Pushkin from Pushkin Industries. This is Deep Background, the show where we explore the stories behind the stories in the news. I'm Noah Feldman. Since July, President Trump has been calling for schools to open this fall for in person learning. Some schools that have already opened, though had to close after coronavirus cases were detected, like a district in Georgia. How should schools be making good decisions about whether to open, what criteria are relevant to that decision making? If they do open, how do they make sure things are safe? And what do they do if cases break out? To discuss these complicated, difficult questions questions without easy answers, were joined by doctor Sean O'Leary. He's Professor of Pediatric actious Diseases at the University of Colorado, of practicing pediatrician, and he's the vice chair of the American Academy of Pediatrics Committee on Infectious Disease. Sean, thank you so much for joining us. Let's just start with basics. What is your view about the criteria that school districts should be using to decide whether they should open in person and if so, just how open they ought to be? So, Folks who are using various metrics to decide how to reopen. I think all of us all along have been saying we would really love to see community transmission as low as possible before we safely reopen schools. The metric that is used most commonly is the percent positivity. So of all the tests that are done, what percentage are positive? Because that is a little bit better measure than just pure number of cases. Pure number of cases reflects your testing capacity. The percent positivity is less sensitive to that. So the numbers I've seen thrown around. Some places are using ten percent, which I think is clearly too high. Others are using five percent. That's probably the most common metric I've seen. That's also saw the Harvard School of Public Health is recommending three percent. Ideally, I'd love to see it under one percent. Honestly, I think there are states in the US that are under one percent positivity, and I think the fact that they have been able to get there says we can all get there, and so the lower the better, basically, because the higher you go, the more likely you're just going to have to immediately shut down. That's striking to me because if we were to aim for something, I mean of course it's great to go as low as one percent, but if we did only reopen schools physically in places where the rate was that low, we would really be having many fewer in person reopenings than it looks like we're about to have. So am I right in hearing you as saying that we're about to reopen too many schools physically. I think if someone tells you that they can answer that question accurately, they're wrong. I don't think anybody knows what's going to happen here. We've never done this before, and the US has done an abysmal job controlling this pandemic as a nation. There are some places that have done it well. So I think what we need to do right now is look to the places where they are reopening where they do have low rates of transmission, and see how that goes, and be ready to adjust as we see that happening over the next weeks to even months. Let's talk about the dynamics within a school, and to do that, I want to start with the question that again has been widely discussed, which is the question of probability of transmission as between children and teenagers, and probability of them then bringing COVID home to other family members. What do we actually know about the odds of young people both getting and spreading COVID relative to adults. Yeah, so we're talking on what is at August seventeenth today, So what I tell you today may not be true tomorrow. But at this point, probably the best study I can tell you about in terms of older children, meaning over ten, is the South Korea study, And in that study, it appeared that adolescence between I believe ten and nineteen was the ages they used in that particular study, were as likely to pass the infection to a household member as older adults. Now, if you look closely at the numbers in that study, though, there were far fewer adolescence in that age group than there were in the older adults, and so that raises the possibility that they were also less likely to get infected. It also may be that they were not out and about and so we're not getting infected to be eligible to the index case. So there are still some unanswered questions for sure in that age group. For the younger children, you may have seen a study that was published a few weeks ago showing that the younger children particularly children under five had higher viral loads when they tested the amount of virus based on a PCR test in their nose. Now, we had seen a similar study in Germany in April where they estimated that the viral loads were similar across age groups, it didn't matter what age you were. We've not seen that the epidemiology follows that though, based on most of the studies we've seen, younger children appear to be less likely to get infected and less likely to spread the infection to others. I'll give as an example the childcare centers in the US. So if you look at the places where the states published their outbreak data, the vast majority of the outbreaks are in places where adults congregate. If you look at the childcare center outbreaks, in the vast majority of cases, the number of adults in the childcare center outbreaks outnumber the number of children in those same outbreaks. And so what that tells me is that, for whatever reason, reasons we don't understand, those younger children seem to be less likely to get infected because remember, those are in settings where they're being investigated, they're being tested, and they're not finding the infections, and those younger kids. So you again, i'd say all of this today, it may change very soon as we learn more. Speaking of changes over time, in June, you were the lead author of a series of recommendations for school reopenings produced by the American Academy of Pediatrics, and at the time you were arguing to characterize your view that we actually ought to be able to do a reasonable amount of school reopening in person, more than some skeptics were saying at the time. But that was a couple of months ago. How are you thinking now about the guideline that you wrote them? Yeah, just to be clear, those guidelines were absolutely a team effort, and I did write a lot of it, but there were a number of us that worked on it, and it's not one of those things that we claimed individual authorship on. It really really was a team effort from the entire academy. But in