in and out, talking etc, for hours, with an airborne virus, seems the teachers will catch it.


We don't know this either. May be age-dependent.


Ever caught a cold from your kid, who didn't have it bad? I have. It's highly likely this is the same, and the burden of proof is on those who want to say this coronavirus is the exception.


> Ever caught a cold from your kid, who didn't have it bad? I have.

Of course, and so has every parent -- what, exactly, are you implying, that the people studying this haven't had this experience? And are therefore not considering that kids can have mild symptoms but still be contagious?

If so, that's an awful lot of ignorance that you are ascribing to everyone studying this with an opinion that doesn't match your lived experience with other viruses.

If not, please enlighten me.

> It's highly likely this is the same, and the burden of proof is on those who want to say this coronavirus is the exception.

Yes. You are literally commenting in a thread about a paper that is trying to provide evidence ("burden of proof") by looking at differential rates of illness, and not simply drawing inferences from general facts about viruses -- which is what you are doing here.


> But we know young people rarely have symptoms

And we know that, while presymptomatic spread is an issue, asymptomatic spread is between rare and nonexistent.

The fact that children tend not to be diagnosed because they tend much more strongly than adults to be asymptomatic when infected is not irrelevant to their propensity to spread the disease.


>>And we know that, while presymptomatic spread is an issue, asymptomatic spread is between rare and nonexistent.

Our knowledge is not that precise yet.

What we do know, based on models, is that "silent" transmission accounts for about 50% of covid-19 infections.

https://abcnews.go.com/Health/asymptomatic-presymptomatic-pe...


We don't know this. We would need full contact tracing and much faster testing to know this. Plus, we now know antibodies may _not_ be the biggest contributor to the immune response. It seems T-Cells are in some cases able to fight the disease without ever mounting an antibody response Thus no antibodies.

But the ol' maxim applies here: absence of evidence is not evidence of absence


> absence of evidence is not evidence of absence

That applies to infection/transmission via schools in general. Precisely because we don't have decent testing and tracing, we have a large number of cases whose origin is unknown. Schools have to be considered as one possibility, especially considering the several cases where reopening schools has been strongly correlated with spikes in infections. The precise mechanism doesn't matter. It's a red herring. Whether it's kid to kid, parent to teacher, cafeteria workers, whatever, it seems to happen some of the time. Until we've clearly ruled out a cause for those unknowns, we have to consider it still operative.


Asymptomatic spread nonexistent?

"Our results indicate that silent disease transmission during the presymptomatic and asymptomatic stages are responsible for more than 50% of the overall attack rate in COVID-19 outbreaks."

https://www.pnas.org/content/early/2020/07/02/2008373117


Sure, if you add presymptomatic and asymptomatic spread you get a large number (because the most infectious period is the presymptomatic period right before symptoms develop.) That doesn't even begin to contradict asymptomatic spread, distinguished from presymptomatic spread, being rare to nonexistent. Usually, this makes little difference because you can individually distinguish the two only in retrospect, but when you have a population (like children) that demonstrably has a much lower propensity to develop disease symptoms when infected and a much higher propensity to remain asymptomatic, it makes a big difference.


You should publish your findings showing it is "rare to nonexistant" so that these researchers no longer waste time studying asymptomatic spread...


The second bullet point of the conclusion states...

| Children are not a major risk group of the covid-19 disease and seem to play a less important role from the transmission point of view, although more active surveillance and special studies such as school and household transmission studies are warranted.

I feel like that is probably the next most important question to answer.


Or we could take a look at Israel where they opened up schools and saw a significant spike[1].

[1] https://www.npr.org/sections/coronavirus-live-updates/2020/0...


Or South Africa where they tried to open up schools for only two grades (7th and 12th).

"Since the first phase of the schools reopening last month, 968 schools have had to close due to outbreaks and 2,400 teachers and 1,260 learners have tested positive for COVID-19."

Source: https://medicalxpress.com/news/2020-07-south-africa-phase-re...

Or the Georgia summer camp that had an outbreak involving 85 campers and staff:

https://www.wftv.com/news/trending/85-campers-staff-test-pos...

Or the Missouri summer camp that had an outbreak involving 82 kids and staff:

https://www.foxnews.com/us/missouri-summer-camp-closes-after...

A lot of this is anecdotal, sure, but I find it hard to believe that kids don't spread the virus if we're seeing large outbreaks like these already.


If you want an example involving younger kids, there was recently an outbreak involving 12 staff and 8 kids at an Oregon daycare that serves kids ages 6 and under [1].

It might be impossible to know whether the adults infected the kids or vice versa (or both), but Coronavirus cases are growing fastest among kids younger than 10 in Oregon right now [2], so ... to me, it makes sense to assume that kids can spread it until it's proven otherwise.

