Coronavirus (COVID-19): Press Conference with Joseph Allen, 06/24/20
You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Joseph Allen, assistant professor of exposure assessment science in the Department of Environmental Health and director of the Healthy Buildings Program. This call was recorded at 11:30 am Eastern Time on Wednesday, June 24.
Transcript
JOSEPH ALLEN: Good morning, everyone. Thanks for joining us. What is most top of mind for me today and my team is the release of a report and associated op ed. The report is called Schools for Health: Risk Reduction Strategies for Reopening Schools, outlining strategies that schools – risk reduction strategies that schools can put in place across five areas: healthy classrooms, healthy building healthy policies, healthy schedules and healthy activities. The related op ed that I just published in The Washington Post this morning titled Yes, we should actually – forget what they titled it, sorry – Yes, schools should be open and we should get kids back to school this fall, where I make the argument that the cost to keeping kids at home is devastating and there a proven risk exposure and risk reduction strategies that can minimize risk for both children and adults.
I’ll take one more second to talk about my background so you know how I approach this. I’m the director of the Buildings Program Facility with Harvard for about 15 years, six years full time of the tenure track. I am also the deputy director of our NIOSH, National Institute of Occupational Safety and Health Education Research Center on Worker Health and Safety. I’m a certified industrial hygienist. Industrial hygiene is a field that anticipates, recognizes, assesses and controls hazards in the workplace, radiological hazards, chemical hazards, biological hazards, physical hazards. While I had a part time employment at Harvard, I was in consulting and used to do forensic investigations of sick buildings. I did this for a long time. And many of these were quite, or were high stakes issues where some buildings people had died, many others were at risk, low information environment, huge financial stakes.
So while the pandemic feels very different and new to all of us, of course, there are elements that feel really familiar to me in terms of the approach you need to take to leverage the best available science you have at hand to keep people safe in buildings. Over the past couple of months, I’ve been advising many organizations on their return to building plans, that includes some hospitals, universities, the courts, prisons, homeless shelter theaters – Harvard’s American Repertory Theater, we have a roadmap for recovery and resilience – commercial real estate, the financial sector. So I’ve gotten to see and put together plans or effective plans to keep the risk significantly reduced as people return to their buildings in office, health care setting or. And now we have my team turned its attention towards schools. OK. I’ll pause there. I’m happy to answer any questions.
MODERATOR: Thank you, Dr. Allen. First question.
Q: Hi, Joe. Thanks. Thanks for taking our questions today. I wonder if you could talk a little bit about risk reduction versus guaranteeing no kids will get infected and perhaps why parents, why that should be enough for parents.
JOSEPH ALLEN: Well, you know, I think we should start with the fact that there’s no such thing as zero risk in anything we do. And certainly that’s not the case during a pandemic. The goal, of course, is zero cases. I share that goal with everybody. I have three kids myself, and we want to protect them and keep them safe and reduce the number of cases. The reality is what we’re seeing and let’s take it on a couple levels, the country the has failed to put in the systems necessary to keep case counts low. And so we’re forced to navigate society, reopening businesses, reopening schools, not in a place where we want to be or should be, but facing the reality that we have. So that is where our first attention should be focused on, is to get the case count lower in the country. We have failed grossly in that regard. So it comes to a risk reduction strategy. The goal is to minimize risk. And we end there to rash reasons why I argue that we should get kids back in school or kids should go back to school the fall.
The first is there are devastating costs to keeping kids out of schools. And I could talk about that. I mean, this is everything from the reality that we now have virtual dropouts. Take Boston, for example, where 20 percent of their kids in May, students, didn’t log into class. Philadelphia had a similar issue where only 50 percent of the elementary school kids were making daily contact. And even those with access who are making contact, I see with my own kids, the learning is very different. So there are consequences to that.
We also know that being in a school impacts their health in other ways, largely being more sedentary, so it’s influencing their physical health, in addition to mental health and their inability to connect with others from a social standpoint. And then it influences their physical health on the nutrition side, where many kids are reliant upon – I don’t mean many, that is an understatement. Millions and millions of kids, tens of millions of kids across the U.S. are dependent on schools for their breakfast and lunch. There are also concerns put out by UNICEF, that children during lockdowns are at greater risk of abuse, neglect, exploitation, violence. And so when we have this discussion about kids going back to school, we have to put in the context of the massive individual and societal costs to keeping kids at home.
And the other side of this is that kids’ risk from this virus are lower, not zero. Nothing is zero. They’re lower. And we have these proven rich reduction strategies that are effective even in hospitals, really high-risk environments. Effective strategies to protect both kids and adults. So when you combine those things, it becomes clear to me that yes, we should be reopening schools in the fall. But that is not an argument for reopening schools business as usual or schools as usual. That’s why we released this report. It’s oh, I actually don’t know the page count over 50 pages and we detail strategies that need to be put in place across those five core areas, classrooms, buildings, policy, schedules, and activities. And with many details below it, right.
