Recently, as students in Chicago and elsewhere were staging walkouts to protest in-school learning, you might have seen Philly’s own Dr. David Rubin, who runs PolicyLab at CHOP, hitting the airwaves to deliver a strikingly different message.
Giving interviews from an office with a framed Bruce Springsteen album cover adorning the wall behind him, Rubin, pediatrician and father of three, has been counseling all of us to take a deep breath, trust science and facts, and resist the urge to react to Omicron as though we were still in 2020. School, Rubin has argued, is the safest place for our kids to be.
It’s the latest entry point for PolicyLab in the national debate over how to react to Covid and its variants. Early on in the pandemic they teamed up with UPenn to create a Covid-19 modeling map to showcase numbers and test positivity rates for every county in the U.S., which informed school safety plans across the country. They also developed a regional testing program which just surpassed one million school-based tests since last January.
Now PolicyLab’s new guidance for in-person K-12 education urges a departure from some of the standard procedures we’ve seen over the past two years of this pandemic. For one, they urge schools to allow Covid-exposed but asymptomatic students and teachers to continue attending in-person—masked at all times. They also encourage discontinuing weekly testing of asymptomatic students and staff.
When Rubin and others suggest we’re entering a new phase of managing a disease more akin to the flu, there are those who wonder if we’re “surrendering” too early. But the consensus among infectious disease experts is that Covid will become endemic, which means we will have to shift our risk management approach to it.
“It was almost as if there was a need for someone to dip their toe in the water and CHOP is taking that first step.”
“The moment we saw the virulence of this infection begin to decrease, we really needed to emphasize that the goal now is to accept that we can’t eliminate transmission,” explains Rubin. “You need to deploy your strategies in a way that can reduce the likelihood of transmission, but allow—whether it’s work or school—people to get back to their lives.”
Over the past month, Dr. Rubin, the father of three girls, has been popping up on the national stage via many radio and TV segments and news articles—explaining the new guidance and working to shift public perception about the intersection between Covid risk and safety at this point in the pandemic. We caught up with him to learn more.
Katherine Rapin: Can you talk about how the PolicyLab’s response has changed since the beginning of the pandemic?
Dr. David Rubin: Early on in the pandemic we were facing a situation with a very virulent virus and completely unvaccinated public. The goal was to eliminate as much exposure risk as possible—I call it the moment of having to choose between bad and worse. Any decision to limit access to education and services that kids receive—the decisions to go virtual, to go to hybrid models—were not taken lightly, but they came at a time when the risk from Covid was fairly substantial. If you look back to last winter, when we were more in that max-protect strategy, you can see that nearly half the people who lost their lives lost their lives last winter. And that was during a moment when people were still working hard to mitigate against the risk of Covid.
Fast forward to this year, and the Omicron variant certainly created a jolt and a lot of anxiety through our communities. But CHOP decided together with the Policy Lab to put out a statement to help change the community’s perception about the stage we’re now in and why our policies are increasingly shifting towards resuming normal school for kids, normal daycares for children as we wind down from this winter resurgence. And the reason being is that now all K-12 students and adults have been offered vaccinations and those who are eligible have been offered boosters. And we’re also seeing a milder variant and a spectrum of illness we’ve encountered with other seasonal viruses for many years. And if we can accept that, we can begin to take the steps that don’t reflexively add layers of restrictions, but actually continue to remove them.
KR: I want to pull out one specific point from the guidance: discontinuing weekly testing for asymptomatic students and staff. Can you explain the reasoning behind that?
DR: When you pivot to a seasonal virus—when you’re chasing mild disease or asymptomatic disease–it becomes more infeasible and impractical. To go through a period when you have 20-25 percent of people infected, everyone is exposed. You can no longer eliminate the risk that an individual might be infectious, but you need to deploy your strategies in a way that can reduce the likelihood of transmission but allow—whether it’s work or school—people to get back to their lives.
“We’re going to encourage folks to continue to get vaccinated and boosted if they’re eligible, because that truly is the intervention,” says Rubin. “It’s not disrupting work, it’s not disrupting schools at this point.”
We also recognize that testing was not available for all schools, and not all schools were equipped to do it. We were creating a system of haves and have nots, which was not fair from an equity perspective. So in the end, we said, look, we can achieve a pretty significant degree of safety by just keeping it simple. Wear your mask when cases are high; stay home if you’re sick; and if you’re exposed, just be careful—if you identify yourself with symptoms, remove yourself from the classroom.
We’re going to encourage folks to continue to get vaccinated and boosted if they’re eligible, because that truly is the intervention. It’s not disrupting work, it’s not disrupting schools at this point. It’s to encourage people to take the one intervention that greatly reduces the risk of severe disease.
