Washingtonians, How’s your State of Emergency Going?

Governor Jay Inslee of Washington was the first to declare a State of Emergency, and he may be the last one to rescind it. “Never let a crisis go to waste” has a corollary, and that is: “Preserve the crisis.”

It’s April 12th, 2022. Governor Jay Inslee has had State of Emergency powers for 772 days. He issued his emergency proclamation on February 29th, 2020, more than two years ago. He was the first governor in the nation to do so, making Washington State’s COVID emergency longer than any other.

Come Saturday, we are again completely alone in the Pacific Northwest in our heightened condition. Oregon rescinded its emergency powers declaration on April 1st, 2022. Idaho’s Governor Brad Little is ending their State of Emergency this Friday. Governor Dunleavy ended Alaska’s State of Emergency a year ago. Montana ended its State of Emergency last June.

We are significant outliers not just in the Pacific Northwest, but when compared with the nation as a whole. According to the National Academy for State Health Policy, only Washington State and West Virginia remain in an indefinite State of Emergency. Thirty-seven states either had no state of emergency or those declarations have already expired (lightest green.) Eleven more are set to expire later this month (slightly darker green.) One is set to expire in May (Illinois), and one in June (California.) In West Virginia, the Governor signaled in March that he’d end the State of Emergency soon but hasn’t done so yet. Local West Virginia news suggests that potential loss of federal health insurance money have likely driven him to delay.

Data from National Academy for State Health Policy, updated to reflect April 12th 2022

The question which matters most is: are we in an emergency?

No matter how you evaluate it, the resounding answer is no. Statewide, just 2.04 people per 100,000 are hospitalized with COVID, not even necessarily due to COVID. In our entire state of 7,710,000 people, just 157 of us are hospitalized for any reason with a COVID-positive test, not even because we have COVID. Remember: most hospitals routinely test all patients upon admission in an abundance of caution. Therefore, patients hospitalized due to, say, highway accidents who then also test positive for mild, asymptomatic COVID will be counted in that 157 tally.

Even erroneously counting every single one of these hospitalizations as being caused by COVID, that’s a current hospitalization rate of 0.002% of our population. Are we in any imminent danger of “overwhelming” hospitals? No.

If this is an emergency, then everything is.

Inslee’s emergency declaration included eight “WHEREAS” justification statements. None of them seem timely or relevant at the moment. Better still, in terms of vaccination, we seem among the most prepared states for future waves, be they minor or major. According to the Washington State Department of Health dashboard, fully 81.5% of Washington’s population over 5 years old have received at least one vaccination dose, and 74% are fully vaccinated. Vaccination will be ongoing and at people’s discretion, with many starting to get their second booster shot. Thankfully, that groundwork for optional self-protection for those most at risk has been laid.

How’s hospitalization trending? I tried to get an accurate hospitalization trend chart from the State of Washington Department of Health dashboard, but was greeted by this:

In what kind of Emergency do we shut down reporting of detailed hospitalization trends?

If you look at deaths with COVID (again, not necessarily due to COVID), the folks at 91-DIVOC have a helpful chart. Does this say “emergency” to you?

Deaths with COVID-19, not necessarily due to COVID-19, out of 7.71 million Washingtonians

Even if you look just at case rates, there’s no need for alarm. Omicron is a milder variant, which results in lower severity of outcome:

COVID Case Rates, Washington State
COVID case rate, Washington State, per State Department of Health

Why is this continuing?

The Governor said the quiet part out loud in his response to KOMO’s Keith Eldridge on Monday: “We want to make sure that federal money keeps coming, so it’s important to keep this in place right now.”

I’m sorry, Governor, but how is that not fraud? I know, that’s a pretty bold accusation, but let’s open the dictionary. Fraud is defined as “wrongful deception intended to result in financial gain.” This is clearly deception. There’s no COVID emergency currently in our state, and there hasn’t been for months.

Or, we can put aside the dictionary, and simply look to legalese. How does Washington State Law define an “emergency?”

The Revised Code of Washington (RCW) 38.52.010 states:

Emergency or disaster‘ as used in all sections of this chapter except RCW 38.52.430 means an event or set of circumstances which: (i) Demands immediate action to preserve public health, protect life, protect public property, or to provide relief to any stricken community overtaken by such occurrences; or (ii) reaches such a dimension or degree of destructiveness as to warrant the governor proclaiming a state of emergency pursuant to RCW 43.06.010.”

Do these conditions still exist?

Every Washingtonian knows that the conditions since 2020 have dramatically changed. We are no longer in lockdown. We are no longer required to wear masks. Kids have been back in school in every district in our state for months. County cases and hospitalizations are low and have been for months.

Bit by bit, the various mandates which were imposed during the State of Emergency are being rescinded. Inslee’s decided that drivers license renewal and learner permit extensions can now expire (proclamation April 1st 2022). He’s decided a mask mandate isn’t necessary; that ended March 12th 2022. Even Seattle’s City Council let the long-lasting eviction moratorium imposed during COVID finally expire.

Adding to the absurdity, both Inslee and his Lt. Governor went on vacation recently. I have no problem with them taking time off, but how can one possibly take a vacation during a state of emergency?

Former White House Chief of Staff Rahm Emmanuel had a famous quip: “Never let a crisis go to waste.” For Inslee, this appears to have a corollary: Preserve the crisis.

Seattle’s 50,000 School Kids Are Odds-On Favorite to be Last on the Planet to Unmask

When A demands something of B and withholds the freedoms of C to get it, don’t we call that a hostage situation?

Since 2020, the United States has been uniquely aggressive in its masking of public schoolchildren. Most of Europe never required masking in schools. In fact several European health agencies explicitly advised against it for elementary school-age kids. The World Health Organization also advised against masking children Kindergarten-age and younger.

In the United States, few areas have been more aggressive in masking than reliably deep-blue Washington State. As state after state ended all mask mandates in January and February 2022, Washington held out for weeks. Finally, Governor Inslee, who still hasn’t relinquished State of Emergency Powers, joined the crowd to allow indoor masking to be optional in public spaces starting March 12th, 2022.

But this relaxation of mandates didn’t apply to public schools. Governor Inslee left the policies for unmasking up to each school district, as informed by their local public health directives.

