Highlights from Dr. Jha’s analysis: Global: - Hotspots are U.S., Brazil & India. Outbreaks in other countries are small compared to those three.
- Globally, we’re in reasonably good shape.
- Countries have used a combination of four tools to effectively respond: masks, testing, contact-tracing, and lockdowns. Many countries have applied the four in different proportions to achieve low transmission.
- Part of the reason why Sweden has done reasonably well is due to built-in social distancing — half of their households are single individuals living alone. But a comparison to Denmark shows that the Swedish initial response was not wise.
United States: - August has been better than July.
- Most people in most countries are “gobsmacked” at the U.S. COVID-19 response.
- America shouldn’t be seen as a single nation — but a patchwork of state responses. States like Massachusetts look like Western Europe in their response, others in the South look like Brazil.
- Has there been an increase in competence from the Trump administration over the summer? No.
- In June and July, a lot more young people have been infected.
- Mortality in hospitals, for the same person, has declined 40-60% — meaning: if someone is infected today, they have about half the risk of dying as they would have had four months ago. This is due to improvements in both clinical practices and treatments.
- In most places, there is little worry about hospital surges. Dr. Jha thinks we’ll get through the rest of this pandemic without more ventilator shortages in the U.S.
- Everywhere that cases have surged, disproportionate impact on communities of color has followed. The numbers are staggering, and there are many explanations: who can work remotely, where we’ve set up testing sites, transmission in multigenerational households, pre-existing co-morbidities, those we deem essential workers, and the quality of care available in lower income neighborhoods.
Massachusetts: - Testing in Massachusetts is in pretty good shape. It’s one of the states with the highest level of testing.
- In early August, Governor Baker listened to the data on an uptick in cases and reined in the re-opening. Dr. Jha wishes he had reined in a bit more, but he credits him with stabilizing the uptick.
What does Dr. Jha do? - Public transportation? The latest data suggests that perhaps we were overstating how big of a problem public transportation is. Dr. Jha would get on a T (not during rush hour) with a mask — and preferably with the windows open.
- Restaurants? No indoor dining, but yes outdoor.
- Outdoors with others: limited numbers, keeping distance, and with masks if closer than six feet.
Schools: - The single biggest determinant of whether we can open schools safely is the level of community transmission. Massachusetts is pretty low, at about 2%.
- Once community transmission is at a pretty good level – experts differ at whether that’s 3% or 5% – schools could reopen. Need universal masking, better ventilation (best is opening the windows), and testing.
- Choosing to be remote-only is not a cost-free choice, Dr. Jha says. The achievement gap has gotten worse, and it is low-income and minority kids who are hurt most. Childcare burdens fall disproportionately on women, and there exist large, longstanding labor market effects on women and their careers. It’s not perfect and ideal to get kids back to school in-person. But keeping kids at home is costly.
- Younger kids transmit less than older kids do — and kids who are really young (K–5) transmit a lot less.
- You can’t run schools without teachers and staff, and if you can’t keep teachers safe, you can’t reopen a school, Dr. Jha says. We’ve got to take care of our teachers, and must fully accommodate remote teaching for those who are high-risk.
Colleges: - There are public-health-driven approaches, and then there are reckless approaches to re-opening college. UNC was reckless.
- If your policy is contingent on 18- to 22-year-olds behaving well, every single day, for the next year, that’s a bad policy, says Dr. Jha. Need to create a bubble with rigorous surveillance testing.
Vaccine & Path Forward: - If this weren’t a presidential election year, Dr. Jha expects that we’d get results from vaccine trials in November/December, FDA emergency use authorization in December, start vaccinating healthcare workers in December, and a large part of country would get vaccinated Feb/March/April — things would look much better by next June. Jha expects that, two weeks before the election, the FDA will issue an emergency use authorization based on incomplete data and we’re likely to see a politicization of the issue.
- The FDA has become politicized by the Trump administration. Jha is very worried about what is going to happen in the weeks leading up to the election.
- By the end of 2020, we will have 2-4 vaccines that will look pretty safe and effective. Based on what Dr. Jha expects under a normal scientific process, sometime in late 2020 or early 2021, many of us would get a vaccine (depending on strategy).
- A vaccine will dramatically slow transmission, but it won’t bring us back to normal immediately.
What should Biden do in his first six months? - Be clearer about the path ahead. Current administration keeps promising miracle cures and short-term solutions. People have to adjust behavior to match reality.