This is not – our goal here was not to say, well, kids should go back to school. We won’t say, well, these are the solutions and the steps that schools need to take right now across all of those different core activities. So I think I answered that a couple of ways that I want to be clear, any time we have that discussion around zero cases of zero risk, you know, there will be cases in schools. That’s unavoidable at this point because of the choice our national government has taken in terms of this absolutely failed response to controlling cases, which other countries have taken a different approach and been controlling it. So we’re stuck in this situation, but we still have to march forward. And I know that if we follow the science, we can significantly reduce risk in schools.
Q: So you mentioned hospitals. So just follow up with an additional question, are there things in here that have been borrowed from hospitals? Because it does seem that hospitals have been successful at dealing specifically with these types of infections and been successful at it.
JOSEPH ALLEN: Absolutely. I mean, and I started the op ed by talking about the basics that are working in hospitals where hospitals have significantly reduced the number of health care provider infections. And really, what are they doing? It’s universal mask wearing and of course, high compliance, aggressive hand or frequent hand washing. They manage their building and ventilation and filtration systems really well. What don’t they do? Physical distance. They can’t. So and by the way, I want to be really clear, that’s not an argument for not physical distance. We should be physical distancing. And my point is that if we have good compliance on even basic control measures, we can – that’s part of the proven risk reduction strategies, rely on what’s happening hospitals.
And then our team, my team went further and we say in addition to those, which I think everyone knows by now are the absolute basics of managing or lowering risk in across society, we go further you know, arguing that we should be putting in even greater or more enhanced controls. I also want to caveat this, and say right up front, a major limitation here is that there is no one size fits all, right. Every building is different. Every district is different. The needs of the student population are different. So what we’ve done is created this menu of options that schools should pursue, knowing that it’s going to be different in each district and right down to each individual school and right down to each individual classroom.
Absolutely we borrow from what’s happening in the health care side of it, advising health care universities. A lot of it from our own work. We’re relying on decades of exposure and risk science. We’re relying on information, even plans I have put in place or I’ve worked with those to put in place across the business community, the American Repertory Theater, our own university, Harvard, other universities. And so we’re relying on all of that. And we think we’ve come up with a set of best practices that schools should implement.
Q: Thanks, Joe.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: Hi. Thank you, Dr. Allen. I wanted to ask you about the Department of Homeland Security released a tool, an airborne decay calculator where you can input the UV index, the temperature, and the relative humidity. And then you get sort of, you know, how the decay, the airborne decay of COVID. And I was wondering what you think about it and how do you use a tool like this when you’re thinking about going back to the office or going outside or what do you think of the tool.
JOSEPH ALLEN: Yes, a nice question. Thank you. I think the tool is really well done and it’s a nice balance between sophisticated scientific modeling and presenting it in a way that is useful for people.
I think, like all models, it has important limitations we should talk about. And that being first, it’s only covering one mode of transmission, airborne. And so the strategies we talked about in our reports cover all modes of transmission. So I just want to flag that, that if someone uses that calculator, they should be aware that other controls need to be put in place. And the calculator that lets you evaluate a couple of different controls. Of course, the same thing applies that with any model, it’s only as good as the inputs you use for it. And it has to be tailored to your specific building or set or classroom or situation. But directionally, yeah, I think it can be useful to help guide that.
The other part I’d say is that, you know, we don’t need every teacher to become an expert modeler in airborne transmission. If we follow these known risk reduction strategies for all transmission pathways, we know we can reduce risk. And now scientists, yes, will absolutely continue to keep quantifying the relative impact. But I don’t think this is a role for administrators or teachers to have to kind of model risk in their building down to a quantified number. And alternatively, the better approach is to apply these comprehensive strategies broadly and pursue them all, not knowing exactly which one provides the exact greater percent of benefit. There isn’t one solution that we should be relying on. We need to rely on all of them at all times. I hope that helps as an answer.
Q: Thank you very much. I ask also because we weren’t thinking about maybe making it even more user friendly. So, for example, if you will use, if someone had to use the zip code, for example, you know, and then we would already have the UV index or the temperature. But then that would only work for outdoor, no?
JOSEPH ALLEN: Yeah. I mean, a lot of these indoor air quality models, and my team just submitted one for publication today, they’re all relying on the fundamental basics here of indoor air quality modeling and taking into account things like air exchange rate dilutions, filtration, UV, to estimate what strategies can reduce risk. But here’s why I think the model’s really helpful and can be good. At the same time we already know that these set or suite of risk reduction measures will have an effect. In other words, enhancing the ventilation and filtration inside a school building or any building is going to reduce any airborne particles if someone is sick and shedding virus.