In a nod to each County’s power dynamics and local conditions and bargaining agreements between the schools and teachers unions, he let each district fight it out at the district/county level.

Predictably, just as with remote schooling, the school districts with the most powerful left-leaning (and arguably outright leftist) unions are now demanding that the student-harming interventions continue. This is despite any evidence of efficacy, or that mandatory masking is worth the harm it imposes.

Sorry kids. At this writing, no date for you to uncover your face is set. You must mask-up 6 hours per day, 5 days per week, indefinitely. The far-too-powerful teachers unions are lobbying for forced masking to continue until “at least May 1st 2022,” an arbitrary date untethered to any kind of concrete conditions, measures or goals. And Seattle Public Schools, for its part, has conceded that any change to the mask guidance requires “bargaining with our labor union partners.”

Seattle’s 50,000 K-12 students are my odds-on pick to be the very last kids on the planet, literally on planet Earth, to be permitted to go mask-optional.

Perhaps Los Angeles Public Schools will pull out a late “victory,” as LA Unified is still pushing back on a date, but even California bellweather San Francisco finally caved to public pressure and set March 12th as their mask-optional date. (More on Los Angeles here.)

To be sure, you can find some scattered parental support for King County teachers unions’ position. Just drop by a Seattle Public Schools parental group on Facebook or even a school board meeting, and you’ll see one or two speakers argue for continued compulsory masking. But with tens of thousands of parents on the other side, they are in an extreme minority. Add to this that there is a strong feeling among some parents I’ve heard from online that their child will be retaliated-against if they speak out against the wishes of this powerful union.

Let’s be clear. The only institution demanding the continued forced masking of 5-18 year olds in King County’s Public Schools are the teachers unions. You’re not hearing this pressure from a broad coalition of parents or students. You’re not hearing it from the Governor. You’re not even hearing this demand come from health agencies organically.

Think about that. Your kid might want to go mask-optional. They have done all things asked of them by adults over the two years of this highly disruptive pandemic.

But because there exists a highly organized, well-funded institutional lobbying group, it probably won’t happen until some arbitrary date. This force is paid for, ultimately, by our tax dollars. This body is not a scientific body. Nor does it offer any evidence the forced masking intervention is effective, or certainly not the path of least harm, when you factor in all the downsides of masking. They don’t offer evidence this policy reliably lowers case-counts or hospitalization when employed in school settings. I really marvel at that. Any kind of illusion that they’re looking out for your student’s mental health, enjoyment, achievement, opportunity or outcomes should be shattered at this point.

Look. We don’t have to guess. We have now run thousands of natural experiments in this nation, and around the world, over two years. Through it all, there is not a single school district you can find which, when it went unmasked or even mask-optional, experienced any noticeable upticks in hospitalization, or even major outbreaks tied to the unmasking decision. Why is that? Should we follow the science, or nah? Do we expect students not to notice?

The mechanics of this are somewhat complex. There’s a State Level order which is expiring March 12th. There’s a County level order which is also expiring March 12th. There’s a Department of Health Face Covering Guidance which is also expiring March 12th.

Regarding that Department of Health order, last week, the heads of local teachers unions here in King County, Washington sent the letter below to Interim County Director of Public Health Dennis Worsham and chief medical advisor Dr. Jeffrey Duchin, lobbying to keep the mask-mandate in place for school kids through “at least May 1st.” See if you can spot the citation of any scientific studies in their advocacy:

But this still leaves the contract between SPS and the union, outlined by the Memorandum of Understanding (MOU) between Seattle Public Schools and the Seattle Education Association (SEA). It mentions masks/masking/mask 21 times. Thus, the reason Seattle kids will be required to mask-up deal with a contractual agreement between two other parties. Rumor has it that bargaining has begun this week (and just this week) on relaxing these terms, but this could well open up a new can of worms, as SEA will likely “demand” things in return for “conceding” and “allowing” students and families to make their own choices on masking.

Got that? Party A wants something from B, and so they’re withholding something from C to get it. Don’t we call that a hostage situation?

Turning back to the union letter above, for months and months these same leaders no doubt urged us to “follow the science” when setting policy. Yet they don’t cite a single study which shows that mask mandates in schools change outcomes, certainly not to the extent that they are worth reductions in social connection, learning loss, or even just enjoyment of school.

Typically, the way to reduce scientific uncertainty in situations like this is to conduct randomized cluster trials. Two randomized cluster trials have been done regarding masking, and neither of them say that mandating masks is a statistically significant way to reduce hospitalization or spread. Dr. Tracy Beth Hoeg has been looking at two very similar and nearby school districts: Fargo ND and West Fargo ND — one required masks and one did not — comparing case rates. The results do not make the mask-mandaters case very strong:

The UK government commissioned a close look at the efficacy of masks in school settings. It failed to identify any clear evidence in favor of this practice.

But the teachers unions have their own reasons. Their stated “rationale” focuses on:

  • “First, we believe it could result in significant anxiety for many students, families and educators, and exacerbate the mental health crisis for them.”
  • “Second, we believe the negative impacts of lifting the mask mandate would be most heavily felt by our Black, Indigineous and People of Color communities as well as by people with disabilities.”
  • “Finally, we believe it could result in a significant number of students and/or educators choosing to go on leave, which would worsen our current educator staffing shortage and unusually high number of student absences”

The first reason these “educators” cite is that somehow making masking optional “could exacerbate mental anxiety.” Any studies to back that up? And if it is even true, whose fault is it that somehow returning to normal is anxiety-producing?

The risk to kids is low. It always has been. Since the start of the pandemic, over two full years, the CDC notes that the number of 0-17 year olds who have died with COVID (not even due to COVID) is 865, as of this writing. That’s out of 74 million kids in that age group:

It’s not like the danger of severe outcomes posed by COVID is higher here. King County’s vaccination rate is among the very highest in the nation, with 95.6% of those 12 and older receiving at least 1 dose, and 87.8% who have completed vaccination series.

