The College Problem: My take…

Every day, we get new headlines:  College X has 800 Covid-19 cases.   That’s it.  That’s the total story.  There is no depth.  What does that really mean?Specifically, how sick are these college students?  This is a really important question. No one discusses this.  Student newspapers are screaming:  “We don’t want any student funerals!”  What is the reality?

If the answer is: “Most are not too sick but a good percentage get rather sick and can’t get out of bed and need to be tracked,” then we might have a problem.  On the other hand, is the answer: “No one is getting sick.  Maybe a bit of a cough, but that’s it!”    If this is the case, why are we freaking out?  Every day, my email is full of notices from several big colleges and no one is even attempting to answer the question: “Is any student getting really sick?”    If someone has such disclosures, please post them.

Many of us have reservations about college openings.  But the focus of the media, students and administration seems all wrong.  Student risk is not the issue…. Or is it? It would be nice to get regular data on this.

Here’s the catch:  Let’s assume student risk is not an issue.  Does that mean everything is okay?  NO!!

Faculty, administration, food service, cleaning, maintenance and other college employees are at serious risk.  As the numbers climb in the student body, even small distanced classrooms are risky for older adults.  Even partially populated dorms can be death traps to older support staff.

The college townspeople are at higher risk.  Going to the grocery store becomes riskier as the baseline rate of disease accelerates.  When students come home on the weekends, their families may get sick and die.

If we could make college a bubble with only young healthy kids and young adults, it seems like a no-brainer:  “OPEN IT UP!”  But, try as we might, the bubble is imperfect.  We could keep students from leaving on break unless they get a negative COVID swab.  We could designate certain stores, bars and restaurants as “Student Only.”  Those facilities could only employ young, healthy people. We could enforce it with a huge wall, topped with barbed wire and guard towers, surrounding the college.

But, what do we do about the older professors on Humira and Enbrel?  What about the administrators with chronic medical conditions?  What about the other workers with hypertension, obesity and diabetes?  When many of our regional colleges have announced limited in-person classes, the response from the faculty has been a resounding:  “You’re not risking my life!  I won’t be there!”

The media is missing the point.  When children are at risk, the story is compelling.  In this case, it is also false.  The real problem of risk is falling on older people, where the story is not so heart-rending.

So….   What do we do?  We open up the colleges.  We stop wasting resources on emphasizing student safety.  Instead, we emphasize another message:  “Don’t kill the older adults in your midst.”  We do our darndest to keep workers and professors safe, meaning more in-person classrooms with the professor at an off-site location.  Younger teachers can still have normal classes.  We try to limit spread.  We still publish numbers on infection rates, but we also track disease severity in the student population.  We encourage students to stay in certain areas and we warn the townspeople that such areas will have more students and more exposure risk.

If worrisome trends develop, we impose restrictions.

Our small practice is seeing a lot of COVID.  The reality is most cases are mild.  On the other hand, we’ve also lost some relatively healthy people in the 50 to 70 age range with unexpectedly severe disease.  The case mix is maddening.  On some days, I feel like an insane alarmist and on other days, I’m reassuring people it is not as bad as they fear.  I flip-flop back and forth.  It is making us crazy.

Steven Mussey MD

Steven Mussey, M.D. is a physician in Internal Medicine, practicing in the Fredericksburg area for more than twenty years. He grew up in Springfield, Virginia and earned a degree in Physics from The University of Virginia, Phi Beta Kappa. He earned his medical degree at The George Washington University and was inducted into the medical honor society AOA. He is Board Certified in Internal Medicine. He served in the Air Force for four years before entering into private practice. He particularly enjoys geriatric medical care and working with complex patients. For almost a quarter century, he has been practicing with one other Internist. Both doctors enjoy practice in a small, but busy office, and plan on working into their 70s, as long as they can still find their way to the office. Dr. Mussey is also an avid cartoonist and has a weekly cartoon in the local newspaper. He also enjoys cartoon animation and has had several public service cartoons playing regularly on the television cable systems. 

  6 comments for “The College Problem: My take…

  1. Kurt
    September 18, 2020 at 6:48 pm

    I live in outer Mongolia in Canton,Illiois. Unfortunately we have not had a really bad Covid outbreak here although 100 folks came down with Covid-19. I fortunately retired from FP medicine on July 1st 2020. I am so absolutely glad I do not practice anymore. The ivory towered bastids think we can save the world but e’ffffff them. I repeat, do not, do not go into family practice as a specialty period! Students heed my warning. You will be condemed to Hades if you pursue Family Practice as a specialty. The insurance companies will think you can get folks to follow your advice but F’em, they are wrong!!! Don’t go into FP!!!! Work your butt off and specialize!!!. Go into whatever you can specialize into. If you don’t, I guarantee you’ll be absolutely miserable.
    Kurt Savegnago. [email protected] if on wants to e’ff with me!!!!!!!!!!!!!

  2. Jane M Orient
    September 13, 2020 at 8:07 pm

    When you see the patients, do you do anything for them?

  3. D. Mittman, PA
    September 13, 2020 at 11:59 am

    Many of the students and young healthcare professionals getting gravely ill after becoming infected are people that are obese. We need to get the word out to clinicians and patients to try their best to control their weight and also take extra precautions if you are overweight to mitigate risk.

    • Douglas Farrago MD
      September 14, 2020 at 9:56 am

      Actually, CV19 has caused 2/3 of all the people who get it to be obese.

  4. Rando
    September 13, 2020 at 9:59 am

    I have the same questions. Not only do they not mention deaths, they also don’t mention hospitalizations so we do not have a handle on how this is effecting younger people. You are absolutely right the risk is mainly to the older adults that come in contact with the students.

    I would take it a step further. Despite the illness being overwhelmingly mild in kids, the national media seems obsessed with the effect of COVID-19 in children. In my state there have been around 1200 COVID-19 deaths with none under the age of 18. If you mention that, people say “well what about cardiac effects, what about brain damage” despite there being very little reliable evidence to support those concerns.

    There is no disease in which the risk to children is zero. The media has no sense of perspective. We sent our kids to school during flu epidemics. We sent them to school when there was a pertussis outbreak several years back. Yes we tried to get them vaccinated but there were still kids at risk and there was no way to get that risk down to zero.

    And this is obviously anecdotal but the teachers I’ve talked to in the past few weeks say “the kids need to be in school”. This is especially true for the most disadvantaged kids. These teachers said this being fully aware they themselves are at risk. We need a calm discussion on this and I don’t see it occurring.

  5. Harrietta Christodoulos
    September 13, 2020 at 9:21 am

    Good analysis. I have noticed the same trend. So, what do we do with the ___ case numbers? Our institution just told the students to quarantine themselves for 14 days…?! How confusing is that? Is it strict quarantine or the looser version of quarantine? What are the deaths ? Isn’t anyone interested in that?

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