My father is one of the deepest thinking, wisest, and, in the best sense of the word, spiritual people I know. Recent events remind me of a key concept he shared. In nature, growth is often most abundant at the intersection of things — in estuaries, for example, where fresh and salt water churn.
Similarly, societal churning forces us to recognize and be open to the fact that we may be in new waters, that our understanding of reality maybe incomplete and that deeper currents or colliding truths are at play.
Crises are both disruptive and offer opportunity to grow.There is a second core principle of emergency response many in our nation have left by the wayside: Build upon and use existing experts and systems, working together and respecting each other’s lanes. This leads to stronger response, greater credibility and better outcomes.
Resuming school in the environment of disease spread is an issue fraught with challenge and difficulty, one where truths collide. Yes, there are risks in reopening schools when disease is present. Yes, we could minimize such risk and stay fully remote or not resume school at all. Yet we see public and political demand to open schools and play sports. We see teachers, though concerned and frustrated, excited to be back with their students. Why? They know that not every child can learn well remotely and they care.
Many denounce Gov. Jim Justice and the public for seeming to value sports over education. Yet, perhaps for many, they really are more than just a game. They provide opportunity for kids to learn and to stay committed to school. They help families rally around something constructive, build community pride, and for some, are a path to higher education.
Reopening schools lays bare even deeper, longstanding truths.
Broadband access is insufficient. Many work paycheck to paycheck in industries that cannot telework. Not all worksites can or do provide paid sick leave or support quarantine. Many families deal with food insecurity, the effects of past trauma, or substance use, making school a respite and a link to safety.
Systemic inequities and racism exist. Addressing these hard and overwhelming truths requires long term commitment, political will, social cohesion and compassion.
And, there’s the truth that disease continues to spread in our communities and facilities at three to five times the rate seen in early summer, with testing increasing only two to three fold. This is despite good things being done by many. How much disease and disruption we can prevent through good leadership, strong emergency management, and community engagement may be hard to quantify, but clearly, there is room for improvement.
Colliding truths are especially hard for politicians in election years. Whether done intentionally or unintentionally, we see them report out information they or they believe others want to hear, regardless of its accuracy, or over-estimate the effectiveness of approaches they have at least a modicum of control over.
In West Virginia, our state is not as green as our map portrays, and, while critical to strengthen and nice in theory, we cannot simply test and contact-trace our way out. What typically works in crises are informed, multifaceted and layered approaches, efforts that engage and build upon the power of community. People need good information, open and honest discourse mixing the collective wisdom of experts with local experience and knowledge, and both internal and external resources — people, finances, frameworks, and tools. While never enough, we already have many of these.
Such work starts and is guided by clear data accurately reflecting community spread — the seven (or 14) day average incidence rate (what Gov. Justice calls “infection rate”). Assuming testing is occurring, incidence rates as calculated on the DHHR website are a fairly reasonable estimate of community risk –potentially even a bit stronger than the Harvard version given our availability of additional information (e.g., outbreaks in closed settings).
This is especially critical for smaller populations. Percent positivity is also a very useful, but not as reliable, standalone measure of risk. Mostly it reflects how robust our testing is. For the most part, the lower the percentage of positivity, the more assured we are that the incidence rate is a reasonable estimate of risk. Where there is low incidence and low percent positivity, one should also look at the recent number of tests per population and where testing is occurring.
How we combine and use these two measures is key. The current “whichever is lower” approach to alert mapping is neither scientifically sound nor societaly appropriate. I know of no health official or data expert able to speak freely, here, at the Centers for Disease Control, or elsewhere who would honestly recommend such.
Most states use incidence (some at rates lower than ours) or metrics combining incidence and percent positivity. All of West Virginia’s incidence color codes except green equate to the CDC’s “higher” or “highest” risk category. For percent positivity, West Virginia’s scale is slightly more rigorous than the CDC’s.
If opting to accept relatively high levels of risk in reopening West Virginia schools, we should be transparent, using accurate data to maximally engage and support higher incidence communities in reducing spread–including but not limited to increased testing.
Why revise how we color code the map now? First, it provides our people, schools, and communities clearer, more accurate information for action now and moving into what winter may bring. It can stimulate prevention measures, mobilize partners, and meaningfully track progress. Not doing so is like coaching and playing football with accurate stats available but a scoreboard on the fritz.
Second, it would reflect that Gov. Justice truly is working closely with scientific advisors, is listening to public feedback and open to change. There are other ways to reach the same outcome more transparently and without undermining the credibility of the state DHHR and West Virginia University. Yes, it will take a bit of humility and courage but those are admirable characteristics in leaders.
Third, even if the current “whichever is lowest” approach is not politically driven, changing before the election avoids even the perception of such.
Fourth, and perhaps most importantly, it makes a strong statement that leadership respects and values the ability of West Virginians to deal with difficult realities and to address them appropriately. It trusts in the power of county health officials, commissioners, school boards, businesses, neighbors and individuals to work at the intersections, recognize uncomfortable truths that collide, design short term ways forward and build public commitment for longer term change.
Many West Virginians before us have come together to do so in wars, floods and economic downturns. Why not pandemics? We teach our children to seek out, evaluate and use credible information; to hear the truth of others with compassion;and to practice critical thinking both individually and as part of a team.
Why not model the same? In fact, why not engage our children in the process as well–what better learning opportunity to understand our inter-connectedness and the importance of finding creative ways forward when risks are high and truths disconcerting?
Unless open and committed to portraying our data accurately and using the expertise of many to address the colliding truths that COVID-19 reveals, we lose critical opportunities–opportunities to save lives now and to begin addressing deeper issues affecting our health and economy in years to come.
Let’s start with sharing data that reveals these truths as real and grants opportunity to drive change.