Lastly, for those who don't know, the CDC internally lists reopening schools as the "highest risk" for Coronavirus spread. [3]

[1] https://www.wweek.com/news/state/2020/06/30/oregon-child-car...

[2] https://www.oregonlive.com/coronavirus/2020/07/coronavirus-i...

[3] https://www.cnn.com/2020/07/11/politics/cdc-documents-warn-h...


> 2,400 teachers and 1,260 learners have tested positive for COVID-19.

It's pretty interesting that almost twice as many teachers as students tested positive. Presumably there are ~20x more students than teachers?

It may very well be the case that children are far less likely to either catch or spread the virus, but far less likely is not the same as not spreading it at all.


They opened up schools, as well as pretty much everything else. So it is not really clear whether the schools were the biggest contributor to the spread.


I don't see why it's an "or". If data from Finland and Sweden suggests school has no impact, and data from Israel suggests it could, that's all the more reason transmission studies are needed.


Assuming children do not spread covid-19 as much as adults, it would be fair to say they still do spread at some degree. Therefore, the question is what is the risk tolerance that is acceptable to society? Are we as a society willing to accept that some adults will be infected and/or die as a result of children going to school? What's the acceptable risk tolerance for teachers? If there is an assumption that some teachers will die, how many is too many?


There is an acceptable risk because we already accept the risk from children being vectors for spreading annual seasonal diseases that do end up killing adults and children. What is that level? Doubt anyone wants to specify an exact number because then they will be forever tarred with that number of deaths. One thing is very obvious about this pandemic: the degree to which it has been politicized has made it impossible to respond in a manner that is similar to other threats of similar risk.


> respond in a manner that is similar to other threats of similar risk

Is there another example in the U.S where U.S citizens reacted reasonably and averted disaster?


It could be argued that the response to the Spanish Flu, Polio, HK Flu, H1N1, Zika, Swine etc. It appears by most measures this is an order of magnitude less lethal than Spanish Flu. THIS one, however, is political.


0.65% IFR as of the latest CDC estimates (July 10)[1]

We had fewer people in 1918 so this would still mean millions of deaths if we let this run it's course without mitigation.

My other concern is whether this virus will have adverse effects later in life when one's immune system weakens.

This virus may very well drastically drop our overall life expectancy.

1. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...


The update the CDC made is interesting. AS the footnote in the estimate table states, the IFR is taken from the pre-print _A systematic review and meta-analysis of published research data on COVID-19 infection-fatality rates_ by Meyerowitz-Katz, G., & Merone, L. et. al. The conclusion of their paper states:

> Based on a systematic review and meta-analysis of published evidence on COVID-19 until May, 2020, the IFR of the disease across populations is 0.68% (0.53-0.82%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents the ‘true’ point estimate..._

There have been several reports that the IFR has lowered since late May, so it will be interesting to see if they rerun their metanalysis with June/July data. Their paper also makes the point that this could be an underestimate due to reporting issues (under-reported deaths). But likewise it could be an overestimate due to under-reporting infections (with so many asymptomatic cases). I am a little concerned over the lack of mention of that fact in the paper, which to me is as important as the under-reported deaths.

I understand your concern regarding long-term impacts. While we can't dismiss those concerns, it would be the only coronavirus in the history of known coronaviruses to do anything like that. So with our knowledge of this virus and the family of viruses, we can say that is "unlikely".

Tissue damage from a lung infection is _not_ rare. The flu does this (https://www.sciencedaily.com/releases/2009/07/090717150302.h.... Any pneumonia can cause scarring of the lung tissue, viral or otherwise.

If you are referring to the clotting and inflammation, again this is not altogether rare for a serious infection. Inflammation is common and not normally dangerous. The clotting is interesting, but also not unheard of. Also some interesting evidence that this may be a secondary infection (perhaps caused by venting? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836438/) https://principia-scientific.org/cv-19-autopsies-show-blood-...

There are going to be a lot of deaths. I can't argue out of that reality. It is really unfortunate. We will all known somebody who dies from this, or at least are within a free degrees. The debate, in my opinion, isn't on preventing all deaths, it won't happen. It is how do we minimize death while preventing long term societal and economic damage. And how do we protect the most vulnerable without causing those damages elsewhere.

I know it sounds weird, but the age stratification of the IFR is a HUGE gift of this virus. It is more age stratified than the flu or other common pandemic sources. We are very lucky. Next time we may not be, so I hope we can learn from this on how to prepare for what we feared this was.


