Tuesday, May 25, 2021

Re-opening schools and beyond: Lessons learned. Or not.


I am not opposed to re-opening schools. When all has been done to ensure that that can be done as safely as possible they should be reopened without delay. But pressuring governments to reopen them before minimizing the risk would be a serious mistake. I am not oblivious to the mental hardships stay-at-home orders inflict on children and their caregivers. Nevertheless, if the past fourteen months have taught us anything it must surely have taught us that more half-measures are not going to stop this pandemic. Re-opening schools now may grant a month or two  reprieve from stay-at-home orders, but it will not help to end this pandemic. 
 

We now know that kids can and do contract the virus, and that they can and do pass it on to others. Masking can go a long way toward protecting kids and adults, but masking by itself may not be enough. There are numerous other measures that could be implemented to safeguard students and the adults they interact with, but, as with the recommendations to prevent the recurrence of the deaths of residents and staff in LTCs over a year ago, many of the available measures have yet to be implemented. Presumably because many of these measures would have been costly to implement, governments have instead opted to wait for salvation in the form of vaccines. Salvation, not only from the deadliest consequences of the virus, but also salvation from the economic costs of having to implement measures recommended by healthcare professionals..

Governments and much of the general public have convinced themselves that vaccines are the answer. And indeed there is a great deal of convincing evidence that vaccines do and have prevented most of the most serious outcomes for those unfortunate enough to have become infected (70% - 95 % efficacy). Initially vaccines were in short supply, but countries who can afford them will soon have enough to vaccinate all of their citizens. Here in Canada it is assumed that after a few months enough of the population will be vaccinated to stem the spread of the virus. With assurances that the end in sight governments are reluctant to implement costly additional safeguards --safeguards that they optimistically hope by September will no longer be necessary. Meanwhile, when case numbers rise to numbers impossible for the healthcare system to cope with, governments reluctantly implement lock-downs, but only if and after it becomes absolutely clear that the number of ICU beds and the staff to treat the severely ill are once again completely overwhelmed. Even then lock-downs are often only partial, and almost always immediately eased or lifted, not when control over community spread has been regained or established, but rather when more ICU beds have become available. Regardless of the extent of community spread, or knowledge about the extent of community spread of SARS-COV-2 and its variants, things are considered to be acceptably under control as long as hospitals aren't being completely overwhelmed.

However new variants have and continue to emerge, some of them not only more infectious, but also less responsive to available vaccines. Yet governments are reluctant to implement costly safety measures and recommendations. Just as governments continue to ignore chronic staffing shortages, very low wages, poor ventilation, etc. in LTCs, so too it is ignoring recommendations regarding the re-opening of schools. It is considering reopening schools without first implementing safeguards that would make reopening them much safer. Reopening without
first fully vaccinating students, teachers and staff; without first ensuring adequate ventilation; without  providing quick rapid saliva testing for all staff and students; without  ensuring that dozens of classroom cohorts don't intermingle daily on school buses; without ensuring contact-tracing and testing capable of keeping up with the number of cases, and; without putting a waste-water monitoring system in place in each and every school.

Understandably, just like everyone else, parents, teachers and students do indeed very much want –very much need—things to go back to normal. ASAP. Governments who want to be popular, and hoping to justify their own inaction, respond to that need by implying that salvation is at hand. By September or so, we are led to believe, when everyone has been fully vaccinated and herd immunity has been achieved, “pent-up consumer demand” will quickly restart the economy. It will be restarted without ever having to implement additional costly safeguards; without having to pay the high costs of increasing the wages of personal support workers;
without ever having to provide affordable housing for the homeless; without ever having to improve ventilation in LTCs and schools; etc. The vulnerable will be less vulnerable if everyone is vaccinated, and it's cheaper to vaccinate them than address the socioeconomic inequities that left them so vulnerable.  Other on-going COVID-related expenses too, such as paying people to stay at home, compensating failing industries, bailing out airlines, will also come to an end in September when things go back to normal. And Canada will finally be able to replace the vaccines it had first donated to COVAX for poor nations, only to later claw them all back to use on its own citizens.