- If tomorrow morning we wanted to bring this pandemic to a close, we could within the next six weeks. We need to turn to cheap, ubiquitous testing. The technology exists, is cheap, and works, but it’s not being used.
- How do we get through this? Our three best tools: Testing, masking, and avoiding large indoor gatherings.
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Ashish is a local treasure. Measured, thoughtful, and expert.
I agree, Paul. Even when he’s delivering news that’s difficult to hear, his straightforward delivery and obviously deep knowledge makes it much easier to take. I always come away feeling better (and better informed) after hearing him. He came to my attention before knowing he was a Newton resident. He is leaving Harvard, heading down 95 South to Brown. Hopefully he commutes to Providence and stays in Newton.
His webinars with Jake have been great. Thank you for summarizing it, Jerry. Though I’d encourage people to watch it as well.
The thing I like about Dr. Jha is that he explicitly states the risks without making me feel scared and finding reasonable optimism. I take what he says very seriously.
One thing that Dr. Jha says in the interview that the current consensus in his field is that for schools there is no distinction between 3 and 6 feet. I am surprised that Jake left this out.
Yes, it’s so clear that Jake didn’t do it to bring attention to himself – he wants only to share a small bit of his enlightenment with us. And look, he conveniently got this puff piece out of it, two days before the election! Quelle coincidence!
I haven’t checked Jake’s Twitter feed recently – has he made any more Islamophobic, anti-Indigenous, or pro-Confederate flag tweets?
A comment has been removed at the author’s request
Jeffrey: they do talk about the 3 feet vs 6 feet social distancing requirement
Quote from the doctor: “Once community transmission is at a pretty good level – experts differ at whether that’s 3% or 5% – schools could reopen. Need universal masking, better ventilation (best is opening the windows), and testing.”
We have NO testing plan in place as of today. And teachers are expected back in the buildings tomorrow to start planning and setup.
The first plan, which we had to vote on, linked to a map of testing sites.
I’ve heard various options being considered by the SC. Nothing concrete yet.
The State offered some mobile testing only if there were two or more cases that could be linked to the classroom. How do we do that without contact tracing… and testing?
I did testing for travel reasons and waited 6 hours for the “rapid” test in a small room next to people who were being tested for exposure. Glad we didn’t catch it from them!! Cost $150pp. Insurance does not pay for asymptomatic exposure.
We need a rigorous testing plan no matter what course we choose.
@ Jeffrey Pontiff
Among the professionals that carry out disease transmission research, modeling, and space design, there is not a consensus that the difference between 3 and 6 feet is not meaningful.
The difference is of particular importance within the real world conditions of school children in enclosed environments for long periods of time. The difference will rarely be of significance in shorter interchanges and when passing through retail environments, etc, in which dosing exposure would be very low.
When the dosing variables include kids moving around, improper mask wearing from kids, long exposure times, uncertain air movement, etc., distance does can sometimes make all the difference to exposure. Experimental and modeling results make this clear.
Particles can travel and remain aloft for long periods of time and can easily travel for distances of 12 feet from unmasked mouths, including gaining momentum when bouncing off of surfaces. But face coverings change the fluid dynamics such that three feet is a very “safe” distance under lab conditions.
Under real world school conditions, three feet has been shown to be a “reasonable” starting point.
I’ve worked with the models. Shifting the assumptions to include a real world range of kid movement and mask issues, not to mention HVAC assumptions, show that the risk profiles for transmission increase too high.
Unsurprisingly, most of the schools that have had to close down (largely in the south) have used the 3 foot rule.
Many professionals, such as Dr Jha, have done remarkable jobs educating everyone on the key issues. However, for many of these professionals, such as Dr Jha, this issue is not actually within their field.
Study of the fluid dynamics of disease transmission is carried out by scientists who operate at the confluence of mathematics, fluid dynamics, and network modeling.
What testing has NPS committed to? That is an important issue. Mayor and Superintendent are awfully quiet.
@Parent and Educator
You may think it was a good idea to essentially shut down schools for a year and half because it is theoretically possible that transmission rates vary with 3 or 6 foot distancing. I don’t know if you think this, but if you do, we disagree.
Dr. Jha has observable credentials (since he uses his real name), as does the AAP, WHO, and the DESE panel of experts,who echo the same message. You imply that 3 feet had a role to play in southern infections. In contrast, everything I have read attributes these outbreaks to the absence of rules about mask wearing. Again, mask-wearing rules are consistent with the advice of the medical experts.