This is the county that teachers unions characterize as risky to unmask before “at least May 1st”

The teachers unions insist that somehow letting kids and their families decide whether to mask up or not doesn’t “center the need of BIPOC communities.” What? Can you help me understand that? Where is it decided that all people of certain identity groups wish their kids to remain masked? If you want to make an identity-based argument, surely it should start with the fact that minority students’ test scores have dropped the most alarmingly during the two years of interruption of schooling? And another major disparity of outcome is between public and private schools — soon, they will be able to compare the mask-free private schoolers with the mask-wearing public schoolers. What signal does that amplify? Do the adults think that kids don’t notice, or talk about it with their friends?

The actions these teachers unions are taking here decrease enjoyment of school and widen disparities of outcome. Already, Washington State families have pulled kids out of public schools during the pandemic — enrollment levels are down more than 4% from 2019. Between October 2019 and October 2019 alone, 39,000 fewer students enrolled in public school in Washington State. Parents are choosing private school, homeschooling, or to leave the state. It’s already likely to result in a $500,000,000 hit to school budgets. The longer we keep kids from normalcy, the more this will increase.

The Seattle Educators Association one of the unions which demanded that teachers get priority vaccination but then kept schools closed more than just about any other district in the nation. In fact, even while they were lobbying for vaccination priority, 74% of them said that even full vaccination wasn’t enough to return to in person learning.

Survey results in February 2021 from Seattle Education Association

What happened next was that the Seattle Education Association and the Seattle Public School Board together kept kids locked out of in person learning longer than just about any district in the nation. Predictably, math and other test scores dropped at a record pace for ‘20-21. The teachers unions who were pushing hardest for prolonged remote schooling haven’t even acknowledged this was a mistake.

Meanwhile, adults (including many teachers) will go to grocery stores, restaurants, bars and more… entirely unmasked this spring. Sorry kids.

There is direct evidence that masking reduces the ability to be heard and understood. After 2 years of social isolation, restoring connection matters. Burden of proof is on those who demand this intervention, not on those who want to make it optional.

A better approach

We have known for some time now that one-way masking works. A well-fitting N95 or KN95 is nearly as good as multi-way masking. Masking should be optional, and everyone’s choice should be respected.

These are the adults we have hired, and that we taxpayers pay, to help educate the next generation. They should be concerned with student outcomes, but these outcomes are not looking good. After two full years of interruption of schooling, why is it that the mask mandates are still on those least at risk? Prolonged social isolation is sure to lead to higher dropout rates, poor academic performance, even suicide ideation.

Once we allow the kids to go unmasked, we need to look into just how it is that we’ve allowed these labor unions to hold tens of thousands of kids social connection, music, theatre, sport, academic excellence back. A child gets maybe twelve years tops of childhood. Adults fighting amongst one another for power has ripped away two of those twelve years for an entire generation of Seattle-area kids. Truly, and I mean this sincerely: shame on us for allowing it to continue.

New HHS Reporting Guidelines Risk Stoking Greater Worry About Pediatric COVID

The department of Health and Human Services is dropping the requirement that hospitals report daily COVID deaths, yet adding a bunch of pediatric metrics which will make pediatric problem look much larger.

On January 6th 2022, the Department of Health and Human Services (HHS) made significant changes to the guidelines by which hospitals report COVID-related statistics. New fields were added, and several fields were dropped. HHS mandates that these new changes be complied with by February 2nd. But these changes don’t seem benign to me — they risk misinterpretation and overstatement of the level of worry we should have about serious COVID in America’s youngest. And two full years into the pandemic, HHS missed yet another easy, obvious opportunity to help us better distinguish between worrisome and non-worrisome cases.

HHS has required that hospitals report key indicator data for a long time. They make adjustments to what is required from time to time. That, in and of itself, is not new. What is new is that they are now requiring several additional fields related to pediatric patient statistics that in aggregate risk the creation of alarming new headlines in a month or two, specifically about pediatric COVID. At the same time, HHS is also dropping the requirement that America’s hospitals report daily COVID-19 deaths. Yes, you read that right; it’s a very surprising directive; we’ll get to that in a moment.

The net result of these changes is that it is we will likely soon see media reports along the lines of “Pediatric COVID Hospitalizations Rise Alarmingly,” and “Pediatric ICU Beds Near Capacity,” when the underlying truth is that worrisome COVID among our youngest adults has been, and remains, extremely low — at the level we should worry about seasonal influenza.

What new data does HHS now want? They’re highlighted in blue in the screenshot below [source: COVID-19 Guidance for Hospital Reporting and FAQs (hhs.gov).]

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COVID-19 Guidance for Hospital Reporting and FAQs (hhs.gov)

Needless to say, the downstream impact of overstating the severity of pediatric cases can be very significant. It “bolsters” the case for unnecessarily prolonged mandates, school and college restrictions, elimination of activities, mandated boosters, masking, and yanking yet more childhood away from those who have always been least at risk of severe outcomes. Kids have inarguably already paid an enormous price in their childhood and mental health toward COVID mitigation, and it’s important that we get the most accurate picture of risks to them to chart the path of least overall harm. This reporting change and the downstream misinterpretations are quite likely to prolong it.

The risk to 0-18 year-olds of severe outcome due to COVID is exceedingly low. At this writing, of the more than 850,000 Americans who have died with or from COVID, the number of 0-18 year-olds who have died with or from COVID stands at fewer than 900. Kids are at greater risk of dying from suicide and vehicular accidents than COVID. They’re not at zero risk, but their infection fatality rate due to COVID is below 0.003%. Every day, when we drive our kids on the highway, we’ve decided that the risk/reward tradeoff is worth it, and that while highway danger is present, it’s not so alarming as to keep everyone home forever.

Overall, risk of fatality due to COVID is lowest for our youngest. Luckily, we as a society now generally understand that. But we still greatly overestimate just how age-weighted COVID is.

Number of COVID-19 deaths in the US as of January 12, 2022, by age. Statista.com. Keep in mind that this is death WITH COVID, not necessarily DUE TO COVID.

The New York Times visualized CDC mortality risk data this way, back in May of 2021:

But now, because hospitals are being required to report pediatric ICU beds and the number of pediatric patients in ICU with COVID, it will tend to make for easy, alarming click-bait headlines.

How so? Well, let’s say you’re operating a medium-sized hospital. More than a year ago, your hospital wisely instituted a policy during this infectious pandemic: all admitted patients are to be tested for COVID, regardless of whether they show symptoms.

