California officially reopens Tuesday after 15 months of restrictions and lockdowns for the COVID-19 pandemic.
California has done a great job in vaccine distribution and uptake, surpassing President Joe Biden’s desired metric of 70% eligible residents receiving their first dose on May 31. However, the general perception that more restrictive measures throughout the pandemic kept Californians safe is not reflected in our difficult third surge, nor the mental health effects on California’s children of prolonged school closures. On this reopening day, it is important to reflect on three mistakes California made in the hopes that more data-driven approaches can be applied to guide us safely out of the pandemic completely.
School closures
California to this day officially has the lowest number of children back to full in-person learning of all 50 states. We have not budged from this last-place position despite data from multiple countries and places in our own (Wisconsin, North Carolina, Utah, Chicago, New York City) demonstrating the safety of in-person learning with mitigation procedures for children and staff. Even in households, children have a threefold lower chance of catching COVID-19 than adults and, if they do, are about half as likely to spread it. Unfortunately, despite article after article by California-based scientists on the safety of in-person learning (in local and national periodicals), almost 80% of our students have not seen the inside of a classroom since March 2020.
The depressing contrast of watching California’s private schools reopen safely for nearly the entire year while public schools remained shuttered underscored the inequities that were deepened by basing decisions off models and metrics that did not reflect the true risk to students and educators. California students with the means to pay tuition or form private learning pods had a school year that approached normal. Those families who did not went without.
The most recent article we wrote from UCSF last week in the Wall Street Journal about school closures detailed the tragic mental health costs of this mistake California made towards our children. Data from hospitals in the Bay Area showed a 66-75% increase among 10- to 17-year-olds screening positive for active or recent suicidal ideation from last year. California Department of Public Health (CDPH) data showed 134 youth under age 18 in California died by suicide in 2020, up 24% from 108 in 2019, and well above totals from 2017 and 2018. Adult suicide rates were down by 11% concomitantly, speaking to additional stressors among children beyond the pandemic from losing support structures in schools. Our data was reflected in national CDC data released last week showing a 50% increase in emergency department visits for suicide attempts among American adolescents (mainly girls) during the pandemic.
Despite publishing a blueprint that detailed metrics for normal school openings for the fall in the New York Times — which are metrics that we have already reached in California — the Los Angeles Unified School District proposed this week twice weekly testing and masking of children and teachers in the fall. Asymptomatic testing of children is not recommended in the yellow tier in California, and we exited the tier-based system in our state today. The CDC recommends masking indoors only in areas of high community transmission and already indicated a plan to likely discontinue mask requirements for children indoors in the fall if community transmission stays low. California continuing the same mistakes around schools for the fall and signaling “abnormal” to our children may lead to ongoing mental health effects.
Closing the outdoors
On Dec. 3, during our third surge, California issued another stay-at-home order which closed large areas of the outside, including outside playgrounds and outdoor dining. However, closing the outdoors, based on how this virus disseminates, is not scientifically based. In fact, SARS-CoV-2 viral particles disperse effectively in the outside air.
A study in Wuhan, China, which utilized careful contact tracing, discovered that just one of 7,324 infection events investigated was linked to outdoor transmission. An extensive review reported that the risk of outdoors transmission of the coronavirus is about 20 times lower than inside. In another analysis of over 232,000 infections in Ireland, only one case of COVID-19 in every thousand was traced to outdoor transmission. And an extensive review from the University of Canterbury last fall concluded that outdoor transmission is rare, citing the opportunity costs of not encouraging the public to congregate outdoors for “the potential impact on physical and mental health and wellbeing.”
Closing events like outdoor dining may have driven people inside during the holiday season, and California had a terrible third surge over the winter holiday. Many places, like British Columbia, kept the outside open as much as possible to allow for congregation and socialization. The principle of harm reduction is to reduce infections from a contagious pathogen by also acknowledging the real-world conditions that may require essential work to continue or people to want to see loved ones. California took a “lockdownist” approach, rather than one of harm reduction, which may have harmed small business owners and increased social isolation in our state more than others.
Unmasking and embracing the effectiveness of vaccines
The revised CDC mask guidance May 13 stated that vaccinated people no longer needed to mask, inside or out. Although not messaged well, the backlash to this response and the hesitation by the public to embrace it is partially the fault of California’s messaging around vaccines and masks.
Masks, distancing, ventilation, testing and contact tracing are tools for COVID-19 mitigation. Vaccines and increasing population immunity are the solution. California not only has one of the highest rates of vaccination in the country, but, unfortunately, has natural immunity from our terrible third surge. One of the most comprehensive seroprevalence studies performed in the U.S. was performed by the CDPH and showed a 38% seroprevalence rate after our winter surge and before vaccines were being rolled out to the general population. Natural immunity and vaccinations are contributing to population immunity in our state, which is keeping our case and hospitalization rates low even as we graduate to less restrictive tiers. Low community transmission keeps our unvaccinated children safe, although our summer camp and school guidance has children down to the age of 2 still masking with low cases and hospitalizations for months across our state.
Despite having some of the most amazing immunology-related research coming out of California (at La Jolla Institute for Immunology and UCSF) showing the durability of the immune response to COVID-19 and the effectiveness of the immune response against variants, California continues to message alarm over variants and test asymptomatic individuals after vaccination, despite the CDC recommending following symptomatic breakthroughs. The way through this communication challenge in California around the CDC guidance on May 13 was to message simply and with optimism. Vaccines work. Continuing to message fear undermines trust in the data we have around vaccine effectiveness and prevents people from returning to pursuing healthy normal lives.
The signaling of abnormal will continue to have effects on our schools and personal fears and California should step forth with optimism and confidence on the power of immunity to get us through this pandemic on this day of opening.
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June 15, 2021 at 06:03PM
https://www.sfgate.com/politics/article/California-reopen-COVID-Monica-Gandhi-schools-dine-16247230.php
Opinion: As California reopens, do not forget these three mistakes on COVID-19 - SFGate
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