No Data To Guide Opening Schools? Not True – But We Need To Collect It

a daycare teacher in action; https://www.mountainhome.af.mil/News/Features/Article/311380/base-honors-child-care-provider-with-annual-award/ (public domain)

Can we safely open schools without placing students, teachers, and staff at risk?  What procedures can be followed to reduce the risk?  What restrictions can we reasonably expect students to comply with?  It all seems like a dizzying set of unknowns.  (Cue the Frozen 2 music.)

But at the same time, Illinois has permitted daycares to open ever since Phase 3 — under a significant set of restrictions to be sure, but open nonetheless.  This ought to be a treasure trove of data on exactly these questions of risk.

The problem is, we don’t have the data.  There’s no tracking of daycare outbreaks in the same way as for long-term care facilities.  And here’s the reply I received to a query I sent to the Illinois Department of Health COVID-19 e-mailbox:

At this time we have not been provided with data in regards to childcare centers. We don’t know if that information will be gathered and analyzed.

Which means that, absent more extensive investigative reporting, all that’s available is a smattering of news reports, both here in Illinois and elsewhere (where procedures and guidelines vary).

At The Center Square, July 7, 2020:

The Illinois Department of Public Health reported 12 outbreaks at daycares, affecting 247 people, including 32 children.

News Channel 20, July 8, 2020, reported a daycare in which a single employee tested positive, but no other workers and no children.

In Texas, as of July 9, Texas Health and Human Services reported 1,799 positive tests — 1,207 staff and 592 children — at 1,131 child care centers.  There are 12,222 centers open in the state, so this means that about 10% of centers had at least one case.  How many of these are instances of an “outbreak” in which covid was passed from one child to another or from a child to an employee?  That’s not clear from these numbers, but certainly many, and perhaps most of these cases were of a single person.  As KVUE reports, citing the Texas Tribune, the state has been unwilling to provide more data, citing “protected health information.”  And in any case, the state also relaxed, then tightened its requirements for daycares, so their covid prevalence is not a helpful statistic without knowing under what specific circumstances it was transmitted among staff or children.  After all, if their employees did not wear masks, and Illinois’ do, that matters, too.

In Connecticut, NBC Connecticut reported on July 3:

About 1,552 daycares have remained open since the beginning of the pandemic. So how many COVID-19 cases have they experienced?

“I’ve heard of 20 to 30 at the most throughout the state while there have been 1,500 programs open over the past three months,” Early Childhood Commissioner Beth Bye said.

And on June 24, NPR reported

The Y says that during the lockdowns it cared for up to 40,000 children between the ages of 1 and 14 at 1,100 separate sites, often in partnership with local and state governments. And in New York City, the pandemic’s national epicenter in March and April, the city’s Department of Education reports that it cared for more than 10,000 children at 170 sites.

Working in early days, and on very short notice, these two organizations followed safety guidance that closely resembles what’s now been officially put out by the Centers for Disease Control and Prevention. The Y says a few staff members and parents at sites around the country did test positive, but there are no records of having more than one case at a site. This, among a population of essential workers.

In a separate, unscientific survey of child care centers, Brown University economist Emily Oster found that, as of Tuesday afternoon, among 916 centers serving more than 20,000 children, just over 1% of staff and 0.16% of children were confirmed infected with the coronavirus.

Of course, daycare centers and schools are not the same.  But schools ought to be safer than daycare centers in most respects.  Schoolchildren can be expected to wear a mask in the same manner as they are expected to comply with other school rules — that is, as long as we’re willing to enforce that demand and provide alternate schooling arrangements for students who won’t (and in cases where parents won’t reinforce that requirement).  Schoolchildren don’t need to play with toys, don’t chew on toys, don’t need the same level of direct contact with teachers.  And so on.

But, again, what will work and what won’t, in classrooms, depends on learning from what has and what hasn’t worked, in daycare rooms.  And we can’t learn from that if we don’t have information.

Contact Tracing is an Urgent Task. So Why Is the State Failing at It?