Now, I do think there’s room for more sophisticated approaches, but I think the better – right now, so this is what we need to do – you can start to tailor it for your specific school or building or classroom by saying, well, you know, the model shows that I get a better benefit if I put an air purifier in this corner versus, you know, increased ventilation over a certain percent. So you could start to do more specific analysis, which becomes a, you know, a way to identify which strategies specific to your classroom or building are going to be most effective.
But I tend not to try to confuse that message to the public and those trying to implement solutions because we can get down in the weeds really fast. And the goal for buildings in terms of airborne transmission is really simple. It’s a prioritization. We talk about it in this report. You want to prioritize bringing in more fresh out there air, higher efficiency filters on recirculated air. In a naturally ventilated building, you want to open those windows and use box fans or other mechanical fans near the windows or in the windows to facilitate the movement of outdoor air indoors. And you should consider supplemental filtration strategies, like the use of portable air cleaners.
MODERATOR: Did you have follow up?
Q: No. Thank you so much, Professor Allen.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: Hi, how are you? Going back to your point about keeping case counts down in the country, Dr. Anthony Fauci told House lawmakers yesterday that the next couple of weeks are going to be critical in our ability to address the surge in coronavirus cases we’re seeing in some states. So my question is, how so? You know, why are these next two weeks critical and what do states need to do? You know, what are possible outcomes, like a worst case scenario or best case scenario?
JOSEPH ALLEN: Yeah. Well, thanks for your question. You know, I absolutely agree with Dr. Fauci and I’d say, you know, not just the next two weeks are critical, but the first couple of weeks in January were critical. February was critical. March was critical. At great expense to the economy, we flattened the curve. It was a success. March, April and May were critical to get the systems in place we needed to control this. We didn’t do it. The country did not do it. It’s an absolute failure of leadership. And we find ourselves in this position right now, in June, with high uncontrolled case counts. Over one hundred thousand dead. Projections of 200,000 dead by October and to be going into a potential second wave in the winter. I find that totally unacceptable. It has been frustrating. We have been writing about – we have known there is a proven plan to save lives and the economy. With other faculty at the Harvard School of Public Health, we released a report called COVID Path Forward, it’s at covidpathforward.com, that outlines 14 priority areas to save lives and the economy.
So I agree that Dr. Fauci’s comment is right, now, we need to fix this and correct it fast. If we don’t, we will be going into the fall with a high case count, heading into a potential second wave with runaway cases in some areas. We open our Schools for Health Report talking about this. In fact, we put in the 14 priority areas to save lives and the economy as a reminder and it’s the end of my op ed, because as we have these discussions about schools and businesses, we have to continually remind ourselves it did not have to be this way. Many countries in the world have shown they can control cases. And so we have to continue to push and demand for better from our national government. At the same time, this is the reality we have.
And so my team myself, I think many other colleagues at the School of Public Health find it’s our responsibility to try to find pathways for which we can reopen schools and parts of the economy because this economy is a public health crisis too. Tens of millions of people don’t have jobs. This is not going to get better soon. The economy is not going to restart when people are scared because we have uncontrolled cases. So, you know, this is not the position I wanted to be in June. I was very hopeful that in March and in April, when we flattened the curve and it worked that the country had bought itself time to put in the proper and necessary protocols and plans in place to manage this more effectively.
MODERATOR: Do you have a follow up question?
Q: Yeah. Is there a reason why Dr. Fauci pinpointed two weeks? Like, is there some sort of like two-week plan that we need to adhere to or that states that are experiencing a surge need to adhere to that he’s looking forward to or? I’m just wondering where two weeks came from, I guess. Why are these two weeks critical?
JOSEPH ALLEN: Yeah, I don’t necessarily know why he said two weeks, but I’ll tell you why I think it’s two weeks, because we can’t delay another second in putting these in place. Because in some of these areas, you’re having exponential growth in cases like we saw in New York early on. If you don’t stop this quickly, it can quickly – we know it can overrun health care, local health care systems. And the time course from infection to the illness and serious illness that presents itself, where people present or need to be hospitalized is about three weeks. And so you have many cases and in the next two weeks many more will be infected while the numbers in the hospitals increase if stronger protocols are not put in place.
Let me say, too, though, that the practices that people have been following, at least in some parts of the country, are having an effect. The efforts to physical distance, universal mask wearing, this must happen. I first wrote about this early on, before CDC advised it. In early April, I wrote in The Washington Post, the debate is over on masks. And to be honest, that was well before I think the public was ready to do that. And even many in public health were reluctant to say that. In early April, I wrote that piece. The debate is over, everyone should be wearing a mask. We know this can have a benefit. Handwashing has a benefit. Maintaining physical distancing has a benefit.