Toy models pale in comparison with real world evidence. Models require strong assumptions. Models are not good at quantifying the counter-factual. If teachers and students are not at school, where are they what is their risk of exposure to COVID-19? What are the other risks in this environment?
Just focusing on teacher infections, Dr. Jha notes in this interview (about Germany, I believe,where students are usually seated less than 6 feet apart) teacher infections are no different than the general population. Eminent epidemiologist, Mark Woolhouse (his real name so you can google to confirm) notes that there is no documented case in the world of a teacher contracting COVID-19 from a student.
There’s no commitment to having the schools conduct surveillance testing and tracing. It’s a very complex issue as described in this article here:
https://theswellesleyreport.com/2020/08/wellesley-explores-school-covid-19-testing-concept/
The tests at cost are $45-60, commercial tests are in the $180-200 range. Plus, as this article spells out, there are a number of logistical, legal and ethical issues involved.
@ Jeffrey Pontiff
Thanks for the comments!
Personally, I am not against shutting the schools, if appropriate metrics are met. So much of the spread is attributable to crowded activities and parties.
Re 3 vs 6 ft. As a variable with potential health consequences, it’s worth another look.
If Dr Jan made a blanket statement on the negligibility of transmission risk profiles at 3 and 6 feet, it would be irresponsible. Or, at least he would have made incomplete statement awaiting many caveats of importance.
The significance of the distancing difference depends on a number of concretely defined variables that affect particle disbursement: such as air flow, movement of people, the quality of masking, and the length of time in the environment.
If all of these variables are buttoned down, the additional space has been shown to be inconsequential.
However, in the real world of schools and similar indoor spaces, kids move around, masks are not used effectively, and air flow standards are not consistently maintained.
Depending on the scenarios, the extra buffer changes transmission risks.
Many negative outcomes have flowed from truly great folks like Dr Jha and Prof Mark Woolhouse occasionally straying from their areas of expertise. And, further, during a pandemic, there are consequences to forgetting the simple lessons with which I know that they were trained: knowing how and when you need to consult the field experts and the experimental literature in the field.
When I studied stats for public policy, they used the term “good enough for government work” when refinement was not of consequence. Now refinement may matter, and it is then time to rely on those with the precise expertise to do so.
For example, Mark Woolhouse is an excellent epidemiologist and researcher. That is one reason why general news articles like to quote him on saying that there has not been a known case of transmission from student to teacher. If that were actually a blanket statement, it would be highly irresponsible. I don’t know the context in which it was made, the context, or limitations expressed.
Most significantly, it’s not getting into the weeds to point out that Professor Woolhouse does not have expertise in the fluid dynamics of disease transmission, the field that experimentally models respiratory transmission. If he did, in January he would not have publicly questioned the value of using non N95 masks, at a time when the consensus among experts in the field as well as published literature on masking was clear on the benefits for slowing transmission. Unfortunately, people in England took him seriously, and their behavior followed Woolhouse’s and others wish-washing statements on the value of masking.
A brief note on the way that experts in the field model.
As an environmental engineer, starting off in the post sars world about five years ago, I’ve had a number of projects in medical and similar settings that required spatial design to account for potential disease transmission. The people we work with rely on the work produced by places like the MIT Fluid Dynamics of Disease Transmission Lab who test and measure these variables in physical spaces. These physical measurements are then used to model variables in differing combinations and at a range of realistic levels.
They do this day in and day out, with meticulous attention to real world validation, and continuous calibration of equipment, assumptions, and algorithms, so that applications to and descriptions of the real world settings are robust and reliable.
To describe the work of these world class, cutting edge experts as using toy models for measuring and describing fluidic pathogen transmission is to completely miss what they do, how they do it, and how it provides the best information that we have had for design and for safety interventions.
That is why, similar to my own occasional design needs, Steelcase is right now working with the MIT Fluid Dynamics of Disease Transmission Lab on design strategy, office space layouts, and materials for mitigating the spread of covid and other air borne pathogens in the workplace. To understand the impact of fluid air borne pathogens in hospitals, offices, schools, etc, you go to the experts, not to MDs or even to epidemiologists with other areas of specialties.
Unfortunately, truly great folks with eminent credentials in their fields, such as Prof Woolhouse, have misunderstood and mischaracterized significant aspects of disease transmission data.
Of course, the most significant example is in regards to the consensus on the effectiveness of face coverings for the general public.
At the beginning of February, the consensus from the “well credentialed” was that basic, non N95 face coverings would not be effective in combating disease transmission.