Illinois state capitol; public domain

Back a month ago, I wrote a commentary in the Chicago Tribune in which I criticized the governor’s complete lack of communication (and seeming lack of plans) regarding contact tracing, despite the mandate that to move to Phase 3 contact tracing must be implemented, and to move to Phase 4, contact tracing must be fully scaled-up (90% of new diagnoses).

In the meantime, the governor has shifted to statements that contact tracing is already underway at local Departments of Public Health, and has shifted to speaking of a 60% objective (e.g., on May 18 and May 29) as well as a doublespeak rewriting of objectives as reaching 90% of the 60% target (I can no longer find this cite), and relabeling the entire project as “‘a goal’ rather than a requirement” (according to a May 26 Tribune report).  However, the Restore Illinois official requirement remains unchanged.

I’ve become resigned to the fact that this is how politics works, that rather than announcing a change that involves an admission of failure and invites demands for other changes, it’s simply memory-holed.  And my anger has shifted from the lack of communication to the lack of urgency in the actions of the governor, the mayor, and the Cook County Board President.

With respect to the last of these, an article on June 11 at the Chicago Tribune was the first reporting on the Cook County Department of Public Health’s actions —  even when I looked just a few days prior there was no information available on the DPH website; now, the website announces that

CCDPH anticipates starting our first group of contact tracers by early August. Contact tracers will be brought on in groups of 50-100. CCDPH will have a full team by the fall.

Again, remember that this is supposed to be in place in order to move to Phase 4, which is otherwise being targeted for just two weeks from now.

Why is this taking so long?

In part, it appears to be the fault of the Illinois Department of Public Health taking nearly three months to allocate funding from the CARES Act, which passed in March.  But it appears, from the Tribune reporting of Preckwinkle’s statements, that the delay is because the county simply does not recognize the urgency of getting the program in place as soon as possible, and is instead using the program to promote social justice objectives even at the cost of delayed implementation.

Preckwinkle said the efforts, funded with a grant from the Illinois Department of Public Health, would focus extensively on disproportionately affected groups that have “experienced systemic racism,” including African Americans and Latinos, both in terms of tracing and hiring of new contact tracers. The program also will be bilingual so hundreds of thousands of Spanish-speaking residents are not left out.

“This grant is so important for those who have been most impacted by COVID-19,” said Dr. Kiran Joshi, one of two senior medical officers running the county Department of Public Health, who said blacks in the county have been affected at three times the rate of whites and Latinos at four times the rate. “We intend to hire suburban Cook County residents for these jobs who are culturally competent, multilingual and have great communication skills.”

The county, however, will take several months to ramp up the program, even though many social-distancing restrictions have been lifted by the state and there’s concern that a future surge could occur soon because of recent crowded conditions during protests over the Minneapolis police killing of George Floyd.

Now, I well understand the importance of hiring tracers who can gain the trust of the tracees, because a program in which individuals are contacted but refuse assistance to enable them to isolate and refuse to provide information about their contacts because they don’t trust the tracer and can’t be persuaded that the greater good of their community warrants these actions, is fairly useless.  But Preckwinkle’s statement goes beyond this acknowledgement to a desire to use the program to advance broader social goals.  And that’s wrong — the top priority should be speed, regardless of whether goals of equal opportunity or extra assistance to underrepresented groups must be sacrificed.

In fact, like it or not, it is likely that a focus should be on disproportionately less affected communities, as the low-hanging fruit, with far more payoff in terms of the effectiveness of the effort.  It seems to me even more the case state-wide, that nipping in the bud an incipient outbreak in a community that’s otherwise been uneffected would be more successful than the greater challenge of dense urban areas with a pre-existing substantial prevalence.

And it’s not just suburban Cook County — in Chicago itself, the process of hiring contact tracers is set to take much longer than it should, due to a process of first identifying an organization with which to contract out the primary organization of the effort, and then distributing funds to

at least 30 neighborhood-based organizations located within, or primarily serving residents of, communities of high economic hardship

which would work at

recruiting, hiring and supporting a workforce of 600 contact tracers, supervisors and referral coordinators to support an operation that has the capacity to trace 4,500 new contacts per day

with an objective of hiring 150 by August 1, and 300 by September 15.