That’s precisely as my own local hospital has instituted (see purple highlighted text); I encourage you to take a moment to check your own:

UW Hospital Tests All Admitted Patients. Stop for a moment, and check your own local hospital.

That’s a wise policy; I have no problem with that.

But here’s how that, plus the new metrics above, add fog. Let’s say you have 5 ICU beds dedicated to your pediatric wing. A recent icy weekend has caused four of those beds to be occupied: two by kids with broken bones for serious injury, one for a grave car accident, and one who has presented for appendicitis. Note that zero of them presented to the hospital because of COVID, but upon mandatory routine testing, it was detected that four of them are asymptomatically COVID-positive because there’s an outbreak in your region at the moment.

Your accurate reporting to HHS, under these new guidelines, will be that 80% of your pediatric ICU beds were taken up by COVID patients. Now, sum that same scenario up from thousands of hospitals across the country, and render it on a nice-looking dashboard. Journalists from around the country will read the dashboard and rush to their media feeds with semi-accurate but extremely misleading headlines: “80% of Pediatric Beds Taken Up By COVID Patients,” or “Alarming Rise in Serious COVID Cases in Young Adults.” Animated infographics will show that pediatric COVID is on a sharp rise because, at a minimum, hospitals weren’t required to break out this data before. Scary infographics will course through social media, and be trotted out by the largest teachers unions and other “let’s close the schools” advocates.

Most maddeningly, HHS is entirely passing up an easy opportunity to actually differentiate between worrisome cases and non-worrisome cases. It’s as simple as this: Did the patient present to the hospital because of COVID-like symptoms, or not? Doctor, nurse or even patient — check a box. Then, allow the slicing and dicing based upon that key variable. Yet here we are, two years into this pandemic, and HHS is not even attempting to ask hospitals to start reporting whether patients are in the hospital because of COVID, or whether they incidentally tested positive.

It’s not like this is some kind of secret revelation, unknown to officials. People like me have been pointing the “with vs. from” distinction out for more than a year. And finally, even Dr. Fauci admitted in late December 2021 that these two conditions, incidental vs. causal, are quite different, explaining it as though it were a new concept:

It’s not just what HHS is adding, it’s what reporting requirements they are dropping. I want to draw your attention to these five in particular:

HHS is removing the requirement that hospitals report the prior day’s death with COVID-19. Daily deaths will still flow through to the CDC via a separate process, but removing daily death counts will make it much harder to separate worrisome cases from non-worrisome cases, because we won’t be able to see infection-fatality-rates for same-hospital data. We also won’t be able to know that zero patients are on ventilators, for instance — another (old) indication of severity.

Note too that HHS is shielding from reporting the need for hospitals to disclose anything about staffing shortages — both the quantity and explanatory fields. It cannot go unnoticed that a substantial cause of many staffing shortages (NPR) at hospitals and elsewhere has been the imposed mandates that they be vaccinated. More here (Business Insider, and here (WSJ).

So, why these changes? As always, I must ask — who benefits by obscuring this picture? I have some hypotheses. But I’ll leave that exercise for now, to the reader.

Children: Vectors of COVID Spread?

A new study from the UK suggests that children are not, in fact, significant vectors of COVID risk.

How much would you say that having one or more young, unvaccinated children (0-11 year olds) in the household increases the household’s risk for COVID?

Well, luckily we have some empirical data on that.

A massive BMJ study of 12 million people from the UK found that the increase in COVID risk is a whopping 0.01%-0.05% in the household if you’ve got a child 0-11 in the household. The numbers are similar to those living with 12-18 year olds.

Not only were increases in COVID very small, but this did not translate into materially increased risk of COVID-19 mortality.

Can we perhaps stop treating children as second-class vectors of spread? When will their social, educational and emotional needs matter enough to be paramount again?

Students and Parents Brace for an Unknown 2021-2022 College Year

The second academic year of COVID begins. What does it hold for those on adult’s launchpad?

As we tape up the boxes to ship off to two universities, COVID’s Delta variant continues to rage on in parts of the country. And my wife and I, like many parents, wonder what the 2021-2022 college school year will hold for our two sons. Will they spend much of the year in their room, watching lectures over Zoom? How well with they be able to connect with their peers? Will they have to mask-up constantly? What events will be possible?

Around the world, we are running a myriad of COVID natural experiments. College campuses are particularly interesting laboratories, because they are semi-closed societies with their own policy-setting administration, rules, monitoring tools and diktats. They involve residential living and close contact. They have built-in healthcare services. They tend to have very bimodal age distributions — lots of younger students and older faculty.

If you’re in college administration, you have many levers to tweak: mask mandates, social distancing, ventilation, symptomatic or asymptomatic testing frequency, and more. Thus, as with last year, there are literally hundreds of thousands of “natural experiments” being run. It’s as though each is its own video game simulation, but in real life, with very real consequences. Take thousands of people, put them in a place with a given set of rules, and watch the results. We’ll be watching our two boys’ experiences.

Judging up close even from a sample of two, the 2021-2022 intervention regimes will vary widely. Most have vaccine mandates, but policies around masks, social distancing, remote or in-person learning, faculty mandates, dining experiences, frequency of asymptomatic testing — even intangible sense of optimism — vary widely.

Such observational experiments are nowhere close to randomized controlled trials, but they’re close enough to offer some comparative insights and hypotheses. I have to confess I already have my hypothesis about which campus experience, overall, would be the one I’d choose for 2021-2022, and which of our sons will likely come out “winning” the year by sheer luck of where he’s landing. But then again, that’s applying my own biases to the mix, and luckily each is excited for their own rapidly-approaching year. It’s all subjective… until June 2022 and beyond, when the “right” policy mix to have chosen will be much clearer.

Comparing Two Schools

We are grateful beyond measure that our two sons are attending two terrific schools. One is off to his junior year at Northwestern University in the Chicago suburb of Evanston Illinois, and the other begins his first year at Vanderbilt University in Nashville Tennessee. Sibling rivalry will no doubt continue.