terms of that, I think, you know, in some ways a lot has changed since then. In some ways things have changed not at all. Right, So, I think many of us who work in the fields of caring for children, whether that's pediatricians or teachers, really recognize that children really need to be in school. The impact that children being at home is going to have It's going to impact all children, but it's going to disproportionately impact our most vulnerable. This pandemic has laid bare the just mind boggling disparities that we have here in the US in terms of how we take care of our poor, how we take care of our elderly, and kids being home from school is just going to widen those disparities even further than they already are. So I still do feel strongly that we somehow need to get kids back in school. One of the things that happened shortly after we released that guidance was that, in a sense, became weaponized. It became a political tool to say we have to open schools, and then it was being used in ways that we're perhaps not for the betterment of children, but for other reasons. We have to have schools open so we can reopen the economy. You know, as you've seen all along, where decisions about this pandemic are made for political reasons. That's when things go the wrong direction. When the decision makers are listening to the public health professionals and the medical professionals regarding how to handle the pandemic, that's where things have gone better. And so that's where I say, you know, things have changed in some ways, they're the same. I do really want to see all kids back in school. I want to see my own kids back in school. It's just not safe in many many places. What you're describing is incredibly complicated. You know, you said, and I completely agree with you, kids need to be in school. On the other hand, you don't want kids to be in school if it's going to mean jump starting the pandemic and we're operating, you're operating under tremendous uncertainty. How do you translate the quantifiable risk on the one hand and then the more difficult to quantify benefits of kids being in school on the other hand. Yeah, that's the million dollar question, right. I think, you know, we are stuck here between two unacceptable choices. So with that in mind, I think what we have to do is make decisions based on what we know and the best evidence at the time. And so, you know, one of the things that we haven't talked about that I think is worth consider is looking to other countries. There have been plenty of other countries who have been able to successfully reopen schools not with zero transmission, but very very minimal transmission. Now, the US as a whole is certainly not in the same place as any of those countries Denmark, Norway, South Korea, you all across the world. There are places that have gotten a pandemic under control, But there are places in the US that are Denmark. So there are places that do have rates of transmission similar to what they're seeing in those countries. And so I think in those places, if we can use the mitigation measures that we know work, then I think in those places we can safely reopen schools. By safe, I think we have to be clear we don't mean zero risk, because there's nothing in our society right now that is zero risk. And I should mention that just because schools are closed doesn't mean that none of the students are none of the teachers, or none of the staff are not at risk for getting the infection. Right if it's circulating the community, they're still at risk. And so it's not as simple as a binary calculation. Open schools there at risks, keep them closed, they're not. It's not that simple. So I think in the places where the virus, when it's under some degree of manageable control. Then you start with the younger kids, so the childcare centers, the pre K. Then you start with K through five, and as you achieve success with those students and in those settings, then you slowly reintroduce the older children and will also be learning best practices along the way in terms of how to manage the virus when it gets into school, etc. You know success stories about how to encourage younger children to wear their masks. You I'm sure seeing the picture of that went viral from Georgia, I'm sure that's not the only school where you know, kids were congregating and not wearing masks. But you know you're not seeing the pictures of the success stories, because there are there are success stories already. A lot of schools are talking about hybrid models, where they say, well, we can't necessarily accommodate all of the students who are enrolled in our school with social distancing, so we'll bring people in for a couple days a week or three days a week in a rotated fashion so that we have some in person experience and then we switch back to the online. What's your instinct about that? I mean, it sounds like a good kind of Goldilock solution. You know, it's not too much, not too little, but it also obviously will only work decently in places where all the kids have reasonable access to online learning possibilities. I agree it has some appeal, but you know, when you really think about it, what problems is it's solving. You know, yes, it does get some face times, some socialization for students, but it doesn't solve the problem of the disparities in internet access. It doesn't solve the problems of trying to figure out how a family handles a child in the home, particularly for the younger children. And so I think it does offer some potential solutions, but I think it's a short term solution. I mean, I think you can probably speak to this as well as I can having Zoom meetings. It doesn't work as well as having an in person meeting. People are easily distracted. I can't imagine how easily distracted I would have been as a high school student. I'm distracted enough when I try to have Zoom meetings, right, So I think trying to show that that that's going to be a good educational model I think doesn't really make a lot of sense. I mean, is it going to work for some students, sure, but for the majority of students, I think it's less than optimal relative to in person learning. I know you actually got COVID early in this process, and I think from what I read that your wife did too. So first, I hope you guys are feeling better now. Yeah, so we both got pretty sick. We weren't hospitalized, but I was sick for about two weeks. She was sick for about three weeks. She was a little sicker than I was, and it was, you know, as advertise, it was pretty miserable. It is one of the many frustrating and but fascinating aspects of this virus that you know