The polio waves in the 40s and 50s I'd argue were handled pretty optimally. Public accommodations were (for over a decade!) shut down when needed to control the epidemic in their area, and the government pushed hard to fund vaccine development. But as far as I've read, there were no significant voices arguing either "polio is just a bad flu" or "we'd better shut down schools until the vaccine is ready".


> There is an acceptable risk because we already accept the risk from children being vectors for spreading annual seasonal diseases that do end up killing adults and children.

This seems to be a common thought, but it is an error to assume that incidence of death = acceptance of death.

The truth is, the socially and politically acceptable incidence of death from seasonal communicable diseases is 0. Yes, deaths still occur, but that is in spite of absolutely tremendous investment of resources to try our very best to get it down to 0.

To pick on the flu, for example, there is no tactic or resource that we have available that we have not deployed. We have invested many $billions to create an annual national vaccination program that aims for 100% uptake and is even backed by a special liability regime to manage lawsuit risk. It is the largest vaccine program we have for any disease.

We have also invested (and continue to invest) additional $billions in studying every aspect of the disease, how it invades the body, how it spreads, how it harms people, etc. We have spent even more to create public awareness of flu symptoms, treatments, and appropriate behaviors.

The fundamental difference between the flu and COVID-19 is the possibility of significant asymptomatic or presymptomatic contagion. With the flu, you're not really contagious until you are symptomatic, so getting people (including kids) to stay home when they feel sick does as much good as a lockdown would. We don't really know for sure with COVID-19. So far it seems like a big possibility, hence the emphasis on masks, separation, stay at home, etc.

Also unlike the flu, we don't know what COVID-19 does to the human body. We don't know how long post-infection immunity lasts, and we don't know what chronic ailments might linger with survivors.

The reality is that we can't compare it with "other threats of similar risk" because we don't know what the risk is yet. That's why it is appropriate for the current response to COVID-19 to differ from the way we fight the flu and other more well-understood communicable diseases.


My wife is a teacher and my daughter will have to return to day care if schools resume.

What bothers me the most is that just like retail / grocery store workers we put people with the lowest earning potential and generally worst benefits directly in the path of this. I don’t want to get COVID but unless I convince my wife to quit her job my odds of getting it greatly increase due to situations out of my control.


I don't want to get covid either but the risk is low enough that it doesn't bother me at all. I try to live my life as it was before pandemic as much as i can.


Isn't living life in the same way pre-covid the reason the US is having so many new cases?


It is. I think that's pretty universally acknowledged, even by those who think it's the right strategy.


Yes but many new cases doesn't mean its bad. Most of it are either asymptomatic or having mild symptoms.


It does seem that way, and I hope it remains so. The demographics have shifted younger. I do worry about my parents, grandparents and friends who have preexisting conditions and the increase risk with so many more cases around.


At least in the United States, I suspect that the adults spreading it are doing it enough that it won't even register as a blip on the radar.


Even when kids go to the physical school, teachers could still video in for the teaching.

Yeah, sounds a bit crazy, but could probably be made to work.


Let's say you're putting a group of twenty-five random sixteen year olds together without a live coach. What could possibly go wrong?


The 16 year olds could step up. These are tough times.

I have much less faith in 8 years olds.

I like the young proctor suggestion a lot!


They could hire one or two 19-20 year old proctors to be in the room with the kids. Would be pretty safe.


The main question is susceptibility. The projection for models have been wrong. Out by orders of magnitudes on deaths. According to them Sweden should have 10 times the deaths they have.

The most obvious answer is that quite a lot of the population are already not susceptible to this virus for whatever reason.

And we also know that the excess death rate on the under 40s is negligible - which is the majority of the population. The median age of deaths is over 80 in Europe.

Since it affects the older population more than the younger, you want to catch it as early as possible. Catching it next year is more likely to kill you than catching it this year.

There is no longer any justification for holding back the majority of the population when we can just retire the old and ask them to keep out of the way until the virus fully burns out.


> Since it affects the older population more than the younger, you want to catch it as early as possible. Catching it next year is more likely to kill you than catching it this year.

That might be true if you assume that there will not be a vaccine AND that medicine will not advance in the near future. But we have already seen medicine get better at treating Covid. (For example, doctors have learned not to use ventilators so much and proning is used more often, from what I understand.) I would rather get Covid now than a few months ago both because the medicine has gotten better and because the hospitals in my area are less overwhelmed—despite the fact that I am a few months older now. Furthermore, if I do have to die from Covid, I'd rather live a little longer first!

> retire the old and ask them to keep out of the way

Plenty of high-risk folks are not of retirement age. And many who are older live with younger family members for various reasons. It is not feasible for all of the high-risk people to "keep out of the way." Who will take care of high-risk elderly and disabled people who need help with bathing and toileting? What should grandparents do who are the guardians of their grandchildren? It's obvious that you have not thought this through.