These two universities share a great deal, making for particularly interesting comparison. Both universities are world-class research institutions; each is listed as a Top 20 University by US News & World Report. They have attached, well-respected medical schools and teaching hospitals. Both take COVID-19 very seriously. Both have access to, and generate, leading-edge research on COVID-19 itself (see some of Vanderbilt’s and Northwestern’s.) In other words, we can take as a given that their administrations care about this pandemic deeply, and have ready access to world-class, informed experts and data.

Environmentally, too, they’re similar: both are located in relatively suburban campuses which are leafy, academic enclaves within larger cities. Both have enrollment in the tens of thousands, though Northwestern is just under twice Vanderbilt’s overall size.

Policy Similarity: Vaccination Required

With respect to COVID-19 policies, both universities require that all students be fully vaccinated. And thankfully, I’m seeing neither complaint nor concern about this on either university’s social media parents’ discussion groups.

But vaccination mandates for colleges certainly aren’t universally popular; this week, the Supreme Court reviewed a petition from a group of Indiana University students objecting to the vaccine mandate. Justice Amy Coney Barrett rejected the petition on behalf of the court.

Thousands of colleges and universities have required that all incoming students be fully vaccinated, barring medical exception. But that’s where the similarities end.

Different Approaches, Different Intervention Postures

Northwestern’s Intervention-Intensive Posture

Northwestern is taking a decidedly more intervention-intensive posture. They reinstated a campus-wide masking requirement on August 4th 2021, applying to all students, faculty, staff and visitors, regardless of vaccination status, except when in a private room or actively eating or drinking. All unvaccinated undergraduate and professional studies students are required to take two Abbott rapid antigen tests weekly; if you’re vaccinated (which our son is), there is no asymptomatic vaccination requirement.

As for in-person learning, at present writing, Northwestern’s administration commits only to a “best efforts will be made” messaging that there will be as many classes in-person.

For our rising junior, of his eighteen months as an NU student, just five of them have involved in-person classes, with the other 13 being via either pre-recorded lecture or streaming services. Last year at this time, we had the boxes packed and plane flights booked, only to hear at the last minute that sophomores and freshman shouldn’t go to campus, nor should they even come back to Evanston itself. A scramble ensued. A full one sixth of his college experience hasn’t even been spent in Evanston, but Zooming in from Seattle, and a third more Zooming in from his on campus room. Regardless of what comes next, he is part of the class that will have had the least amount of on-campus experience in Northwestern’s history. So restoration of in-person learning and activities are of special interest to him and us.

Vanderbilt’s Intervention-Lighter Posture

By contrast, Vanderbilt was among the first major universities to publicly commit, back in March of 2020, to full in-person, residential learning for Fall of 2021, and as of this writing, they have not retracted their stance. They’ve also got an in-person Family Weekend planned for the first weekend of October 2021, complete with football game and social and learning events. Northwestern tentatively has a plan for a Family Weekend November 5-7, and emphasizes with every communication that it is subject to local conditions.

With respect to masks, Vanderbilt has been more reticent to impose new requirements, though they did just say that as of August 16th, masks will be required indoors, except for offices and shared workspaces (for fully vaccinated individuals.) And they are actively monitoring when to update this guidance. For the 2021 school year start, masks are not mandated for vaccinated individuals in private offices or shared workspaces under most conditions.

So Much Variance At Adult Life’s Launchpad

In a week, our Seattle-raised eighteen year old will be getting settled in his first-year dorm room, getting to know his new roommate from Miami, Florida. The Miami student, benefitting from a lockdown-light approach in his city and state, will very likely have enjoyed his learning in-person all year. Our son will report that his senior year was spent connecting in via Zoom from his bedroom here in Seattle.

This kind of scene is playing out now in dorm rooms across the world. They’re comparing notes on us. Did we, the adults, get it right for them?

They’re finding out very clearly just how varied it’s all been, on a one-to-one level. A vast new layer of differences and advantages have been layered onto existing socioeconomic differences and living situations at home, abilities, disabilities and more. This layer involves voluntary, deliberate administrative policies imposed upon them, without their input, for better or worse.

Given the varied university experiences I’m already seeing as a parent, I fast forward in my mind to four years from now. When this generation graduates, they’ll meet someone at work or socially, and it will all start again: “Say. Did you too Zoom in for half of your college experience?” We are adding new layers upon layers of differentiation to an already stratified society. A kaleidoscope looking at a mosaic. Some will have burned the midnight oil to master standardized tests, others will have opted not to take them. Some will have endured a life of lockdowns or restriction, others relative openness. Today, at the very time they are reaching for new freedoms, they’re navigating highly varied regimes of what is and is not allowed. Checking in with an ever-changing rule regime, and staying within the prescribed guardrails (or finding ways not to, as the case may be) will be a big part of their psyche and skillset.

Information Gap for Parents and Students

These variances are necessary, I suppose, but I hope that we can both learn from them and make their differences more visible to students and families during their college selection process. Will there be a reckoning at the end of the year? A harm-reducing, optimal winning slate declared? Thus far, I’m underwhelmed by the degree of objective, empirical comparison of the intervention regimes imposed in the 2020-2021 school year, given all that’s at stake. Perhaps we don’t want to know what we’ve lost in the process; decidedly, some will lose, and others will come out ahead.

The impatience, too, is palpable. For instance, there is a growing sense on the Northwestern University Parents Facebook group, particularly among Class of 2024 and 2025 parents, that more effort should be made to publicly commit to full in-person learning, or at least be very transparent about which classes will be fully in-person. In regular “Return to Campus” discussions, Northwestern’s leadership has been relatively noncommittal, assuring that they’ve learned that some forms of remote education actually work very well for them. Humor helps with coping: Last year at this time, when Northwestern suddenly moved fully online for freshman and sophomores, my son joked, “We’re all University of Phoenix students now.”

That’s all well and good, and I appreciate that administrations have a lot to solve for. But it raises a question. Going forward, shouldn’t applicants and parents know more about a university’s overall intervention posture before enrolling?

Among other things, universities could be asked to report the percentage of in-person classes to guidebooks and college rating institutions like Barrons and the Princeton Review, and to include this information in their annual reporting to the “common data set” used in college comparison. And shouldn’t percentage of in-person learning be factored in as part of a college rankings? Do “mostly online” educational experiences deserve to be in their own evaluation category?