forty percent of people are asymptomatic, because we sure weren't. But I actually have ended up being one of those long haulers. So I don't know if you've heard much about that. But I was well for about two weeks and then was you know, had gotten back. I'm a runner and I'd gotten back into running, and I guess I just pushed it a little bit too much. Then after a long run one day, I said, WHOA, that feels like when I was sick. And that's pretty much happened since then, so you know, I'm functioning. I'm okay, you know. And some of the people that have these long term symptoms are most it sounds like, are much worse off than me. They're having ongoing fevers and severe headaches. I just have some some chest tightness and sort of occasional malaise. I would call it just feeling kind of lousy that kind of comes and goes in a in a fairly unpredictable fashion. But it's a very, very strange virus. It's like nothing I've ever felt before. And through this, your kids manage not to get it. Yeah, well that's another thing, right, there's my n of two, my two kids. We initially had thought that perhaps we got it from them because we got sick around the same time, which suggested a common exposure, rather than say you bring it home from the hospital. Right. So, No, I was not doing any clinical time at that point. My wife was, and so it's possible that she picked it up at clinic. It was before that people were being really careful because this was in March, so it's possible. Although I got sick only twelve hours after she did, but our kids never got sick. We actually had their antibodies tested and they were negative. So you know, there's my n of two that kids are less likely to get infected. I don't know. You know, we were both sick enough that we were not being particularly good about distancing with our kids in the house. When you think about the broader cultural implications of this period of time for kids, how do you imagine they're going to come to make sense of this over the long run. And obviously that's going to be different if a year from now we have evidence of vaccines working and we have distribution of vaccines and things go back to normal, then it will be if a year from now we instead think that the vaccines don't work that well, or perhaps you know, heaven forbid, don't work at all, and we start to reintegrate our lives sort of accepting a high probability of getting the virus. But when you think just right now about what life is like for kids, how do you think they're going to make sense of this over the course of their lives. Yeah, that's a really interesting question. I actually when this all started, even you know, in February, I was trying to encourage my kids to write a journal this is a historic time. There's probably hopefully that could be another time like this in our lifetimes. How'd that work out for you? Well, yeah, they have not. I encouraged it, but they haven't, So I don't know. I mean, I think it's fascinating. I don't think I have a thing I can look back on in my lifetime and say, oh, they're going to remember it that because we really have not experienced this. You know, kids are fairly resilient, and I do think, you know, the majority of kids are going to be able to bounce back from this when we get into a new time. But boy, I can't wait to get to the other side of this and see. I mean, I have to say, I'm astonished by how well my kids have dealt with it. And I can't make out whether it's because of the famous resilience of kids, which I would like to be the answer, or because so much of their social experience was already online that they're able to have much more continuity in terms of it being a percentage of what their social life is like than it was true for me or for other adults who aren't digital natives. That's a really good point. I mean, my kids have sort of been the same. I mean, you know, this is a whole other conversation, but what is the impact of all this digital time on our kids? All this screen time. It's I've certainly watched my fair share TV when I was growing up. I also was, like many other kids, out playing, probably at least as much, you know, with the kids in the neighborhood as I was watching TV, if not more. Whereas you know, nowadays, I think of many many kids are spending much much more time on screens, and I think that, in reality, you know, may have a bigger impact on our kids than this pandemic. But I don't think any of us really knows what that means in the longer term. Let me close by asking you a kind of what if question. As we get these reopenings, and as some districts, even districts with low prevalence numbers, reopen and then get salient cases transmitted in schools, there's going to be some reaction, and it could be in the line of panic reaction, Oh no, we have cases, let's shut everything down, or it could be a more moderated reaction in the form of, well, statistically, if we do this in lots of places. Inevitably, they're going to be some places where the numbers are going to go up. So let's all, you know, keep our clothes on and try to be rational and move slowly. This My questions are too, First, which should be the reaction. Should we say, oh, this isn't working broader shutdowns or should we be a little more cautious about it? And second, what do you think will actually happen in the real world. Well, you know, the reality is happening already in some of the places where schools have opened, and unfortunately, the examples are getting in the news media are in the places where, you know, where there's widespread community transmission, where it's completely not a surprise that they've had those problems. I do think we need to have rational conversations about how to handle it. We also need to recognize that it's going to happen. I mean, it's it's inevitable that there will be cases in schools, just as it's inevitable that there will be cases in the community. So we have to prepare for that. We have to plan for that, and you know, the districts and public health departments around the country are are already doing that. They're making those plans for what happens when a student gets sick, what happens when a teacher gets sick, you know, as you put it, Yeah, and we need to have a measured response to that and not close at the first sign of an infection has been transmitted in school. Now, if we do see I think this is not going to be the case. But for example, if we do see that in places where there is low community transmission, that all of a sudden the schools become sort of these super spreader events, then we have to take a big step back. I don't think that's going to happen, though, because