So if we put in these strategies – and also what gets talked about less and that’s my real wheelhouse here beyond exposure risk, is healthy building strategies, including greater ventilation and better filtration. We know these can have an impact. And so we need to be getting this message out even more widely and getting to a place where we have even greater compliance.
Q: Thank you.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: So here in Florida, we’ve had two teenagers die from COVID in the past week. And as we see these cases spike and kids eventually go back to school, will there be more of these younger deaths to come? Is this something that was expected or do we need to use even more caution now that we’re seeing this?
JOSEPH ALLEN: Well, so let’s start by acknowledging that any death is a tragedy and an avoidable tragedy. So I want to acknowledge that and recognize that, you know, our goal, of course, is zero cases. That’s my goal. I think that’s everyone’s goal in public health.
When we think about schools, we have to weigh it against the other benefits. And knowing that while cases do happen and these extremely unfortunate and sad deaths of young kids will occasionally happen, the risk to kids are lower than they are for adults. And they can be lowered even further with a comprehensive set of control strategies or risk reduction strategies. So, you know, we acknowledged right in the front of our report. There is no risk – there will be cases, there will be an occasional outbreak in a school.
If the goal – I mean, the goal is zero cases, but the only way to have that happen would be for schools to shut for the next year. The country can guarantee that there’s not another case of a kid in school if we keep school closed for another year, but that’s not acceptable in terms of the other risks that come from keeping kids out of school and the risks I talked about it in the opening response to physical health, to mental health. We’re talking about food security here. We’re talking about physical safety, isolation, virtual dropouts. These have devastating consequences to the individual and society.
And if kids don’t go back to school, we actually can’t restart the economy. Nurses and doctors may not be able to go to work. Health care workers may not be able to get to work. Teachers won’t be able to get back – if one district says no and one says yes, a teacher with kids in a different district won’t be able to go back and teach. People who are working from home won’t be able to go back. This is – I talk about this in the op ed – this is disproportionately impacting women who now working three jobs, working women out have their job, they’re household managers, they’re home schooling or a home teacher. And this has the potential to widen the gap, the gender gap, in terms of pay and career advancement.
We have to take all of those things into account. I think it’s so easy to say, well, we can’t accept even one case of a kid. But I think that’s dangerous, too, in the sense that that means schools have to stay closed and it comes with all these other consequences.
MODERATOR: Did you have a follow up?
Q: No. I think that’s good. Thank you so much.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: Thanks. Thanks for taking my call. So I understand where you’re coming from with, you know, the risks of keeping kids out of school. But what most – and I cover education, so I’m sort of elbows deep in the discussion schools are having right now about how to reopen safely – most school districts I’m talking to are not talking about not bringing kids back. It’s that how to bring kids back while also adhering to the six foot physical distancing rule means that they literally can’t bring every kid back every day. So you’ve got options for alternating day schedules or alternating week schedules. The only way the schools can bring kids back all the time is to have them closer than six feet.
So are you recommending that schools focus more on all the other building air quality measures and hygiene control measures and just kind of like forget about the six foot rule or are you suggesting that – I mean, is what you’re saying just exactly what all the other district leaders are talking about right now, which is that we are going to bring kids back, it’s just going to have to be sort of half time unless there’s another major outbreak and then we’re going to be all virtual all the time again?
JOSEPH ALLEN: Yeah. So thanks for your question and comment, and I appreciate it and that you’re deep in this, too. So let me add or give some comment on how I think about this. I wouldn’t go so far as to say we shouldn’t be doing physical distancing. So I’d be really clear there. We should be doing our best to maintain physical distancing. But I’ll tell you about the challenges and also how to get around that. Let me start with the first – let me start with that.
We have to take into account these holistic risk reduction strategies. I’m going to talk about elevators for a second, because it’s informative to what’s happening at schools. And I wrote a piece in USA Today on elevator etiquette in the age of COVID. CDC’s guidance says maintain 6 feet of distance, even in an elevator. Well, that essentially means one person in an elevator. That’s not going to work in major cities and tall buildings. Second, importantly, the risk can be managed in the elevator, especially in an elevator where you have a short duration of time. And my concern is that you create a secondary condition if you so strictly follow that that might be worse than the original. So to be specific, one person up and down in an elevator might create overcrowding in the lobby as people wait two hours sometimes to go up or down, or overcrowding on the floors.