KR: In sum, the new guidance directs schools to prioritize reducing the impacts of social isolation and learning loss for kids over minimizing Covid risk as much as possible. Can you talk a little bit more about the data behind that calculation?
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DR: I think the impacts of access to education aren’t just for learning loss, but also all the services that kids receive through school including nutritional services, psychological mental health services, the activities they do, the socialization that is provided there. We’ve seen a tremendous increase in mental health issues, particularly in adolescent kids, and both anxiety-related disorders and depression. A lot of that predated Covid, but it’s truly been magnified and exacerbated by the pandemic and is providing a level of urgency. The moment we saw the virulence of this infection begin to decrease, we really needed to emphasize that the goal now is to accept that we can’t eliminate transmission, that fortunately we’re dealing with a virus that—although it can still make some people very sick, for most people, results in much milder infection.
We have interventions—vaccinations and boosters—that are very effective at reducing the impact of severe disease. And so when you take that in total, and you compare that the calculus against the risk to children and their families, it becomes a consensus across our leadership at CHOP that we need to do everything we can to help families to move on from the trauma of the last two years and think of this moment in a capsule: no we really do have an opportunity to continue the path to normal and we need to.
KR: Yeah, and how do you do that? How do we get everyone to be comfortable with a certain level of risk when some have been through so much and are comfortable with very little risk and others feel like any restrictions are an infringement on their freedom?
DR: I think people see with their own eyes. So many people got it and I think not all, but most people saw family members get it over the holidays and it was milder. People didn’t lose taste and smell like they did earlier on; they didn’t have the severe outcomes to the same degree. And so that helps to change public perception.
But then because this has moved so quickly, and our CDC or public health authorities can’t move that quickly as they appraise the guidance, we think this is a really important time for other leaders to step up. And I think that’s what’s really important about what CHOP did, as a respected institution within the city to say, ‘Look, we saw the kids who came in through our emergency department and we’re comfortable that that spectrum of illness was very consistent with what we see with other winter viruses that we’ve seen for many years.’ And if other leaders can join in trying to help educate the public of why this moment is different, then you can begin to change public perception. And now over the next few weeks, we’re likely to see quickly declining transmission within the region that will help as well.
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KR: What impacts have the new guidance had so far on school districts?
DR: It was almost as if there was a need for someone to dip their toe in the water and CHOP is taking that first step. I think it influenced a lot of health department guidance; it’s influenced school, school policies throughout the region; and we’ve had feedback from other states that have adopted many of the recommendations. So I think this is the beginning of a turning point.
“There’s no clear finish line to Covid,” Rubin says. “We’re hopeful that this will become a virus that resembles other seasonal viruses in terms of how sick it makes people. But that’s something that we can accommodate in our lives and people can get used to that risk.”
KR: Why is this so important to you and your team to see a shift in the way that we’re navigating the situation in schools right now?
DR: We did this because we’ve always felt like we had on the ground experience. In this case, we care for children at CHOP, both in our hospital but also in our practice; we have nearly 600,000 children who come to our health system every year. And that if we could deploy our scientists, our research and our guidance with some level of expediency in a way that would help families navigate this pandemic, well, that was the kind of impact that we were looking for when we created PolicyLab. That’s why it’s so important to all of us.
KR: I know that the pandemic has been completely unpredictable, but I’m still going to ask: From your perspective—closely monitoring the data from the get-go—where do you think we’re headed over the next several months?
DR: I think the worst part of this crisis is over—it’s not done, though. We’re still seeing risk in terms of transmission that’s probably three to four times higher than it was around the Thanksgiving holiday. That will continue to decline, and within a couple of weeks, to most Philadelphians it’s going to feel similar to what they felt in October where you occasionally hear about someone getting Covid, but for the most part it’s not an everyday discussion.
There’s some question whether we might see a little bit of a bump back around spring break (because it’s during those moments for people who travel or gather for Easter or Passover that you sometimes see some extra transmission), but so many people have had Omicron over the last few weeks that the likelihood of that being substantial is much lower.
There’s no clear finish line to Covid. We’re hopeful that this will become a virus that resembles other seasonal viruses in terms of how sick it makes people. But that’s something that we can accommodate in our lives and people can get used to that risk. Of course we’ll always be on the lookout for other variants, and if something changes and a more virulent variant comes, obviously we’d have to adapt to that. But right now there’s a strong sense of optimism in terms of the direction we’re moving.
Header photo by Muneer ahmed ok / Unsplash