if you look at the countries where they've done it right, that's not been the case. To me. The hard part is going to be we are a big country. Lots of places are going to reopen, and it's going to happen somewhere. I mean, when you say it's not going to happen, I agree with you that on the whole. Statistically, the best reading of the statistics is that probabilistically it won't happen in many, many, many places. But it's just in the nature of an experiment with a large n that some outlying events will occur, and then in our media world, it's guaranteed that those will be the ones that get the salient news coverage. And that to me is where the rubber meets the road. You know, when there's one school district or two school districts or even five around the country that do have super spreader events and those are being splashed all over the television, then what does everybody else do? That is a moment where people will come to you and say, okay, doctor Larry, tell us what to do, and how will you try to differentiate in that moment between outlying cases and a trend that does look like, boy, we need to reevaluate in light of the new data. You know, my approach. I think for many of us, our approach has been all along to just keep a very open mind and recognize that there's a lot we don't understand right now about this virus and that we're learning more every day. And I think we have to take that approach going forward and be ready to change course and not have our heels dug in that our course of action is correct. So I think that's the first thing. The other thing, you know, I'm Sarmont Colorado. And one of the things that we are trying to do is set up you know, somewhat of a buddy system for lack of a better word, between physicians, pediatricians, internists, family docs, and school districts and teachers so that we can all be in these conversations together, you know, the folks that are on the ground making these decisions, to be able to have a dialogue so that everyone is on the same page. Okay, we've got too many cases. Now we need to stop. Let's reevaluate and work together to figure out how we're going to reopen schools. Because when you have these factions of you know, say, a group of teachers and a group of you know, medical professionals, and a group of public health folks and a group of politicians all saying different things, obviously it's that's not going to work. I want to thank you for your time today, but also for the work you're doing to try to bring reason and logic to some very very difficult decisions under really really challenging conditions. Thank you for that. And I also hope that your symptoms ease and you can get back to running. I know that to lose the endorphin rush is pretty devastating in its own right. Yeah, thank you very much. I really really enjoyed talking to me. Listening to doctor O'Leary really brought home to me the almost impossibility of making well thought through choices about questions as difficult and as fraught as reopening schools. First, there's the business of trying to balance two things that aren't obviously comparable to each other. Kids need to be in school and the benefits of their exposure to education and to other kids on the one hand, and the risk of the transmission of the coronavirus on the other hand. Then there's the problem of how school districts, run usually by elected public officials who operate in interaction with teachers and teachers unions can make good decisions in the light of the advice they're getting from the scientific and medical community, without being unduly influenced by the pressures of the outside world, but positively taking into account the preferences of the public. That's an even harder problem. Finally, take this entire mess and throw it into an election year cycle, and it becomes almost impossible to imagine this decision making process proceeding in a way that's satisfactory. Add to that the fact that this is the United States and we have thousands upon thousands of school districts all over the country that will have to make independent, decentralized decisions, all under very different local conditions. Given all this complexity, what Sean has done is to lay out for us what he thinks we should be thinking about. We should be thinking about the rate of community transmission. We should be thinking about the value to kids of being in a social situation and of getting an education. We should be thinking about the vast, morally troubling disparities in wealth and in background, and in socioeconomic status and in race that have inflected the entire COVID process, and which are very very present when it comes to figuring out who goes to school and who can learn at home, and what conditions obtain in both of those situations. We are, after all, talking about an educational system in the United States that itself is plagued by disparities associated with wealth, even when there's no pandemic going on. Last, but not least, Sean is urging us and officials in schools to use some common sense to be rational in updating in the light of new information, but simultaneously not to treat outlying cases as though they're a sign that we should absolutely reverse course. Probably for me, that's the most powerful lesson here. We should not be jumping to conclusions. We should be acting cautiously and carefully, weighing and balancing different values, and understanding that the choices that we face are in some way unacceptable choice. Nevertheless, they are the choices that we are being forced to make. I won't say that I walked away from my conversation with Sean feeling more optimistic about our ability to make these decisions well, but it was a reminder that they have to be made, whether we like it or not. Until the next time we speak. Be careful, be safe, and be well. Deep Background is brought to you by Pushkin Industries. Our producer is Lydia Jane Cott, with mastering by Jason Gambrell and Martin Gonzalez. Our showrunner is Sophia mckibbon. Our theme music is composed by Luis GERA special thanks to the Pushkin Brass Malcolm Gladwell, Jacob Weisberg, and Mia Lobel. I'm Noah Feldman. I also write a regular column for Bloomberg Opinion, which you can find at Bloomberg dot com slash Feldman. To discover of Bloomberg's original slate of podcasts, go to Bloomberg dot com slash Podcasts. And one last thing. I just wrote a book called The Arab Winter, A Tragedy. I would be delighted if you check it out. If you liked what you heard today, please write a review or tell a friend. You can always let me know what you think on Twitter. My handle is Noah r Felt. This is deep background