But how realistic is this popular narrative? Will things indeed go back to normal after everyone has received two doses of a vaccine? Given that there is a significant amount of vaccine hesitancy, is herd immunity even achievable, much less probable? Supposing that vaccine hesitancy is overcome –a pretty big 'if'; will vaccines adequately prevent infection and reinfection by all of the new and constantly emerging variants? (We have seen that where there are large numbers of people infected  --India and Brazil spring to mind--n
ew variants, some of which will be more infectious and/or vaccine resistant, will continue to present.) Furthermore we don't yet know how long antibodies, whether induced through vaccination or acquired by a previous infection, are likely to last; they almost certainly have an expiry date. Given all this, herd immunity by September, even at a national level, seems to be far from a bankable certainty.

“We are all in this together” we are repeatedly told. Indeed this pandemic is a global phenomenon, and as long as it continues to exist anywhere on the planet the threat of a local resurgence remains. That threat can be somewhat mitigated against by closing borders, issuing immunity passports, quarantining visitors, etc. The assumption here is that, although we cannot realistically see eradicating this virus globally in the foreseeable future, we can circle the wagons and make sure we can weather the storm ourselves; we can take steps to make sure that no one in our lifeboat –in our nation-state—becomes infected by not allowing a potential carrier to board our lifeboat. Or, even if a handful of them do get aboard, we can shut down our borders to ensure that they don't become so many as to once again overwhelm the capacities of our healthcare system, however adversely closing our borders might affect our economic recovery.
 

Exactly how Canada's economy –or that of any other wealthy nation state for that matter—can possibly recover in a globally interconnected and interdependent economy is also absent from popular narratives.  The question of how things can possibly return to normal in a world in which we are all dependent on global supply chains for raw materials, access to markets, consumer goods, industrial goods, food, sources of cheap labour, etc. that all of us rely on remains unanswered. International tourism may rebound somewhat when vaccinated citizens of wealthy countries resume visiting each others' countries; airlines, hotels and restaurants may also recover some of their lost business. But these things represent only a fraction of the economy, and therefore only a partial economic recovery at best, not a return to normal. Many businesses have already permanently closed their doors. 

And if the health of the economy continues to trump human rights and the health of people, we can expect the safeguards designed to protect even the citizens of wealthy nation states from possible infection by the citizens of poor ones, to be relaxed in favour of economic growth; such safeguards, like the safeguards intended to protect individuals within nation states from each other, will repeatedly be relaxed, probably until our ICU beds are once again filled to capacity and our healthcare systems, like those of our global neighbours to the south, at the verge of becoming completely overwhelmed.

But perhaps the most disconcerting and painful lesson we can learn from this pandemic is that we have collectively proven ourselves to be incapable of summoning up the political will to achieve the level of global cooperation required to defeat this virus. If that is indeed the case we cannot expect to survive the even greater threat of global warming either. In both cases the primary decision-makers are the rich and powerful, unwilling to give up their privilege as long as they continue to believe that their own lifestyles will only be marginally impacted. In both cases we have already seen that the most vulnerable –the first to die—are the poor and powerless. We are already witnessing rich nations hoarding vaccines, much like people in rich countries hoarded toilette paper early on in this pandemic. We are seeing powerful giant transnational pharmaceuticals prioritizing patent rights over and above human lives, while they rake in mega profits. And we are criminalizing and punishing victims: climate and pandemic refugees, like economic refugees, are either being  refused asylums, imprisoned and warehoused, or callously left to drown in the Mediterranean or die of dehydration in some desert. 

Whether or not the rich and powerful eventually drum up the political will to cooperate with each other soon enough to avert falling victim to the coming apocalypse and save themselves, we'll never know. We won't be around to witness it.