So I think the same thing applies here for schools. We want to maintain physical distance thing as best we can. Absolutely. I’m going to be really clear there. There are going to be times when that’s going to be challenging. For example, on a bus that is going to be challenging. So we talk about rethinking transportation, encouraging other modes, but recognizing many kids still have to take the bus. Well, you can open up the windows. They can wear a mask. That is effective. Again, look at what’s happening in hospitals. High risk environments. They’re not always able to physically distance. So what do they do? They put in more stringent other controls. They try to physically distance as best they can, certainly when the masks come off and doctors and nurses and health care providers are taking a break, but they stay physically distant.
We can do the same thing with school. Even in the classroom and we talked about the importance, the difference between physical distancing and group distancing in this report and I think it’s absolutely critical. Because you want to slow transmission chain, so recognizing that within a classroom, it’s going to be really hard to stay physically distance the entire time within a class. But if you separate classrooms as best you can into pods or you limit the cross, let’s say pollination of the groups, you can slow those transmission chains, so if someone does get sick, it doesn’t spread through the entire school fast. It can be stopped within a classroom. That’s really important.
Why I don’t – we talk about these discussions that are happening in terms of modifying attendance schedules, but I flag it in bold in this report for this reason. I don’t think it’s a good strategy at all. I don’t think it can work. How is a teacher with a child in another school district going to manage that? If their kid is on the A week, and on an on week, and then an off week, on their off week, that teacher won’t be able to teach in the district where they teach that week. They’ll have to be home. It’s not going to work. I don’t see how. I saw that article in The New York Times a couple of weeks ago promoting something like that. It doesn’t make sense to me. It’s detached from the reality of how this can actually work if you think in terms of systems. Yeah, that’s great for risk reduction at one school or one classroom, but it’s not going to work societally. So I think that’s a big problem.
I also think at the same time that these other solutions can effectively reduce risk. Now there is – you know, kids are going to have to wear masks and so are teachers. I recognize this comes with a lot of challenges in terms of learning, comfort, mask fatigue. We talk about the need to build in mask-free time where people are spread out, kids are outside, get them separated, give them time to take their mask off, keep the teacher away. Teachers maybe use face shields if they’re far enough away and don’t need to use the masks.
But my team’s approach, you know, I’ve been in these discussions for a while and my team’s approach to this was, look, schools are going to eventually need to reopen and we need to put forward a plan that can keep risks as low as possible. Whether or not our strategies here are acceptable to a district, or acceptable in terms of a learning environment, or to parents, that’s another question that’s not really for us to answer. In other words, if parents decide or teachers say well, that’s not going be an effective way for students to learn if they’re wearing a mask and they’re separated. I get that will be very different. It is going to have to be different. If you want to keep kids safe in schools, that’s the way it’s going to have to be. The alternative, as we’ve been talking about, is we’ll have to close schools for another year and the cost of that approach, of closing schools, is too great, in my opinion.
MODERATOR: Did you have a follow up?
Q: No. That’s it. I’m good. Thank you.
MODERATOR: Thank you.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: Hi, Joe. Just a follow up on your recent comments, so actually your earlier response about lessons from hospitals where you can’t distance, but compliance is very high. And it sounds like you’re really describing a scenario that’s very similar in many ways. So if we’re not doing A/B days for kids going to school, and it sounds like from what you’re saying, you do not recommend that, but rather to have kids in schools with as much distancing as possible but heavy use of masks to kind of compensate for where it’s not possible. I wonder if you could talk if A, that that’s accurate, but second, if you could talk a little bit about the difficulties of compliance with high school or elementary school kids.
JOSEPH ALLEN: Yes, I think you have it characterized correctly. Yeah, definitely I think, as I described, I think there are big problems with these A/B schedules or plans for the reasons I said. I do think schools should get creative in terms of scheduling in different ways. So can you start earlier and end later as a densification strategy so you can stagger arrivals? So not everyone is rushing in at, you know, the bell goes off at 8:00 in the morning and you have a couple of hundred kids rushing in. So can we stagger it and know one great enters at seven thirty, one seven thirty five, one seven forty, right? Same thing with release. You know, can we get more creative where, especially the older grades where they switch classes, the bell goes off and everyone runs around, you know, can we get a bit more creative? But how we do that make it a bit more orderly, stagger it a bit, encourage bathroom use during class time so there’s not a rush in the three-minute gap between schedules, between classes and things like that. So that’s, I think, they’re are – so while I don’t agree the A/B scheduling approaches are things we can do, we should be thinking about during the day.
In terms of compliance, yeah, I agree, this is going to be the biggest challenge. And I think this is where a lot of people are pushing back, even at the university level. I think the most important recommendation we have, this is the first one in our health policy section, which is that schools need to establish and reinforce a culture of health, safety and shared responsibility. This is really the only way we’re going to get through this. We have to move from the place where mask wearing and hand washing is an exception to where it’s the norm and it’s expected. In fact, it requires a great deal of social trust. So we have to establish reinforce this culture of health, safety, and shared responsibility.