Pushkin from Pushkin Industries. This is Deep Background, the show where we explore the stories behind the stories in the news. I'm Noah Feldman. Since July, President Trump has been calling for schools to open this fall for in person learning. Some schools that have already opened, though had to close after coronavirus cases were detected, like a district in Georgia. How should schools be making good decisions about whether to open, what criteria are relevant to that decision making? If they do open, how do they make sure things are safe? And what do they do if cases break out? To discuss these complicated, difficult questions questions without easy answers, were joined by doctor Sean O'Leary. He's Professor of Pediatric actious Diseases at the University of Colorado, of practicing pediatrician, and he's the vice chair of the American Academy of Pediatrics Committee on Infectious Disease. Sean, thank you so much for joining us. Let's just start with basics. What is your view about the criteria that school districts should be using to decide whether they should open in person and if so, just how open they ought to be? So, Folks who are using various metrics to decide how to reopen. I think all of us all along have been saying we would really love to see community transmission as low as possible before we safely reopen schools. The metric that is used most commonly is the percent positivity. So of all the tests that are done, what percentage are positive? Because that is a little bit better measure than just pure number of cases. Pure number of cases reflects your testing capacity. The percent positivity is less sensitive to that. So the numbers I've seen thrown around. Some places are using ten percent, which I think is clearly too high. Others are using five percent. That's probably the most common metric I've seen. That's also saw the Harvard School of Public Health is recommending three percent. Ideally, I'd love to see it under one percent. Honestly, I think there are states in the US that are under one percent positivity, and I think the fact that they have been able to get there says we can all get there, and so the lower the better, basically, because the higher you go, the more likely you're just going to have to immediately shut down. That's striking to me because if we were to aim for something, I mean of course it's great to go as low as one percent, but if we did only reopen schools physically in places where the rate was that low, we would really be having many fewer in person reopenings than it looks like we're about to have. So am I right in hearing you as saying that we're about to reopen too many schools physically. I think if someone tells you that they can answer that question accurately, they're wrong. I don't think anybody knows what's going to happen here. We've never done this before, and the US has done an abysmal job controlling this pandemic as a nation. There are some places that have done it well. So I think what we need to do right now is look to the places where they are reopening where they do have low rates of transmission, and see how that goes, and be ready to adjust as we see that happening over the next weeks to even months. Let's talk about the dynamics within a school, and to do that, I want to start with the question that again has been widely discussed, which is the question of probability of transmission as between children and teenagers, and probability of them then bringing COVID home to other family members. What do we actually know about the odds of young people both getting and spreading COVID relative to adults. Yeah, so we're talking on what is at August seventeenth today, So what I tell you today may not be true tomorrow. But at this point, probably the best study I can tell you about in terms of older children, meaning over ten, is the South Korea study, And in that study, it appeared that adolescence between I believe ten and nineteen was the ages they used in that particular study, were as likely to pass the infection to a household member as older adults. Now, if you look closely at the numbers in that study, though, there were far fewer adolescence in that age group than there were in the older adults, and so that raises the possibility that they were also less likely to get infected. It also may be that they were not out and about and so we're not getting infected to be eligible to the index case. So there are still some unanswered questions for sure in that age group. For the younger children, you may have seen a study that was published a few weeks ago showing that the younger children particularly children under five had higher viral loads when they tested the amount of virus based on a PCR test in their nose. Now, we had seen a similar study in Germany in April where they estimated that the viral loads were similar across age groups, it didn't matter what age you were. We've not seen that the epidemiology follows that though, based on most of the studies we've seen, younger children appear to be less likely to get infected and less likely to spread the infection to others. I'll give as an example the childcare centers in the US. So if you look at the places where the states published their outbreak data, the vast majority of the outbreaks are in places where adults congregate. If you look at the childcare center outbreaks, in the vast majority of cases, the number of adults in the childcare center outbreaks outnumber the number of children in those same outbreaks. And so what that tells me is that, for whatever reason, reasons we don't understand, those younger children seem to be less likely to get infected because remember, those are in settings where they're being investigated, they're being tested, and they're not finding the infections, and those younger kids. So you again, i'd say all of this today, it may change very soon as we learn more. Speaking of changes over time, in June, you were the lead author of a series of recommendations for school reopenings produced by the American Academy of Pediatrics, and at the time you were arguing to characterize your view that we actually ought to be able to do a reasonable amount of school reopening in person, more than some skeptics were saying at the time. But that was a couple of months ago. How are you thinking now about the guideline that you wrote them? Yeah, just to be clear, those guidelines were absolutely a team effort, and I did write a lot of it, but there were a number of us that worked on it, and it's not one of those things that we claimed individual authorship on. It really really was a team effort from the entire academy. But in