This is bad advice. We have no idea if it can be caught twice.

https://www.theguardian.com/world/2020/jul/12/immunity-to-co...


We know that some process has caused deaths to drop to near-zero in the places that were disaster zones at the beginning of April, even though they're no longer shut down and haven't entirely eliminated the virus. It's hard to imagine what that process could be if not immunity.

(Of course, since I'm sure I'll be called on this, the fact that herd immunity is possible does not by itself prove it's a wise course of action.)


> It's hard to imagine

Hard for who? This is Epidemiology 101 stuff. You don't have to totally eliminate a virus to go back to normal. If the few infected individuals are quickly identified and isolated, along with contacts, outbreaks can be contained quite well. Test, trace, and isolate. We've been managing many other diseases this way for years. There's little mystery to it.


The mystery is that the drop happened even in areas such as Sweden which did not do this.


People in Sweden did social distance, did stop going out to bars and cafes etc.


> It's hard to imagine what that process could be if not immunity.

The first paragraph of the article amiga_500 linked says: "People who have recovered from Covid-19 may lose their immunity to the disease within months, according to research suggesting the virus could reinfect people year after year, like common colds."

I don't think there is significant doubt that immunity exists; the question is how long it remains in effect. The drop in deaths that you mention would be compatible with a several month long effective immunity period, but a herd immunity approach would probably not work well if reinfection is possible every year.


Poor quality stuff. If this can be caught again, there is no natural herd immunity.


If you haven't read it yet, this short report seems to conclude that for reasons that are not yet well understood, children are not very likely to contract the disease, and if they do contract it, are not that likely to spread it to others. As a result, school closings (or the lack thereof) do not seem to have a major effect on the spread of the disease. Pulling some key quotes:

"Outbreak investigations in Finland has not shown children to be contributing much in terms of transmission and in Sweden a report comparing risk of covid-19 in different professions, showed no increased risk for teachers."

"In conclusion, closure or not of schools had no measurable direct impact on the number of laboratory confirmed cases in school-aged children in Finland or Sweden"

"In the contact tracings in primary schools in Finland, there has been hardly any evidence of children infecting other persons. The Swedish comparison of number of reported cases among staff in day care and primary school to number of cases in other professions does not show any increased risk for teachers. This also indicates that the role of children in propagating this infection is likely to be small. Various papers on contact tracing have also found that children rarely are the first case in family clusters (4, 12, 13)."

"Closing of schools had no measurable effect on the number of cases of covid- 19 among children."

"Children are not a major risk group of the covid-19 disease and seem to play a less important role from the transmission point of view, although more active surveillance and special studies such as school and household transmission studies are warranted."

Intriguing.

This Mercury News article from a couple days ago tells the same general story, and offers some theories on how things might work biologically:

Coronavirus: Why kids aren’t the germbags, and grownups are.

As school districts sweat over reopening plans, a growing body of research suggests young children are unlikely to transmit COVID-19 virus. They get it from us.

https://www.mercurynews.com/2020/07/10/coronavirus-why-kids-...


I don't see any data for adult infections. That's what we're concerned about mostly when opening schools. That the kids will infect the adults who will infect each other. I can't believe they have the audacity to publish this paper and its conclusions which clearly cannot be drawn from the data presented. This is pure and utter garbage, garbage that will be used by idiots to make policy decisions that will kill people unnecessarily. The paper should be retracted and peer reviewers should rip it up. What idiocy.


6% of infected people in Orange County, California are children 0-17 - this is after many restrictions. Even if the percentage stays at 6% after schools reopen, we're talking about a huge ripple effect on the whole population. Unlike adults, kids really can't follow strict measures - America is no Finland, no Sweden, no Asia!


Can anyone comment if this document 'Covid-19 in school children - A comparison between Sweden & Finland' is an official report ? I'm unable to find it by browsing or searching for it on the website.



Frustratingly unhelpful paper, for those looking for useful, applicable measures and measurements.

No details around:

* distancing measures * space utilization * travel arrangements * coplay arrangements


I guess this is the closest to what you are looking for. Google translate is usually pretty good.

https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utb...


The reason the comparison is interesting is that Sweden didn't really implement such measures. Schools there have been operating pretty much as normal.


I understand and appreciate the Swedish strategy...and its failings for its adult population. With respect to what may be claimed "success" in its juvenile population, because of potential applicability (or not) to other communities, details of "normal" are essential. Those are entirely absent from this report.

More directly- as a parent in NYC, I am unhappily looking forward to people citing this unhelpful paper and "the Swedish model" claiming return to school will be safe. No and no is what I say to them.

Cheers.




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