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.

231090cookie-checkThe College Problem: My take…