terms of that, I think, you know, in some ways a lot has changed since then. In some ways things have changed not at all. Right, So, I think many of us who work in the fields of caring for children, whether that's pediatricians or teachers, really recognize that children really need to be in school. The impact that children being at home is going to have It's going to impact all children, but it's going to disproportionately impact our most vulnerable. This pandemic has laid bare the just mind boggling disparities that we have here in the US in terms of how we take care of our poor, how we take care of our elderly, and kids being home from school is just going to widen those disparities even further than they already are. So I still do feel strongly that we somehow need to get kids back in school. One of the things that happened shortly after we released that guidance was that, in a sense, became weaponized. It became a political tool to say we have to open schools, and then it was being used in ways that we're perhaps not for the betterment of children, but for other reasons. We have to have schools open so we can reopen the economy. You know, as you've seen all along, where decisions about this pandemic are made for political reasons. That's when things go the wrong direction. When the decision makers are listening to the public health professionals and the medical professionals regarding how to handle the pandemic, that's where things have gone better. And so that's where I say, you know, things have changed in some ways, they're the same. I do really want to see all kids back in school. I want to see my own kids back in school. It's just not safe in many many places. What you're describing is incredibly complicated. You know, you said, and I completely agree with you, kids need to be in school. On the other hand, you don't want kids to be in school if it's going to mean jump starting the pandemic and we're operating, you're operating under tremendous uncertainty. How do you translate the quantifiable risk on the one hand and then the more difficult to quantify benefits of kids being in school on the other hand. Yeah, that's the million dollar question, right. I think, you know, we are stuck here between two unacceptable choices. So with that in mind, I think what we have to do is make decisions based on what we know and the best evidence at the time. And so, you know, one of the things that we haven't talked about that I think is worth consider is looking to other countries. There have been plenty of other countries who have been able to successfully reopen schools not with zero transmission, but very very minimal transmission. Now, the US as a whole is certainly not in the same place as any of those countries Denmark, Norway, South Korea, you all across the world. There are places that have gotten a pandemic under control, But there are places in the US that are Denmark. So there are places that do have rates of transmission similar to what they're seeing in those countries. And so I think in those places, if we can use the mitigation measures that we know work, then I think in those places we can safely reopen schools. By safe, I think we have to be clear we don't mean zero risk, because there's nothing in our society right now that is zero risk. And I should mention that just because schools are closed doesn't mean that none of the students are none of the teachers, or none of the staff are not at risk for getting the infection. Right if it's circulating the community, they're still at risk. And so it's not as simple as a binary calculation. Open schools there at risks, keep them closed, they're not. It's not that simple. So I think in the places where the virus, when it's under some degree of manageable control. Then you start with the younger kids, so the childcare centers, the pre K. Then you start with K through five, and as you achieve success with those students and in those settings, then you slowly reintroduce the older children and will also be learning best practices along the way in terms of how to manage the virus when it gets into school, etc. You know success stories about how to encourage younger children to wear their masks. You I'm sure seeing the picture of that went viral from Georgia, I'm sure that's not the only school where you know, kids were congregating and not wearing masks. But you know you're not seeing the pictures of the success stories, because there are there are success stories already. A lot of schools are talking about hybrid models, where they say, well, we can't necessarily accommodate all of the students who are enrolled in our school with social distancing, so we'll bring people in for a couple days a week or three days a week in a rotated fashion so that we have some in person experience and then we switch back to the online. What's your instinct about that? I mean, it sounds like a good kind of Goldilock solution. You know, it's not too much, not too little, but it also obviously will only work decently in places where all the kids have reasonable access to online learning possibilities. I agree it has some appeal, but you know, when you really think about it, what problems is it's solving. You know, yes, it does get some face times, some socialization for students, but it doesn't solve the problem of the disparities in internet access. It doesn't solve the problems of trying to figure out how a family handles a child in the home, particularly for the younger children. And so I think it does offer some potential solutions, but I think it's a short term solution. I mean, I think you can probably speak to this as well as I can having Zoom meetings. It doesn't work as well as having an in person meeting. People are easily distracted. I can't imagine how easily distracted I would have been as a high school student. I'm distracted enough when I try to have Zoom meetings, right, So I think trying to show that that that's going to be a good educational model I think doesn't really make a lot of sense. I mean, is it going to work for some students, sure, but for the majority of students, I think it's less than optimal relative to in person learning. I know you actually got COVID early in this process, and I think from what I read that your wife did too. So first, I hope you guys are feeling better now. Yeah, so we both got pretty sick. We weren't hospitalized, but I was sick for about two weeks. She was sick for about three weeks. She was a little sicker than I was, and it was, you know, as advertise, it was pretty miserable. It is one of the many frustrating and but fascinating aspects of this virus that you know