Whether to send one’s kids back to school has been a fraught decision for both students and parents. Dr. Hannah Lichtsinn is a pediatrician as well as an activist, with an eye on the social determinants of health, including the inequities that have worsened this pandemic’s back-to-school season. Like Dr. Rishi Rattan, with whom we spoke to in August, she is also a member of the advocacy group Right to Health Action, which is working to promote the People’s Pandemic Prevention Plan. We checked in on their progress in working with the Biden campaign to make this plan a reality. She spoke with Associate Editor Sophia Crabbe-Field on September 15.
Sophia Crabbe-Field: What would you say, in broad terms, are the preconditions for safe school reopenings?
Dr. Hannah Lichtsinn: I think that for schools to open safely, we need to ensure that, one, we have control over local community spread of COVID and, two, that our schools have the space, equipment, and other resources that they need to create a safe environment. And that means very different things in different places. For example, it could mean having large enough facilities so that kids can be in school in the classroom, distanced from each other, which in some districts throughout our country is impossible right now, if schools were trying to be at full capacity. It also means having basic hygiene needs met, like bathrooms with enough soap and paper towels, having good air flow and ventilation in every single classroom, having plenty of access to water, not from a shared drinking fountain for students, those types of things. It also means having a safe way for students to get to and from school, making sure that there’s enough transportation, whether it’s through buses or public transportation.
SC-F: So far, on the ground in Minnesota, have you seen any schools or any school districts or communities that have been implementing these kinds of policies?
HL: So in Minnesota, every school district is handling this a little bit differently. Our governor and health department gave some guidelines based on case counts of COVID in counties as to whether schools could be in person, hybrid, or distanced at different ages. So, for example, if there are more than 50 cases per 10,000 people in a county, then that school district has to be all distance learning for everybody. If it’s less than that, that district could still choose to be all distance learning, but it’s not required to be. So we are seeing a lot of districts go back with hybrid models, which means the students are divided into two groups to keep the numbers down. And two days a week, half the students are there, and the other two days a week, the other half are there. And otherwise they’re doing distance learning. It’s also a lot about the space issues, allowing for students to be further apart.
However, in our two major urban districts in Saint Paul and Minneapolis, they weren’t even, by cutting class sizes in half, able to have enough space to safely return to the classroom for elementary school, middle school, or high school. That doesn’t even get into their transportation needs in creating a safe environment for that. Now, in some of the more rural or even suburban districts, they are going back to at least a hybrid model, if not fully in person. And we haven’t had enough time yet to know exactly how that will go.
SC-F: And the places that have opened up fully for in-person learning, are any of those following some of the guidelines that you mentioned?
HL: So the expectation is that students will be six feet apart from each other. There are limitations on how many kids can be on a school bus at a certain time. And there were recommendations made for how to implement healthy airflow in a building, but there were no criteria set that a school had to do things a certain way. And there’s certainly no enforcement of airflow policies or guidelines. So each school is doing it the best they can.
SC-F: So looking at other countries where schools opened earlier than the U.S., in some countries like New Zealand, it went very well, and then there are countries like Israel, where their numbers seem controlled but school openings seemed to unleash a disastrous resurgence. What can you tell us about this? What did these countries get right or wrong?
HL: That’s a good question. And I don’t have detailed knowledge of it, but what I can say is we haven’t seen countries open schools in nearly as risky a situation as we are in now. So the examples we’ve seen in other parts of the world, they opened schools during a time when case numbers overall were going down significantly or had gone down significantly. In the United States, we are in a phase of this pandemic where our numbers are at worst going up, at best stagnant. The things that I have seen being helpful are slow steps forward. So rather than sending all the kids back to school at once, slowly re-introducing students, carefully monitoring rather than making a large sweeping change for the whole population at once, seems, from what I’ve read, to have been a safer, more healthy way to go back to school.
SC-F: So looking now at other states in the country that have opened up for more in-person learning, what are we seeing so far?
HL: We’ve seen that COVID spreads really quickly through schools. We have seen districts that tried to open up all at once, especially at the high school level, and had to reverse course almost immediately because of viral spread, through students and teachers and staff. We saw that in Indiana, we saw that in Georgia, and I imagine as more school districts open, we’ll see that in more places, if schools are trying to open in that way.
SC-F: For the children who are learning from home or distance learning at the moment, do you see that exacerbating existing inequities between children?