And, again, quite apart from the appropriateness of prioritizing workers from low-income communities for city jobs, in general, contact tracing is not just a city jobs program.  It is an urgent task.  The work of hiring tracers should have been started months ago, not months in the future.

What’s more, even this plan is being criticized by Chicago activists, who want the hiring to be done within the Chicago Department of Public Health itself, rather than being outsourced, and who are treating this as a matter of shoring up governmental institutions.

Also joining the group were current and former union officials who have an interest in seeing the ranks of public workers expand. They included Tony Johnston, president of the Cook County College Teachers Union, who said city community colleges should be training new contact tracers, and Matt Brandon, former secretary-treasurer of International Service Employees Union Local 73 and current president of Communities Organized to Win.

Contact tracing is not a jobs program.  It is not a stimulus program.  It is not an economic rebuilding program for poor communities.  It is certainly not a program for building up a unionized workforce.  And city, county, and state government officials who treat it as such, rather than ramping up tracing as quickly as possible, during this limited window of opportunity of lowered infection rates due to lockdowns and warmer weather, are failing the people they serve.

Has Pritzker Abandoned Contact Tracing as a “Restore Illinois” Requirement?

Illinois state capitol; public domain

It’s right there in black and white:  contact tracing is a key part of Illinois Gov. JB Pritzker’s “Restore Illinois” plan.  To move from Phase 2 to Phase 3, permitting the opening of child care, retail, and gatherings of 10 or fewer people, requires the beginnings of “contact tracing and monitoring within 24 hours of diagnosis.”  To move from Phase 3 to Phase 4, permitting the opening of restaurants, personal care services, health clubs, and schools, as well as gatherings of 50 or fewer people, requires fully scaled-up contract tracing, that is, “for more than 90% of cases in region.”

But as I wrote last Saturday at the Chicago Tribune, however crucial contact tracing is, the state has provided virtually no information on its timing or its progress in implementing the program.

Only just today did the Department of Public Health provide a press release on the topic (can I take credit for this?), informing residents that county public health departments will actually be running the initiative, with funding and technical support from the state, and with Partners in Health in an advisory role.  Two specific counties will be “immediately” piloting the program.  The governor further stated at today’s (Monday’s) press briefing that at present 29% of diagnoses are “engaged in a tracing process” and “that’s a number we want to push as high as possible, to the industry standard of over 60%.”

Despite this, last week Pritzker announced that “all regions across the state are now on track to meet the metrics needed to move into the next phase of reopening.”

How does this make sense?  With only 11 days until the first possible “Phase 3” date, and with only a 2-county pilot program in place, how can the state be on track to meet its Phase 3 contact tracing requirement?

And how does a verbal target of aiming for “the industry standard of 60%” match up with the Phase 4 requirement of 90%?

What’s more, the state provides regular updates to metrics in the areas of testing and hospital admissions and resources, but no updates on contact tracing.

It’s as if they’ve forgotten about these requirements.

Has the state abandoned them, that is, continuing to strive for additional capacity but no longer requiring implementation/scaling to move to the next phase?

And, if so, why is the state not revising its plan, but instead simply treating them as if they don’t exist?

My guess:  the governor knows there is tremendous pressure to revise other components of the plan:  the inclusion of very geographically distinct counties adjacent to “collar counties” in the same region as Chicago, the continued closure of restaurants until Phase 4, the limitation on gatherings to 50 persons regardless of the capacity of a given facility, and so on.  Were he to revise the contact tracing component, he would further increase calls for revisions of other sorts.  So long as no one with any particularly strong voice or much political power calls him on this, he continues to be enabled to insist that his plan is unchangeable, set in stone, rather than risking opening it up to the sort of negotiation which he insists is impossible because he is guided solely by “science” and “data”.

Now, this is an admittedly cynical answer, but I can’t make sense of this any other way.  And, much as I hate for it to be true, as it implicates a wide range of bureaucrats as well in this convenient omission, it does, at the same time, offer some firmer reason to believe that, however painfully delayed Phases 3 and 4 are implemented, however many restaurants and other small business will shut down, it will at least not be delayed even further.