We talk about some of the things. You can’t just roll out and hand someone this pdf report and say, OK, here’s our health and safety plan. Schools and districts have to provide training to teachers, staff, students, parents, guardians, prior to school opening, when school opens, every week. Daily communication. Start each day with a morning announcement across, a whole school announcement reinforcing the health messaging. Create and display signs everywhere around the school. Hold weekly and monthly all-staff meetings. Reward good behavior. You know, that is how we can get to a place of compliance is if you change the culture. And I know there’s, you know, having discussions – I have three kids. I have a 13-year-old, a 10-year-old and an eight-year-old. And I understand the compliance challenges. But with the training and messaging that’s happening, I think we can get to a place where compliance is much greater. It won’t be perfect, but I think we can get to a place where it’s good, if we enlist everybody in this shared responsibility role. It’s not just the district’s responsibility, not just the school’s, not the state’s. It’s parents, it’s guardians, it’s students, it’s teachers, it’s administrators, everyone who can shift this culture.
Why I’m optimistic is think about where we were in March. So before I wrote that piece on masks in early April, if you saw someone wearing a mask in a grocery store in March, it would have caught your attention. But think about how quickly that changed. By mid-April, it was the opposite. If you went into at least the area where I am in Massachusetts and probably New York, which was hit very hard early, if you went to a grocery store and you now see someone without a mask, that’s different, right? The culture has already shifted. Same thing with a conversation with a neighbor on the street. The first one we all had with a neighbor at six feet felt awkward, right? And now it feels awkward if someone broaches your personal space and comes within six feet. So I’m optimistic on that front that the culture can change. But it doesn’t just happen by itself. It has to be strategic. It has to be reinforced daily, multiple messages and enlisting everybody as safety and health ambassadors.
Q: I wonder, just to loop this conversation back to the broader national coronavirus picture that you also have talked about this morning, do these recommendations vary at all, depending on – in your feeling that we pretty much have to open schools because of all the benefits they provide and the risk of a lost school year, does that vary at all, depending on, you know, the state of the local pandemic? It seems like cases here in the northeast where they’re on the downswing versus cases in other states that may be looking like they’re starting to spike a little bit? Is kind of the state starting point important here?
JOSEPH ALLEN: Yeah, absolutely. And in our report – let me just quickly name the guiding principles we talked about here, and I’ll get to one that’s directly relevant to your question. So follow the precautionary principle, layered defenses, share responsibilities – we’ve talked about that – limit transmission chains. We’ve talked about that. Be flexible, which is related to your question. I’ll answer that in a second. And then ensure equity. We have to recognize that for many students – well, nothing is equal across society and we have to ensure equity in our approach here.
On flexibility, absolutely. Look, the science is changing daily. It’ll change by the end of this week. It will change next week. Certainly, the science will change by September, including the treatments that are available to us, the testing that’s available, our understanding of disease dynamics. So the plan you put in place today is going to change. Everyone has to be comfortable with that. And it should change. And it should also change based on the local conditions, absolutely.
The approach that I’ve been advocating for – and this works for many businesses too, and universities – is a phased approach with specific gating criteria where the first phase should be the most restrictive because you have to first demonstrate that you can control risk. And so it would be foolish to go in and with a limited set of controls and find out that wasn’t enough and you’re playing catch up with people getting sick. The better approach is to go in with every controller you can think of in September and if, and only if, you demonstrate that you can control exposure and risk in your school and the regional disease dynamics are such that it is getting under control, then you could start to peel back some of these strategies. And so you can go from phase one, if the gating criteria met, you go to phase two, another gating criteria, phase three, where you can start to loosen these controls, fully recognizing that this is not like after a hurricane where the damage is done and you march forward stepwise. You know, if your school is in what you call your phase three plan, you might have to go back to phase two or phase one, depending on what’s happening in your school – if there’s a case or multiple cases – and what’s happening in your region.
So all that to say, yeah, you know, we have to be dynamic and flexible because the information coming out is changing. Our understanding today is very different than it was in March. It’ll be different in September. It’ll be different in December. But to get schools reopened, we need to start with the most stringent controls in place.