Now that COVID is endemic and remote education has gotten widespread awareness and trial, it’s quite likely colleges will continue to partially adopt remote education to varying degrees, particularly for undergraduates. I’ll admit it can have many benefits, but also many drawbacks. At a minimum, though, with the kinds of tuition fees these universities demand, it’s reasonable insist that they be more transparent about it, as it so dramatically impacts the college experience and might or might not match the desires of the student.

Now that we’re headed into year two, it’s time to let in some daylight. Universities have been too able to keep their decisions close-to-the-vest. Some appear too ready to impose cost on those who are already enrolled rather than aggressively fight for a full return to in-person learning. In my more cynical moments I feel some are even coasting a bit on a brand that got them there, not wanting to challenge what may be a somewhat reluctant cadre of faculty, without enough of a sense of immediate urgency to restore to the best that an in-person university learning experience can offer, which is what built their worldwide reputation in the first place. I hope I’m wrong.

Off to ship those boxes, and hope for the best.


UPDATE, August 17 2021: In a Return to Campus webinar yesterday, Northwestern’s administration indicated that most if not all undergraduate classes will be fully in-person. Remote viewing / recording options are discouraged, and ultimately up to the instructor.

Students: Don Your Masks, Evidence Be Damned.

Imposing these new restrictions is like forcing everyone to drive 10mph on the highway, because 30% of drivers refuse to wear a seat belt.

UPDATE, September 4 2021: Since the original date of this post, several pieces have come out arguing the same. I’d recommend The Downsides of Masking Young Students Are Real by Dr. Vinay Prasad, and The Science of Masking Kids at School Remains Unclear, which appeared in New York Magazine. Another polemic that I don’t fully agree with, but which has links to many important studies that we should at least know before deciding where the balance of harm lies, is Masking Children: Tragic, Unscientific and Damaging, from the American Institute for Economic Research. Finally, in the weeks since the publication of this piece, the UK, Ireland, France and Denmark (as well as Sweden of course) have also decided not to mandate masks on younger learners, concluding quite specifically that the balance of harm is in masking, particularly on the youngest learners. The varying approaches between the United States and UK, Ireland, France, Denmark and Sweden should provide yet more empirical comparison. Set yourself a reminder to check on per-capita spread and mortality outcomes for K-12 learners come late November.

On Wednesday, Governor Inslee reiterated his mandate that all K-12 learners, faculty and staff wear masks to start the 2021-2022 school year, regardless of their vaccination status. Further, Inslee provided no threshold, metric or milestone when this requirement would end.

From the ever-drying well, he’s saying once again: “trust us.”

How long will we continue to force the least COVID-vulnerable among us with the least voice to sacrifice big parts of their lives for those with the most choice to change our odds? Seattle’s public schools closed for in-person learning longer in 2020-2021 than any other school system in America, save San Francisco. We need the highest-possible bandwidth of communication between teacher, students and one another to have any hope of making up for a very lost year.

Imposing these new restrictions is like forcing everyone to drive 10mph on the highway, because 30% of drivers refuse to wear a seat belt.

Let’s remember that everyone twelve years old and up has been eligible for free and highly effective vaccines for months. Each member of my own family of five (ages 14-56) has been fully vaccinated since June; we jumped at the opportunity as we each became eligible during the spring. These vaccines greatly limit the risk of hospitalization or mortality.

Yes, there is vaccine hesitancy, and while I’m very supportive of persuasion over shaming, assumption-making and ridicule, I’ve also had it with the suggestion that the rest of society has an obligation to wait for everyone to change their minds.

The two leading teachers unions in America oppose vaccine mandates for their members. OK. I respect personal and organizational choice; that’s entirely their right to do so. But this stance certainly undermines their ability to then claim faculty vulnerability as a key concern. All teachers and staff have the option to get vaccinated. Indeed, after lobbying the governor, they were granted prioritized vaccination status starting in March of 2021, so they’ve had the option far longer than most. There are very rare health conditions where physicians might say that vaccines aren’t a wise choice. The question then: Is the least harm to require all their students in the school to wear a face covering seven hours per day, or might that teacher need reassignment to remote work?

Imposing these new restrictions is analogous to forcing everyone to drive 10mph on the highway because 30% of us refuse to use a seat belt. At some point, leaders need to weigh evidence and relative total harm. A big part of that calculus is looking at relative numbers.

One thing is clear: this mandate is not primarily about minimizing harm to students.

COVID is Extremely Age-Discriminating

Statistically, kids are simply not at significant risk of hospitalization or mortality from COVID, not yet anyway. In fact, they at lower risk from COVID hospitalization or mortality than influenza, by the CDC’s own data, despite CDC Director Rochelle Walensky’s comments yesterday to the contrary. The CDC’s data suggests that kids 0-17 years old are anywhere from two to seven times more likely to die from influenza than COVID. In fact, the age-weighted severity is perhaps the biggest mercy this awful pandemic has brought. Here in America, the youngest among us survive, more than 99.9% of the time.

That doesn’t mean we shouldn’t take COVID risk in schools seriously, but it does mean we need some sense of proportion of the relative harm we are choosing, and yes, masking is harm. Sensible policy weighs the harms imposed with the likelihood and weight of harms forestalled, and chooses the least harm-imposing path.

We are learning about COVID-19 all the time. But one of the few conclusive facts about COVID-19 is that it is extremely age-discriminating when it comes to its worst outcomes: hospitalization and mortality.

Out of 74,000,000 Americans 18 and under, the total number of 0-18 year old Americans who have died of COVID since the pandemic began is 337. According to the CDC, the infection fatality rate for COVID for those 18 and under is astonishingly low; statistically close to zero. While comparisons to the flu are always fraught, it’s worth noting that the infection fatality rate for COVID is anywhere from half to one seventh that of the flu for this 0-18 age bracket.

You can find full hospitalization and mortality data for influenza by age group on the CDC’s website for comparison.