forty percent of people are asymptomatic, because we sure weren't. But I actually have ended up being one of those long haulers. So I don't know if you've heard much about that. But I was well for about two weeks and then was you know, had gotten back. I'm a runner and I'd gotten back into running, and I guess I just pushed it a little bit too much. Then after a long run one day, I said, WHOA, that feels like when I was sick. And that's pretty much happened since then, so you know, I'm functioning. I'm okay, you know. And some of the people that have these long term symptoms are most it sounds like, are much worse off than me. They're having ongoing fevers and severe headaches. I just have some some chest tightness and sort of occasional malaise. I would call it just feeling kind of lousy that kind of comes and goes in a in a fairly unpredictable fashion. But it's a very, very strange virus. It's like nothing I've ever felt before. And through this, your kids manage not to get it. Yeah, well that's another thing, right, there's my n of two, my two kids. We initially had thought that perhaps we got it from them because we got sick around the same time, which suggested a common exposure, rather than say you bring it home from the hospital. Right. So, No, I was not doing any clinical time at that point. My wife was, and so it's possible that she picked it up at clinic. It was before that people were being really careful because this was in March, so it's possible. Although I got sick only twelve hours after she did, but our kids never got sick. We actually had their antibodies tested and they were negative. So you know, there's my n of two that kids are less likely to get infected. I don't know. You know, we were both sick enough that we were not being particularly good about distancing with our kids in the house. When you think about the broader cultural implications of this period of time for kids, how do you imagine they're going to come to make sense of this over the long run. And obviously that's going to be different if a year from now we have evidence of vaccines working and we have distribution of vaccines and things go back to normal, then it will be if a year from now we instead think that the vaccines don't work that well, or perhaps you know, heaven forbid, don't work at all, and we start to reintegrate our lives sort of accepting a high probability of getting the virus. But when you think just right now about what life is like for kids, how do you think they're going to make sense of this over the course of their lives. Yeah, that's a really interesting question. I actually when this all started, even you know, in February, I was trying to encourage my kids to write a journal this is a historic time. There's probably hopefully that could be another time like this in our lifetimes. How'd that work out for you? Well, yeah, they have not. I encouraged it, but they haven't, So I don't know. I mean, I think it's fascinating. I don't think I have a thing I can look back on in my lifetime and say, oh, they're going to remember it that because we really have not experienced this. You know, kids are fairly resilient, and I do think, you know, the majority of kids are going to be able to bounce back from this when we get into a new time. But boy, I can't wait to get to the other side of this and see. I mean, I have to say, I'm astonished by how well my kids have dealt with it. And I can't make out whether it's because of the famous resilience of kids, which I would like to be the answer, or because so much of their social experience was already online that they're able to have much more continuity in terms of it being a percentage of what their social life is like than it was true for me or for other adults who aren't digital natives. That's a really good point. I mean, my kids have sort of been the same. I mean, you know, this is a whole other conversation, but what is the impact of all this digital time on our kids? All this screen time. It's I've certainly watched my fair share TV when I was growing up. I also was, like many other kids, out playing, probably at least as much, you know, with the kids in the neighborhood as I was watching TV, if not more. Whereas you know, nowadays, I think of many many kids are spending much much more time on screens, and I think that, in reality, you know, may have a bigger impact on our kids than this pandemic. But I don't think any of us really knows what that means in the longer term. Let me close by asking you a kind of what if question. As we get these reopenings, and as some districts, even districts with low prevalence numbers, reopen and then get salient cases transmitted in schools, there's going to be some reaction, and it could be in the line of panic reaction, Oh no, we have cases, let's shut everything down, or it could be a more moderated reaction in the form of, well, statistically, if we do this in lots of places. Inevitably, they're going to be some places where the numbers are going to go up. So let's all, you know, keep our clothes on and try to be rational and move slowly. This My questions are too, First, which should be the reaction. Should we say, oh, this isn't working broader shutdowns or should we be a little more cautious about it? And second, what do you think will actually happen in the real world. Well, you know, the reality is happening already in some of the places where schools have opened, and unfortunately, the examples are getting in the news media are in the places where, you know, where there's widespread community transmission, where it's completely not a surprise that they've had those problems. I do think we need to have rational conversations about how to handle it. We also need to recognize that it's going to happen. I mean, it's it's inevitable that there will be cases in schools, just as it's inevitable that there will be cases in the community. So we have to prepare for that. We have to plan for that, and you know, the districts and public health departments around the country are are already doing that. They're making those plans for what happens when a student gets sick, what happens when a teacher gets sick, you know, as you put it, Yeah, and we need to have a measured response to that and not close at the first sign of an infection has been transmitted in school. Now, if we do see I think this is not going to be the case. But for example, if we do see that in places where there is low community transmission, that all of a sudden the schools become sort of these super spreader events, then we have to take a big step back. I don't think that's going to happen, though, because