That expert consensus gave way to a new consensus that face covering may be helpful to stop covid positives from spreading, but it provided no protection for the wearer.
That consensus gave way to the consensus that face coverers also benefit.
Having read much of the experimental literature in the field since 2015, i was gob-smacked by these consensuses. Viral disease transmission experts that I touched base with were beyond gob-smacked.
Because the experimental literature was clear on the benefits, their expert consensus, so very sadly, was that community spread will lead to the terribly difficult job of having to re-educate people to begin wearing face coverings.
How was this known? Following sars, those who investigate the fluidic transmission of disease went heavy into examining the role of masking among the front line health professionals who bore the burden of working the sars patients. In a nutshell, the results showed that N95 masks were necessary within these settings. The results also showed that while a variety of other face coverings provided some benefit, they were truly insufficient for the level of exposure that these front line workers experienced in these medical settings.
Job done..?. The study reached a valuable conclusion. N95 masks were necessary ppe for front line health professionals. For those who only read abstracts, that was the take home message; this finding did address their research goal. But, then come covid 19, and certain experts ran with this take home point, supporting their claim with reference to a study showing that non N95 coverings provide no benefit. Other experts then quoted these experts until a so called consensus was reached on the ineffectiveness of face coverings for the general public. If you can all recall, while covid spread through MA, there was an actual stigma on face coverings. At the beginning of March, when I implored my daughter and spouse to cover up, they would not.. It was unnecessary they said…people would look at them funny… every day on tv they saw heavily credentialed WHO , DSE, and CDC experts telling them that it was unnecessary. That I could pull old papers from my files and walk through the scatter plots and the tables that showed the benefits to reducing transmission, individually and collectively, was not sufficient to cut through this uninformed consensus. I’m not an expert in the field. And, I don’t play one on TV. But, having become conversant in the experimental literature when it overlapped with my own field, and having expertise in applying and understanding the significance environmental factors to strategic interventions, the matter was clear.
Cut back to the 3 vs 6 ft. issue. The data is clear that there are real world, real classroom conditions in which the transmission risk profile over that distance is relevant for impacting spread from student to student (potentially making those students a vector of transmission). The variables are concrete and easily modeled for a number of scenarios that account for how much kids move around, how well they mask, and a variety of air flow scenarios When all factors are well controlled, the difference may be negligible. If the factors are not well controlled it’s up to a community to decide how much of the additional, worthwhile distance buffer they want to forsake for the trade-offs.
As with masking and disease transmission, that there are different risk profiles is easy to see in the appropriate data.
It’s So hard for all of us to deal with the complexity of information and know who and how to trust.
In the end, at this time, hybrid schooling, remote teaching, and having students in buildings has put us into one large experiment
@Parent and Educator-
A question for you that I haven’t found adequately addressed in my readings. A short preface: I know measles is highly infectious and considered to be an air borne infection. How does Covid-19 compare with measles? I’ve read about the choir that socially distanced but still through singing, a there was a super spreader event. I also reviewed a lab dynamic fluid study that suggested that particles of Covid-19 would be present in the slip stream of a cyclist, hence the suggestion was well more than 6 feet of distancing. Early on in the pandemic, I understand that some hospital procedures (intubation) were recognized as high risk for exposure of air borne particles in large quantities.
So, can you shed some light on the current thinking/best evidence on air borne transmission vs large particles?
Thanks in advance for any info or insight.
@ Lisap
Great question about air borne vs large particles.
I’m working on deadlines through tomorrow, but I’ll try to address as best I can afterwards.
Great question because defining and describing the contributions of each form of transmission (larger particles/droplets vs air borne/aerosols) informs so much of the way that interventions and spaces need to be designed.
The nutshell is that your difficulty in finding straightforward material that addresses the contributions of aerosols reflects the fact that the understanding of aerosol’s role is still evolving.
That aerosols were either not involved to any significance in past coronas and especially not in the flu left researchers a bit flat footed in examining their role within covid 19.
Importantly, the consequence of this early over reliance on transmission models like that of the flu was that counter measures looked too much as if they were designed for the flu, particularly with too much attention to spread via surfaces, despite little evidence for this mode of transmission, and too little attention to respiratory air borne methods of transmission, which very early on was pointed to as a strong explanation for the types of spread that were being seen in China.
@Parent and Educator,
Thanks so much – great info and I look forward to hearing more – once you get through your deadlines. (I understand those very well! LOL)