Zooming out, here’s the hospitalization curve, all American age groups since the start of the pandemic. Note the black dotted lines at the very bottom of this chart. It’s hard to spot, since it is literally along the y-axis at zero:

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As for “breakthrough infections”, let’s look at the likelihood of severity for the vaccinated. Thus far, there are about 160 million Americans who have been fully vaccinated. And thus far, there are about 6,000 “breakthrough” infections which have led to hospitalization. That means that if you’re vaccinated, there’s about a 0.00375% chance you might be hospitalized due to COVID, based on current statistics. (Again, please get vaccinated if you can!)

Some point to “Long COVID” as a concern that we should guard against. To which I’d first say: what evidence can you show that masking K-12 learners even slows spread and reduces chance in any meaningful way of catching COVID-19? Why haven’t mask mandates “bent the curve”, in state after state when they impose or remove mask mandates?

These aren’t assertions to be made cavalierly; I have spent hours upon hours with 91-DIVOC and other terrific COVID charting sites. For each of the very few cases where you can plausibly point to a mask mandate having “bent the curve” within weeks or months of imposition or relaxation, I guarantee you I can show you three states and situations where no change from prior pattern was observed. Is there a chance that the “virus is gonna virus” folks are actually mostly correct on this issue? Has anyone checked in on Sweden’s overall mortality lately, compared to other European nations? How about those of Florida or Texas?

And what about long literacy? Long impacts from high school dropout? Long language acquisition? Long loss-of-socialization? Long impacts from less physical education? Music? Theatre? We will have interesting empirical testing data between kids raised in each state over the coming decades to compare.

Washington State’s Learners Will Be Uniquely Restricted

Washington State is taking a pretty aggressive stance here, compared to most other states in the union.

The data-collection site burbio.io tracks school mask mandates, along with other metrics. Their latest map shows just how unique Inslee’s position is. Not only is Washington State one of only six states to mandate masks for in-person schooling, the vast majority of states have either no mask mandate or a ban on mask mandates at present writing. Look how green this map is below:

2021 School Mask Policies, Burbio.io Mask Tracker

For the lucky 30% who head to college, imagine first-year roommates as they unpack in their dorm, meeting each other for the first time: one from Florida and one from Washington State. How will they describe their high school experiences?

Do we think this will have a positive effect on Washington State students’ learning, attendance rates, drop-out rates and post-secondary next steps? Do we imagine that it will have no effect?

We are Putting Mandates Uniquely On Kids

Even more, this new emphasis on K-12 learning feels uniquely punitive to one age group. Do you see any ways this might backfire?

Inslee recommended, but does not require, masking for adults when out and about.

Let’s say that again. There are no statewide age-dependent mandates for most adults for their daily activities — be it work, or shopping or dining or entertainment. There’s only a recommendation from the Governor that you should wear a mask when indoors or with unvaccinated individuals. Yes, there are workplace restrictions in some areas, but adults still have choices not to work in those roles.

This “mask up in school” requirement applies equally to students and adult staff, but if you’re in the 0-18 year age group, that pickup from school and then errand-running experience is going to seem like entirely separate rules for you versus the adults you see out and about.

Then there’s the matter of cynicism and buy-in to institutions. Do we imagine that teens don’t have access to Google or social media? Clear, peer-reviewed and validated evidence does not exist which shows those school districts which imposed mask mandates did any better than those which did not, certainly not in terms of the outcomes which matter most: hospitalization and mortality.

Follow the Evidence, or Nah?

I am evidence-driven.

If you have been truly evidence-driven from 2015-2021, thank you. You’re a rare bird. You’ve been willing to go with what the evidence says, even if it may be counterintuitive. You’ve been willing to update your prior assumptions, even if it goes against your tribal narrative of the moment.

I certainly believed, a year ago, that mask mandates might slow the spread and were well worth a try. It’s intuitive, after all: COVID is an airborne virus, and it even spreads when you’re asymptomatic. So limiting airflow plausibly would limit negative outcome.

And even despite my acquired skepticism, even to this day, as an adult, I’ll comply with a mask mandate, though now, more begrudgingly than before. But this doesn’t mean I’m comfortable at all with this entirely optional harm being imposed and extended for our youngest without compelling evidence. Doing so not only imposes harm but it erodes trust in our institutions and leaders.

Here is our fully vaccinated Vice President, for instance, saying that if you don’t like wearing a mask, get vaccinated:

Huh? She is vaccinated, yet she’s wearing a mask. Hardly modeling the scientifically clear benefits of getting vaccinated.

To be sure, there are very clear lab experiments performed where aerosol spray is measurably reduced by wearing a mask. Masking clearly reduces large particle aerosol transmission and reception in lab settings. And there are very valid reasons that surgeons wear masks. They do work. I am not saying that masks do not work. What I am saying is far more nuanced.

The strongest study I was able to find — and it’s the only one — took place in Georgia, within a school district (not across multiple districts). It found that imposition of both better ventilation and mask mandates appears correlated with lower spread. But as noted, there are at least four potentially large confounders:

First, many COVID-19 cases were self-reported by staff members and parents or guardians, and prevention strategies reported by administrators or nurses might not reflect day-to-day activities or represent all school classrooms, and did not include an assessment of compliance (e.g., mask use). Second, the study had limited power to detect lower incidence for potentially effective, but less frequently implemented strategies, such as air filtration and purification systems; only 16 schools reported implementing this ventilation improvement. Third, the response rate was low (11.6%), and some participating schools had missing information about ventilation improvements. However, incidence per 500 students was similar between participating (3.08 cases) and nonparticipating (2.90 cases) schools, suggesting any systematic bias might be low. Finally, the data from this cross-sectional study cannot be used to infer causal relationships.

Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools — Georgia, November 16–December 11, 2020

Mask efficacy appears to depend highly upon both the type of mask used, the compliance with the mandate in an entire cohort, and the aerosol size in question. Masks in general may work to slow the spread, but has it been clearly demonstrated that in K-12 settings, masks so reduce negative outcomes like hospitalization or mortality that they’re worth the harm imposed? I’m not seeing such evidence.

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Sources for data noted above. Visualization created by Emily Burns, PhD Neuroscience

COVID-19 size distribution is shown in the lower left.

In Theory, Theory is the Same As Practice

Empiricists live by real-world observations. Labs are imperfect representations of the real-world. Fortunately, this past year has seen numerous “A/B” tests of various policies. If masking K-12 learners made substantial differences in outcomes, wouldn’t we have seen it? Wouldn’t we have seen Texas’ COVID case count skyrocket after mask mandates were relaxed? We didn’t.

