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A century ago, American communities grappled with another deadly pandemic, The Spanish Influenza. Then as now, leaders failed to provide accurate information about the disease, leaving Americans isolated and ill-informed as they confronted an immense tragedy.
The history of that earlier pandemic suggests that, as the Evanston Township High School community moves forward with reopening for in-person learning in the fourth quarter, we will need clear, transparent direction that is informed by scientific data. Moreover, everyone in the community must act responsibly.
As John Barry explains in “The Great Influenza: The Story of the Deadliest Pandemic in History” (2004), the 1918 influenza virus killed with exceptional speed and brutality, much more than today’s coronavirus. People died within 24 to 48 hours from symptom onset. Many victims bled from their nose, eyes, and ears. Victims’ blood was so deprived of oxygen that their skin color darkened to the point of making race undeterminable. Tragically, that virus killed not only the elderly, but 20-40-year- olds in the prime of their lives.
In 1918, American soldiers were fighting abroad in World War I. As the virus raged through communities at home, public health departments tried to maintain morale by telling people, “It’s just the flu.” Just the flu? Just imagine …
Panic set in. Trust was lost. Parents in their 20s died, while their orphaned children suffered from starvation. No one reached out to help. Americans didn’t know how – or whom to trust.
“Society is largely based on trust when you get right down to it, and without that there’s an alienation that works its way through the fabric of society,” John Barry states. “When you had nobody to turn to, you had only yourself.”
When we consider the move forward with ETHS’ reopening, we must trust the data – and in one another.
The scientific data supporting reopening with layered mitigation is compelling. The ABC Science Collaborative, a coalition of faculty from Duke University and the University of North Carolina, studied in school transmission among 11 school districts comprising 90,000 students, faculty and staff. Community cases were 773, but only 32 cases were found in schools utilizing layered mitigation. If in-school transmission were as prevalent as community transmission, they would have expected 800-900 cases. Data there and elsewhere suggests that schools may actually have a protective effect; that is, schools are safer than simply being in the community, and schools may reduce the spread of the disease.
Layered mitigation – use of masks, distancing, handwashing, and ventilation – works for all people. Those with vulnerabilities – obesity, diabetes, asthma, heart disease – can protect themselves from contracting the virus with layered mitigation. The same is true for those who are not especially vulnerable themselves, but who live in vulnerable families. Non-white communities associated with ETHS have suffered from more infections, hospitalizations, and deaths from COVID-19 due to health disparities that have existed for decades. Data shows, however, that reopening schools will not fuel the pandemic. Vulnerable communities will not suffer from reopening schools any more than if schools remain closed. This is so vital to understand why ETHS is making the right move to in-person learning for the fourth quarter.
Furthermore, the data regarding the high cost of declining adolescent mental health with school closures further supports ETHS’s reopening decision. Isolation, depression and suicidal ideation have all increased as a direct result of remote learning. Area pediatricians are treating this at alarmingly high rates. Returning kids back to school with their friends and teachers in the building can reverse this terrible trend.
The hard part now, like one hundred years ago, is trusting this data, and trusting each other. As Mr. Barry states, “Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.”
We have already suffered the terrible consequences of not heeding Mr. Barry’s advice. The Trump Administration fueled distrust by undermining mitigation strategies and downplaying the severity of the virus. It didn’t have to be this bad.
We must begin to build back trust. Physicians and public health professionals are crucial to this process because they are trained to sort through data coming from all over the country and around the world to interpret the implications for the ETHS community. School administrators, teachers, and faith leaders are also critical because people look to them for guidance and information.
How do we proceed ethically? As doctors, we believe the following:
First, District 202 should convene a medical advisory board whose members include a diverse array of doctors and public health officials. District 202 administrators should work with that board to explain scientific findings to the community and be completely transparent with their plans. The medical advisory board can support ETHS with the “how” and “why” of mitigation strategies that will be crucial to a safe reopening.
Second, we must all embrace the vaccine. In addition, Evanston should provide priority access to our Black and Brown communities, which is in line with what we have done for other vulnerable populations, such as nursing home residents and individuals over age 65. The vaccine will directly address the disparate health outcomes between whites and non-whites with coronavirus – but only if it is made accessible to all and concerns about its safety are dispelled.
Third, all families – but especially those that have been relatively spared because disease and death have not struck as close to home – must show that they can be trusted. Teens and adults must avoid parties, avoid non-essential travel, and avoid indoor dining and bars until vaccinated. Anything less suggests little regard for the lives of Black and Brown families in our community.
Finally, and over time, we must work harder to end health disparities between white and non-white communities by improving access to affordable and quality care.
ETHS has already taken a big step in this direction by having a fully staffed physicians’ office within the walls of the high school that is open to all.
We commend ETHS’ plans to move forward with reopening. The cost of not doing so has been mounting. But more importantly, with layered mitigation, school reopening is safe for everyone. For this to work, we must trust our leadership – and each other.
Here’s our chance.
Eric Chehab, M.D.
Shana Christian, M.D.
Cathy DiVincenzo, M.D.
Valerie Kimball, M.D.
Matthew Pellerite, M.D.