“No simple answer”
“Covid State of Play” examines sick buildings, planning lags, and reopening
In the absence of leadership guidelines for mitigating COVID-19, creative solutions — in concert with established public health recommendations — are key.
Low-cost air quality sensors, rethinking what schools look like, and identifying new modes of collaboration are a few of the creative approaches discussed during a recent discussion hosted by Jonathan Zittrain and Magaret Bourdeaux of the Berkman Klein Center’s Digital Pandemic Response program.
The talk examined the current “Covid State of Play,” and covered COVID-19 testing, school reopenings, and ventilation. Their guest, Joseph Allen, is an Assistant Professor of Exposure Assessment Science at Harvard’s T.H. Chan School of Public Health.
Bourdeaux, also of the Harvard Medical School’s Global Public Policy and Social Change program and the Harvard Kennedy School’s Security and Global Health Project, outlined the current testing situation in the United States, urging for more action and implementation.
“I think this is all about hard work. It is about systematic planning. It is about leadership and not counting [on] that there’s going to be some miracle cure, some miracle intervention that is going to save us. We are going to have to actually do the work that is required to control this outbreak and we just have to grow up and do it,” she said.
Allen added that there ongoing work on a rapid saliva-based at-home test, which needs to be reviewed by the FDA but has the potential to be a quick, accessible, low-cost test. “There is the technology available for at-home rapid tests. To Margaret’s point, we need it now,” he said, noting that the test isn’t the same as the PCR tests currently in use. “It takes a different mentality. It’s not a diagnostic test like we expect at the doctor’s office. It’s a tool to control the pandemic or help control the pandemic, so we need a mindset shift here and think about how we think about testing.”
School reopenings without testing infrastructure and public health implementations are also a pressing concern. Atop the testing challenges, many schools and universities have buildings with poor ventilation, Zittrain pointed out. Bourdeaux and Allen emphasized how being outside is safer than being indoors, but buildings with good ventilation are important for mitigating the spread of COVID-19.
“We are in the sick building era,” Allen said, meaning many buildings meet only minimum air quality standards to save energy. “So we’re paying the consequence right now for our choices that we’ve stopped designing buildings for people.”
Zittrain inquired about the use of carbon dioxide sensors in indoor spaces to monitor the air quality, a tool Allen said is already in use, and that his lab has also built. “Some of these can connect to the building information system, so in real-time it can, to your point, ‘hey, your CO2 hit a certain level. Let’s open up the dampers in here.’ In fact, it’s called demand control ventilation,” Allen explained.
But the availability of low-cost carbon dioxide sensors means employees can also raise red flags about air quality. “It’s democratized this healthy buildings idea and people are sharing that data. They are sharing that. Buildings are getting labeled sick buildings,” he said. “People can finally make the invisible visible with these cheap sensors.”
With “sick buildings” as a backdrop, the conversation shifted to whether schools should reopen. Allen, a proponent for reopening schools, argued there should be prerequisites to opening: “One, you have to control the spread and two, you have to make enhancements to your risk reduction strategies within the school. So it’s the when and the what. When to open and what has to be done, and so that’s where I’ve been bullish to say hey, if you do those things, sure, schools should open.”
Allen cited recent reopening failures in states like Georgia as examples of when these conditions were not met and should not have opened. “I am confident if we meet those metrics you’ll have low community spread and the probability of entering into the school and your new cases lower, that’s obvious as a numbers game. And then if you put these other strategies in place which we know work in hospitals and elsewhere, including and beyond airborne transmission, it’s mask-wearing, it’s de-identification, it’s managing flows of people and queues of people,” he said.
Bourdeaux echoed Allen’s concerns, emphasizing the importance of controlling community transmission, including case counts, and “understanding how robust your public health measures to end community transmission are.”
She compared the current response to the virus to the way people experience a hurricane, where the storm blows over and the perceived danger subsides. Instead, she said, there is more work to do from a public health perspective before having the reopening conversation. Bourdeaux said having a national plan and for having the important conversations to help stop the spread of the virus should be part of this action plan.
“We’re not having a very intelligent conversation about really what we’re dealing with to date, and so that’s not related to schools and whether schools could be made safe,” she said. “They absolutely can be made safe. We’ve seen buildings like hospitals, as Dr. Allen has pointed out. We can make places safe but I think that it’s asking a lot to say okay, let’s reopen schools when we’re not having a smart conversation about where we stand with community transmission in general.”
While children have lower infection and mortality rates, Allen countered that schools play an important function for many students, and other risks — such as access to food and virtual dropout — should be factored in as well. “If we don’t think there are consequences to keeping tens of millions of kids outside of school, they’re at higher risk of abuse and neglect, exploitation. The loss of learning. The loss of socialization. Over 30 million kids rely on schools for meals. These are massive costs and it’s horrifying to recognize that our country hasn’t prioritized this,” he said.
Along similar lines, Zittrain asked whether any official guidelines for reopening might further intensify the inequalities between wealthier communities — who have access to more resources — and marginalized communities, who are disproportionately impacted by COVID-19.
These inequalities will still exist with virtual schooling, Allen said. “This virus is exposing deep fissures within our society, the structural racism that’s in our society that exists within these schools. If we keep kids all at home that’s going to exist for the exact same reason and if you bring back some, well that inequality, inequity is going to exist and be exacerbated as well. There’s no simple answer here other than honestly it’s a systemic issue that needs to be fixed and fixed fast.”
To address these myriad challenges presented by COVID-19, Zittrain asked about best practices for sharing information and working together. Both Allen and Bourdeaux underscored the great opportunities and responses they have seen. Allen described the past few months as a period of great collaboration and camaraderie with “the whole world, every scientist and medical professional is focused on the same problem.” As an illustration of such new collaboration, he cited a report he worked on to advise school superintendents. Bourdeaux similarly emphasized how so many people are trying to take action to help and support during the pandemic, and referred to a recent poll that says most Americans support a mask mandate.
The trio also explored creative ways to host schools, such as makeshift schools outside, similar to how hospitals made tented spaces in parks. Allen pointed to an op-ed he wrote outlining steps to reopen, which includes temporary school spaces.
“Let’s put some tents. Let’s use the ball field. Let’s get creative. Look at what the medical community did…There were tents in Central Park,” he said. “We should turn convention centers into schools. Let’s put tents in every park. We can get real creative here instead of saying well, we have this old crumbling infrastructure, what are we going to do? Let’s just jam a thousand kids back into it and do everything the same way. Instead, I think there are some creative solutions out there.”