The highly age-discriminatory nature of the virus suggests that there’s something uniquely better about youths’ ability to process the virus. Therefore, let’s use the data from districts, counties, states, provinces and nations, and explore the question: Did K-12 mask policy impact hospitalization or mortality in that community? It does not appear to have done so, certainly not consistently or predictably.

And though I’ve scoured Semantic Scholar, 91-DIVOC and elsewhere for charts and studies, despite a full year’s worth of real-world policy variance, no one appears to have yet validated that mask mandates for K-12 learners greatly limit community hospitalization or mortality. So what the hell are we doing?

Even in the policy rollouts themselves, the same leaders who declared that the vaccinated can remove their masks aren’t coming forth now with clear and convincing evidence which shows that K-12 masking slowed hospitalization or mortality. Some among us conclude: because it doesn’t exist.

In other words: In theory, theory is the same as practice. But in practice, it never is.

Vaccines Work. Why Don’t We Let Them?

The evidence establishing the effectiveness of US-approved vaccines is overwhelming. Vaccines work. They have dramatically reduced the worst COVID outcomes, especially for adults. Please get vaccinated if you haven’t.

But I have searched and searched for data supporting the effectiveness of masking for K-12 learners, and have yet to discover any cross-regional correlations which show that K-12 masking reduces hospitalization or mortality in the surrounding community.

I have however run across numerous intriguing datasets which run counter to data-free claims of effectiveness of this policy. Let’s look at Canada, for instance.

Four Provinces, Four Policies

Canada’s four largest provinces took very different approaches to masking. Take a close look at the chart below. Can you spot a clear difference in negative outcomes? Are the patterns wildly different? Is the area under the curve?

One kept schools open, no masks. One kept schools open, with masks. One closed schools entirely. Can anyone tell them apart in this graph? If you think you can, venture a guess which one was most restrictive.

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Per-capita case counts over time, four Canadian Provinces with very different mask mandates

Answer key: Quebec dropped masks in June. British Columbia mostly never required them, but then did starting in the Spring for grades 4+. Ontario was most restrictive throughout, using remote schooling for much of the 2020-2021 schoolyear, but masking when any in-person learning happened in most public schools.

You can do this same experiment comparing Florida (no mask mandate) to Texas (dropped the mask mandate in March) to even Sweden (no mask mandate.) Generally, it’s not been obvious that the more restrictive the mandate regime results in the least harm overall.

Those urging the imposition of masks often push back that masks cause harm. They’re really no big deal. What’s the downside?

Yes, It’s Harm We are Imposing On Our Kids.

First, several psychologists do hold that masks inhibit language acquisition, particularly for those with learning disability. Reading lips is harder, watching how to pronounce phonemes is harder, and emotional conveyance is restricted.

Read: How masks could affect speech and language development in children | CBC News.

There’s a rather loud contingent on Twitter (often voiced by those affiliated with teachers unions) who try to muster the argument that masking isn’t harmful to learners. Yet the same people who say it imposes no harm then say the quiet part out loud:

So in other words, masks impose no harm or burden on kids, but masks also greatly limit social connection for kids and constantly reinforce there’s something to fear. OK.

Let’s be honest. No one wants to wear a mask. What do we call mandating something upon another human when they do not want to do it? How often are kids’ masks washed? Have you smelled your students’ mask recently?

Though harm imposed by seven hours per day of masking seems minimal to many, this harm is very high to some, particularly earliest learners, those with learning disabilities, social extroverts, and more.

[Full disclosure: my fourteen year old daughter, though fully vaccinated, willingly complies with masking. She’s a bright and mature learner. Since she has no choice in the matter, I’m not attempting to change her mind, given the alternative, and I don’t want to contradict what will certainly be the school’s own guidance, though I am sharing my opinion with leadership.]

Masking adds friction to social connection. Laughter. Language acquisition. Bonding. Enjoyment of learning. Social signals. These kids endured a full year of remote schooling and masking. How much do we care how well they connect with others? Shouldn’t the data that this harm is worth it be crystal clear?

These kids have endured a full year of low-bandwidth, low-touch, low-connection schooling. We need the highest possible bandwidth communication to have any chance of making up for the many losses endured in the 2020-2021 school year.

Some psychologists estimate that up to 70% of communication is nonverbal. I do not see ANY COMPELLING EVIDENCE which says that they, uniquely, should have a mandate and mask up for 6+ hours every day, but we in the outside world should not.

Separate Rules for Adults and K-12 Learners Will Breed Resentment

I don’t think leaders quite realize the buzzsaw they are walking into. Telling the public that once vaccinated, you can remove your mask, but even if you are vaccinated and/or are in the least vulnerable group, you still have to wear one, will not go well. Students and parents alike have access to Google. The studies just don’t exist which clearly demonstrate mask efficacy at reducing hospitalization or mortality in K-12 environments.

If this is about reducing spread, at least have the courtesy to show that masking K-12 learners reduces spread, because you’re imposing harm. Or if this isn’t about kids at all, but somehow about protecting those who choose to remain unvaccinated, I’d challenge you to show your moral calculus that says that imposing harm on the least vulnerable is the right moral tradeoff.

We adults can go out. We can go to bars. Go to restaurants. We can and should get vaccinated to dramatically reduce our chances of the worst outcomes.

Yet they have to mask up in schools. What kind of leaders continue to insist that the LEAST vulnerable to COVID among us need to continue to make sacrifices for others? Why are we working so hard to portray children as vectors of a virus we have effective vaccines for?

As with the CDC guidance about school “reopening” in January, I suspect we will discover that teachers unions had a very big part in this entirely unscientific new mandate now being handed down. Where is the evidence? Have we all just given up on the whole “follow the science” stuff?

Vaccines… immunize. Let’s let them.

DISCLAIMER
I am not a physician. I’m not a scientist, nor do I have medical training. I’m simply interpreting the facts as I see them, linking to credible sources to back up my viewpoints. “Minimal risk” is still risk. You may view tradeoffs differently. The opinions posted here are my own.