if you look at the countries where they've done it right, that's not been the case. To me. The hard part is going to be we are a big country. Lots of places are going to reopen, and it's going to happen somewhere. I mean, when you say it's not going to happen, I agree with you that on the whole. Statistically, the best reading of the statistics is that probabilistically it won't happen in many, many, many places. But it's just in the nature of an experiment with a large n that some outlying events will occur, and then in our media world, it's guaranteed that those will be the ones that get the salient news coverage. And that to me is where the rubber meets the road. You know, when there's one school district or two school districts or even five around the country that do have super spreader events and those are being splashed all over the television, then what does everybody else do? That is a moment where people will come to you and say, okay, doctor Larry, tell us what to do, and how will you try to differentiate in that moment between outlying cases and a trend that does look like, boy, we need to reevaluate in light of the new data. You know, my approach. I think for many of us, our approach has been all along to just keep a very open mind and recognize that there's a lot we don't understand right now about this virus and that we're learning more every day. And I think we have to take that approach going forward and be ready to change course and not have our heels dug in that our course of action is correct. So I think that's the first thing. The other thing, you know, I'm Sarmont Colorado. And one of the things that we are trying to do is set up you know, somewhat of a buddy system for lack of a better word, between physicians, pediatricians, internists, family docs, and school districts and teachers so that we can all be in these conversations together, you know, the folks that are on the ground making these decisions, to be able to have a dialogue so that everyone is on the same page. Okay, we've got too many cases. Now we need to stop. Let's reevaluate and work together to figure out how we're going to reopen schools. Because when you have these factions of you know, say, a group of teachers and a group of you know, medical professionals, and a group of public health folks and a group of politicians all saying different things, obviously it's that's not going to work. I want to thank you for your time today, but also for the work you're doing to try to bring reason and logic to some very very difficult decisions under really really challenging conditions. Thank you for that. And I also hope that your symptoms ease and you can get back to running. I know that to lose the endorphin rush is pretty devastating in its own right. Yeah, thank you very much. I really really enjoyed talking to me. Listening to doctor O'Leary really brought home to me the almost impossibility of making well thought through choices about questions as difficult and as fraught as reopening schools. First, there's the business of trying to balance two things that aren't obviously comparable to each other. Kids need to be in school and the benefits of their exposure to education and to other kids on the one hand, and the risk of the transmission of the coronavirus on the other hand. Then there's the problem of how school districts, run usually by elected public officials who operate in interaction with teachers and teachers unions can make good decisions in the light of the advice they're getting from the scientific and medical community, without being unduly influenced by the pressures of the outside world, but positively taking into account the preferences of the public. That's an even harder problem. Finally, take this entire mess and throw it into an election year cycle, and it becomes almost impossible to imagine this decision making process proceeding in a way that's satisfactory. Add to that the fact that this is the United States and we have thousands upon thousands of school districts all over the country that will have to make independent, decentralized decisions, all under very different local conditions. Given all this complexity, what Sean has done is to lay out for us what he thinks we should be thinking about. We should be thinking about the rate of community transmission. We should be thinking about the value to kids of being in a social situation and of getting an education. We should be thinking about the vast, morally troubling disparities in wealth and in background, and in socioeconomic status and in race that have inflected the entire COVID process, and which are very very present when it comes to figuring out who goes to school and who can learn at home, and what conditions obtain in both of those situations. We are, after all, talking about an educational system in the United States that itself is plagued by disparities associated with wealth, even when there's no pandemic going on. Last, but not least, Sean is urging us and officials in schools to use some common sense to be rational in updating in the light of new information, but simultaneously not to treat outlying cases as though they're a sign that we should absolutely reverse course. Probably for me, that's the most powerful lesson here. We should not be jumping to conclusions. We should be acting cautiously and carefully, weighing and balancing different values, and understanding that the choices that we face are in some way unacceptable choice. Nevertheless, they are the choices that we are being forced to make. I won't say that I walked away from my conversation with Sean feeling more optimistic about our ability to make these decisions well, but it was a reminder that they have to be made, whether we like it or not. Until the next time we speak. Be careful, be safe, and be well. Deep Background is brought to you by Pushkin Industries. Our producer is Lydia Jane Cott, with mastering by Jason Gambrell and Martin Gonzalez. Our showrunner is Sophia mckibbon. Our theme music is composed by Luis GERA special thanks to the Pushkin Brass Malcolm Gladwell, Jacob Weisberg, and Mia Lobel. I'm Noah Feldman. I also write a regular column for Bloomberg Opinion, which you can find at Bloomberg dot com slash Feldman. To discover of Bloomberg's original slate of podcasts, go to Bloomberg dot com slash Podcasts. And one last thing. I just wrote a book called The Arab Winter, A Tragedy. I would be delighted if you check it out. If you liked what you heard today, please write a review or tell a friend. You can always let me know what you think on Twitter. My handle is Noah r Felt. This is deep background