HL: Yeah. There’s so many problems with the way school is happening this year. We already have profound opportunity gaps for education in our country, and this is going to make it worse and set many kids and families back profoundly. There are basic problems: In order to do distance learning, you have to have a place to do it from. For kids who are housing insecure or homeless, school is their place that they can be during the day. For some kids, home is chaotic and not a safe space, and the school, again, was their place that they could be and be safe, let alone learn. We also have issues of, when doing distance learning, a lot of that relies on Internet and not everybody has access to Internet.
I know a lot of states, communities, and other organizations are working to ensure that students do have access. But it’s still not perfect, and the Internet is not considered a public utility, so there will be gaps there. There’s also gaps with support, so even with distance learning, even for students who have a great deal of synchronous or live teaching with their teacher, it’s not the same as having someone in the room who can give you hands-on support. So there’s going to be a huge range in access to hands-on teaching and support, let alone supervision during the day, between kids with more resources and kids and families that don’t have those resources. How many kids will just not go, not participate, who may have gone to school if there was physical school?
SC-F: I know that there’s sort of been an evolution over time in terms what we know of the effects of COVID on kids with regard to symptoms and to how much they’re able to spread the disease. I’m wondering if you’ve seen any effects of COVID on children in your role as a pediatrician?
HL: I haven’t actually treated any children who tested positive for COVID. I have cared for many adults who have it. What really concerns me is the long-term implications of this illness. We know a few things: We know that young children especially have not been getting very sick from the respiratory virus itself. We also know that older kids transmit this virus just as quickly and widely as adults do. But what we don’t know are the long-term effects of this illness. When I look at any disease process, I think about what’s happening now. Of course the immediate effects of something are important and we need to address them, but we also need to think about the long-term downstream effects.
So, for example, strep throat, why do we treat it with antibiotics every time? It’s not because the sore throat itself is so debilitating. It’s because if we don’t treat it, it can lead to rheumatic heart disease, which can lead to heart failure and stroke. And before we started treating strep throat with penicillin, that was widespread. We don’t know the downstream long-term consequences of this virus. There was a study recently that looked at college athletes who had tested positive for COVID, many of them without any symptoms at all, and one third of the athletes tested showed signs of cardiac inflammation, what we call cardiomyopathy, which can lead to heart failure. So we don’t know enough yet to know what the risk is. And that to me is really scary with our kids.
SC-F: And on the flip side of that, how have you seen parents struggling during this time, worrying about whether it’s safe to send their kids to school or not? How have you seen this play out both as a pediatrician and as a parent?
HL: I’m laughing because this is the most stressful thing I’ve ever had to do as a parent or that any of the parents I know have had to do. Trying to choose what is the best thing for our children when there’s no guidebook on how to do it and the data is constantly changing, it’s incredibly hard and incredibly stressful. In my clinic, I was talking to a young mom with a couple of kids, a single mom. And I asked her “What are you planning to do for the school year?” Her district was distanced, but I asked, “If it switches to hybrid, what would you do?” And she said, “Oh, I’m not sending them to school. That’s not going to be safe.” Whereas I know some other people who just don’t feel like they can even remotely survive another month or two in the home all together because they don’t feel like their kids are learning or having a good experience. I don’t think there’s an easy path for parents right now, but for those parents who can afford to hire a nanny or feel comfortable sending their kids to a smaller daycare or private school, they have way more choices than parents or families who were depending on school for their only source of childcare to be able to go to work.
SC-F: Do you see this creating any sort of stronger momentum for parental or sick leave policies to change in the U.S.?
HL: I hope so. I think that schools serve so many purposes right now in our country. They are a source not only of education, but also job security for parents because without childcare it’s impossible for parents to work. And we’re seeing that now. And I think that it makes it harder for our leaders to ignore the importance of childcare and financial support for families, because we’re going to have people who can’t engage in the workforce and can’t go to work because they have to care for their kids. I truly do hope that our political leaders recognize that and recognize more the importance of childcare.
SC-F: How do you think we can support teachers at this time?
HL: I think at the most fundamental level, we can support them by fully funding our school districts and our schools, making sure that teachers have the supplies that they say they need and the space that they say they need, because no one knows better than they do what they actually need in order to educate our children. We haven’t chosen to fully fund our schools for a long time, and if our teachers didn’t have what they needed before the pandemic, how could they possibly have what they need now? Number two, our teachers need to know that they have ready, easy access to testing for themselves in their classrooms, that they have support from their school administrators to get care when they need it and to be away, as soon as there’s any sign of symptoms or that they were exposed to in their classroom, without losing their pay, so that’s paid leave for these people. And health care access, just like everybody should have access to care without fear of paying for it. Certainly the folks who are working to take care of others, whether in a health-care environment, working at a grocery store or delivering food, or as a caregiver or a teacher, people shouldn’t be risking their own financial wellness to care for others.