And I want to add some that I haven’t talked about yet on this call, but it’s absolutely critical. This has to start right now. We don’t put in these plans and policies when teachers come back a couple of days of the week before school. This has to start now. In fact, the healthy building strategies we talk about must start now. Schools must be inventorying what their mechanical systems can and can’t do, commissioning them to make sure they’re performing well, upgrading the filters, bringing in supplemental portable air cleaners, bringing in experts in that field, engineers, building engineers, to help with their system. For those with natural ventilation, it’s doing that testing and monitoring and verification, to be sure well, how much air can we actually bring into this space if the windows are open? There are tools and techniques and experts who can help you figure that out, how to bring and recirculate more, even a naturally ventilated building, mechanically ventilated. Every building type, right, there are experts out there. This is the time to start getting your signage right. Setting up rules that traffic in corridors. Putting in Plexiglas barriers at fixed locations like the reception desk and the cafeteria.
So, you know, this is the reason why we pushed to get this report out right now. My kids had their last day of school yesterday. Intentionally we got this out now to say this is the time to think about schools. We didn’t release this report in September or August. Now is the time to start putting in developing these plans and policies, in particular around the healthy building strategy.
Q: Thank you.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: I’ve got, I’ve actually got three if you have the patience. I’m thinking about how K-8 kids are, you know, squirmy and how kids in grades 9 to 12 simply won’t do what they’re told and then how both of those scenarios are very different from a university setting. So I’m wondering, what’s the most important advice that you’d offer each of those institutions that would vary notably based on those three different scenarios and settings?
JOSEPH ALLEN: Yes. Nice comment, thanks. I think I disagree with the premise a little bit. You know, compliance issues happen at the university level, too, for all sorts of things, right, with young adults. And I have young kids and they do somethings really well and they’re easier, they’re more compliant for some things and not others. Teenagers are different. So we can vary – so I’m not sure that it’s universal or it’s so easy to chunk out that, at least in my experience or opinion. But I think it’s the same guidance that I said maybe two answers ago on the need to establish and reinforce this culture of health, safety and shared responsibility.
Like I said, I have more faith in kids of all ages and young adults and being able to adhere to these policies when it becomes part of the culture. Already I see it in some schools, you know, anti-bullying campaigns, they work when it becomes part of the culture. And I have to say too, you know, and this is where bringing in the parents and guardians is going to be key, where if the entire society is taking this seriously, which I recognize is a challenge right now, I think we can say move the needle on compliance. You know, I see changes already in my own kids and other people’s kids where, you know, they know what’s going on. They know it’s serious. And their behavior has changed accordingly.
So I guess I might it be a little overly optimistic, and I think this is where maybe the limiting transmission change comes in or, you know, we talk about different things, physical distancing and group distancing, where group distancing becomes really important, knowing that compliance may not be perfect. But if compliance is imperfect within a classroom, but it’s pretty good, but it is not perfect, you can help minimize explosive outbreaks in schools. If you have uncontrolled mixing of the student population and there’s low compliance, that’s a higher risk for an outbreak in a school.
Sometimes it’s hard to pull out any one of these things without talking about it holistically in terms of the overall approach and what the goals are, recognizing that there’s goals at the individual risk level, the source control with mask wearing, there are goals for within the classroom, there are goals to limit contact or transmission change across classroom. Across schools, there should be efforts to limit contacts between schools so we limit transmission chain in a community. And you know, we haven’t talked about this, but, you know, there is still going to need to be there’s a place for remote learning because they’re going to be some who are taking care of others or whoever are high risk themselves who won’t be able to come to school. And so we have to ensure that we set up the systems where remote learning can still happen.
One of the ideas we talk about in this report is the idea of having district wide remote learning so teachers in the classroom can focus on in classroom learning, but even by grade level, you have someone who is always constantly every day, substitute remote learning teacher for the grade. Now the lesson plans will be off but the point is you have that ability – it won’t be perfectly synced – but you’ll have that ability that kids who can’t make it, or kids who have to go out for a day or two, or if they get sick and need to self-quarantine, that the systems are in place. If it’s left up to the individual teacher, maybe in some schools and some teachers can manage that just fine, managing both in classroom and remote. I think it’s quite challenging. So districts and schools are going to have to get clever about offering constant remote learning. I like the idea of doing what the health care system did when there was a shortage. They immediately certified people who had just graduated and they called up a reserve corps of newly retirees. Well, we could do the same for school. These could this could be the reserve corps that manages and does remote learning while in classroom teachers continue to teach in the classroom.
Q: I appreciate the push back and that’s good information. Thank you for that. Specific concerns and recommendations for college dorms?