SC-F: With regard to your work with the advocacy group Right to Health Action, I spoke to your colleague Rishi back in August about the People’s Pandemic Prevention Plan and what the goals were for the group. I was hoping I could get a bit of an update on what you guys have achieved since then?
HL: So we have been pushing the People’s Pandemic Prevention Plan and now have tens of thousands of supporters. I think we’re upwards of 70,000 people who have signed and endorsed this plan. We actually will be holding a town hall on Saturday of this week with Heather Booth of the Biden-Harris campaign and Kristen Urquiza of Marked By COVID to talk about this platform and talk about why it’s so important we take steps now to prevent this from ever happening again.
But when I think about the devastation this pandemic has caused across so many areas of our lives, we can’t have this happen again and again, at an accelerating pace, which is what we’re on course for right now if we don’t change how we approach how we fund public health in the United States and in the world. So, for example, our push for a permanent public health corps, that piece of our platform is now part of the Biden campaign commitment to have a permanent public health corps of 300,000 people working in their own communities. And that can mean fighting the pandemic now and making sure families have food, housing, and water. But after the pandemic it can mean things like making sure communities still have those tools that will protect them the next time something happens so that everybody has a roof over their head, every child has access to food and water, and an environment where they can learn and stay healthy and grow.
Other pieces of our campaign are, again, unfortunately becoming even more clear in their need: the importance of addressing climate change as a health issue, for example. With the fires on the West Coast right now, I don’t think anyone can argue against that. That is not a healthy environment to be living in when there’s not clean air to breathe. Even here in Minnesota today the sun was orange from the smoke out West. And if we don’t do something about climate change, people will continue moving into areas that are on the intersection with wildlife, which is how zoonotic diseases then get transmitted and the cycle starts again and it’s going to continue cycling until we have sustainable solutions.
SC-F: Can you also tell me a bit more about the sign-on letter you guys are working on now with Senator Warren and Representative Khanna?
HL: So Senator Elizabeth Warren and Representative Ro Khanna are, I believe in the next couple of days, going to start circulating a congressional sign-on letter in support of our pandemic prevention plan. And we are going to help circulate this to again get more support because these are, to me, and I think to all of us in Right to Health Action, the very basic tools that we need to have in order to get through this pandemic and prevent the next one. So they’re going to be asking for these same demands, which, just to delineate, it’s a national public health corps, with good living wage union jobs; access to medications, so that all of the medicines that are developed using taxpayer money are available to anybody who needs them; then, three, taking a global approach to prevention, so recognizing that viruses don’t respect borders and that we need to help invest in the most impoverished countries in the world to help them end this pandemic so that we can end it here too; and then responsible development in trade to help stop climate change, and especially climate change-driven disease, like I was talking about.
SC-F: I know as the numbers continue to go up in the U.S., people are looking at how much lower the numbers would have been if the cases per capita were similar to other peer countries. And so what do you think are some of the main highlights of what the U.S. should take from the responses of other countries at this point?
HL: We do know how to end this pandemic here in the United States, it’s not rocket science, it’s really basic and it would involve a complete shutdown for six weeks, ensuring that every person living in this country has access to their basic needs: food, housing, medicine, water, a safe place to be during that time. If we did that, and we really did it, we would be done, this pandemic would be over. But we haven’t chosen to do that. And for whatever reason some countries have taken more stringent approaches. You look at New Zealand and they’re back to life as normal, and that’s great and I’m really happy for them.
I think we can learn from that. I think that there are a lot of reasons why that type of action in the United States would be really hard, and one of them is that we’ve lost our sense of being part of a larger community here and that and we’ll have to give something up in order to get through this. So I think what we can learn here is that it is possible, but that we really do all have to work together. It is going to keep existing until we have a vaccine and use that vaccine widely, or until we stop being around other people for an extended period of time.
SC-F: How optimistic are you that should there be another pandemic we will be prepared and that things will play out differently?
HL: I have great hope. I really do. I think that we can make choices moving forward to create policy that will prevent this catastrophe from happening again, but it’s going to take strong leaders and it’s going to take commitment from people in power to engage with smart policy like the People’s Pandemic Prevention Plan to ensure that this doesn’t happen again.