JOSEPH ALLEN: Well, I think it’s the same healthy building principles. You know, it’s not a book plug but I wrote a book called Healthy Buildings with a professor out of Harvard Business School. We talk about the healthy building strategies. I’ve been talking about helping building strategies. The first piece I wrote was in Financial Times in early February saying healthy building strategies or healthy buildings are the first line of defense against novel coronavirus. That applies for offices, schools, dormitories, the same kind of general principles here. And actually, some of the things in our report or other pieces I’ve written would be really, I think, helpful in that regard as we talk about higher ventilation rates, better filtration, better ventilation, limiting contact chains. I don’t think that’s reasonable or practical to think that students who share a room are going to wear a mask all the time or even in the same dorm. Maybe not. But again, under the same logic where we apply for K-12 schools, you want to promote physical distancing and group distancing as much as possible so that if you do have secondary cases, they’re confined to a smaller group as possible so that you can protect other groups so you don’t have uncontrolled outbreaks, in this case, out of campus.
Q: OK. Last question. So I’m thinking that a lot of parents – I know this would be the case for me -aren’t going to be able to figure out exactly how effectively a given school or a given classroom has implemented their proper protocols. And, you know, we may not understand all of it. We may not get a good communication from the school. Assuming you agree with that some extent, what would be your sort of your one-liner advice to parents who are just going to be terrified no matter what might get done between now and when school opens?
JOSEPH ALLEN: Yeah, I mean, right. The only way anyone is going to really know is if the schools do a good job of communicating what they’re doing. And then parents will be able to assess the seriousness of the degree to which they’re implementing these controls. So someone can take this report, read it as a parent, get informed and then compare it to what the school is sending out and ask if there’s something missing. Do your own gap analysis. I saw this report from the Harvard School of Public Health, the Healthy Buildings program, that says we can do this are we doing that? You should ask. I think the time to ask is right now about what those plans are. There will be some things that are that parents will be able to judge, so they know if appropriate controls are in place, right.
You’ll be able to see signage. You’ll get a sense from the emails that go out. You’ll get a sense of the compliance around mask wearing the first time you’re at the school, you see the school or some of the summer messages. That’s one way to get a sense of how that’s going. If you don’t see it happening, you should be on the phone, sending emails asking why you don’t see that happening. There are some strategies that are invisible, though. For example, this ventilation question. You should be asking your school, what are they doing over the summer to ensure that there’s sufficient ventilation in the classrooms. You can read that short section we have that are giving you – bring someone up to speed, even if you’re non-technical, hadn’t really thought about it, tells you why it matters and what you should be asking for. Send them the bullets. Ask them if they’re if they have a MERV 13 filter, recirculated air. If they don’t, ask why not. So, yes, it is the time we should all be asking those questions of our schools. And the communication is going to be the tell or really the way any of us to be able to assess how a school is doing.
Q: Yeah. Yeah. Related to that, I’m imagining other readers of these stories saying, all right, Mr. Allen, what are you going to tell your kids to do differently or to not do when they go back to school this fall?
JOSEPH ALLEN: Well, absolutely, they have to wear a mask. They have to wash their hands before they leave home, as soon as they enter the classroom, every time they leave the classroom, every time they reenter the classroom. Stay away from others as best you can. And the usual stuff. Listen, your teachers and administrators follow the rules. These are codes of conduct. And to take it seriously and look, you know, kids learn also from the behavior of adults. So we all have to model this good behavior.
When I go out, I grab my mask. Now, if I left the house and didn’t grab my mask, my second grader says, Dad, you forgot your mask. So, you know, we all have to model this good behavior. And I really try to stay apolitical here because I don’t want to lose audience on these strategies. But let me just say this. We need better modeling of a good behavior from our national leaders. And that’s broadly speaking, but I meant it in terms of best practice for minimizing risk from COVID-19.
They should be encouraging mask use. They should be physically distancing at meetings when they’re on television. They should be talking about the benefits. I don’t quite understand it because the way to re-open the economy and save lives is through these methods, these preventative methods. You know, it seems as a country we’re falling back into the model we tend to always fall back into, which is treatment over prevention, medicine versus public health. We’re waiting for the COVID Cured headline. It’s not going to come. And we continually and repeatedly under-invest in public health and prevention. But these are the strategies that our leaders should be promoting right now, these preventative risk reduction measures.
Q: Thank you. Good answers. I appreciate all of them.
JOSEPH ALLEN: Thank you.
MODERATOR: All right. Thank you, Dr. Allen. It looks like that’s our last question and we’re out of time for today. Do you have any final thoughts you would like to share?
JOSEPH ALLEN: No, I want to thank everybody for taking the time to write about this. We recognize it’s a really sticky question. It’s really difficult and challenging. And at least our approach is that if we take into account the costs and benefits holistically and acknowledge that there are serious cost to individuals and society from keeping schools closed and knowing that there are prevention techniques to reduce risk. My opinion, well, I’ll say for my team, we’ve released a report with strategies that can reduce risk. And my opinion that I outline in the Washington Post is that, yes, kids should be going back to school in the fall.
This concludes the June 24 press conference.
