Whether you live in a “red zone” or a “green zone,” Covid-19 remains a very real threat across the U.S. Assessing what’s safe and what’s not for your family depends on a range of factors that are confusing and leave us asking more questions. To get clarity and context on the risks of Covid-19, we’re with William Haseltine, a renowned scientist and infectious disease expert known for his groundbreaking work on cancer, HIV/AIDS, and the human genome. A former professor at Harvard Medical School and Harvard School of Public Health, he is now President and Chair of ACCESS Health International. Professor Haseltine shares information from his two new “living” ebooks, “A Family Guide to Covid” and “A Covid Back to School Guide.” He presents the facts and gives an unbiased, realistic explanation about the dangers of this virus – and answers questions honestly about what we should do to keep our kids and families safe.
Listen to this episode to learn:
For more information, visit https://accessh.org/covidfamilyguide/.
Advice from an expert: What parents need to know about Covid-19
Intro: Welcome to the Equal Parts Podcast, brought to you by Care Work.
Emily Paisner: Being a working parent is hard. This year we're facing a lot of unanswered questions about the health and safety of our families. Professor William Haseltine is a renowned scientist who's well known for his pioneering work on HIV AIDS, cancer, and genomics.
He was a professor at Harvard Medical School and Harvard School of Public Health and is now the President and Chair of ACCESS Health International, a think tank focused on improving access to high-quality affordable health care for people all over the world. Professor Haseltine has written two important resources for families trying to navigate life in the middle of a global pandemic: A Family Guide to COVID, and A COVID Back To School Guide.
These are living ebooks meaning they're constantly being updated as new facts and information about the virus become available. He also has a new autobiography coming out this October, My Lifelong Fight Against Disease: From Polio and AIDS to COVID-19.
In this episode, Professor Haseltine answers the questions that we all face every day when it comes to COVID and our kids. He offers clarity on making decisions that are best for our families as we all continue to navigate this pandemic together. Have a listen. Professor Haseltine, thank you so much for being here today. We really appreciate it.
William Haseltine: It's my pleasure. Thank you.
Emily Paisner: In both of your ebooks, you write about the importance of having situational awareness about the coronavirus. You point out that one of the first things we need to know is the risk of infection in our community, and that we should be checking it often almost as much as we check the weather. Can you tell us a little bit more about that?
William Haseltine: Yes. It is pretty much like the weather. When you go outside, you want to know if it's sunny, a light rain, a heavy rain. If it's a terrible thunderstorm or a hurricane, you stay inside. If it's a tornado, you go to the basement. That's pretty much like COVID. If there's nobody infected in your community, you don't have to worry.
If there are some, but not many, that's between those numbers that you can tell how many people for a hundred thousand, then you've got to take precautions. That's a yellow sign. If it's more people infected, and you're likely to encounter somebody who's infected, highly likely that's orange. If it's really dangerous, that's red.
If you take a look at the map of the country, they often display it in terms of no color, yellow, orange, and red. You can find that kind of information out by zip code and by county. I urge every parent to do that because the chance of meeting somebody who's contagious is directly related to that color coder.
Emily Paisner: You also write about gauging our own personal risk. Of course, this is going to vary from person and family to family. Overall, what are the questions you recommend we should be asking ourselves and things that we should be keeping in mind to determine that level of risk for ourselves and our families?
William Haseltine: We're talking about the hierarchy of risks. The first is to know if you're likely to bump into somebody who's contagious and that's what we've just talked about. The second is if you bump into somebody who's contagious, how risky is it for you? There are a number of factors that determine risk. The major factor is age.
The older you are, the more likely you are to get infected, and the more likely you are to suffer the serious consequences. That's because your immune system doesn't work so well, and the virus can really attack you much more readily. Then if you're younger, there's a number of other considerations, which added to age makes it even more dangerous.
Those include being obese. Obese doesn't mean you're hugely fat. It means body mass index over 30. Most people we think of is really heavy, our body mass index over 40. That's really dangerous. Then there's underlying conditions like asthma, being under cancer treatment, cardiovascular disease. Those are all predisposing conditions, whether you're young or old.
All of those are important to understand. If you're a family unit, it's important to consider everyone in the family. If you're living with your parents, for example, you're living with or having in your house a cousin come to visit who has serious asthma, or maybe overweight, those are all serious considerations for evaluating your risk and the risk of others. Another risk is pregnancy. Pregnancy not only predisposes women to infection. If they are affected, the course of the disease is likely to be more severe than if they're not pregnant.
Emily Paisner: We know that half of a million US children have been diagnosed with COVID 19 according to the American Academy of Pediatrics and the Children's Hospital Association. What do we know about children and the risk of contracting and spreading COVID?
William Haseltine: It really depends on the age of the child. We call it children, people who are 18 and younger and you really have to stratify what you mean by children. If the child is under the age of five, they can be infected, they can produce enormous amounts of virus, they can spread the virus to other people, but it's unlikely that they'll fall ill themselves.
We actually have a good understanding of why that is; the viruses that latch on to a certain component on yourself. Young people don't have much of that component in their lungs, they have it in their upper respiratory tract, their nose. They don't have it in their lungs. Although they get infected, they generally don't get the worst consequences of this disease.
Then there are children from five to let's say adolescents, 12, they can be infected, they don't get most of the symptoms but if they do get one of the delayed symptoms which is called multi-system inflammatory syndrome, it is very, very serious. They can appear to be perfectly healthy three weeks after infection and then fall really seriously ill.
They can be treated with high dose of corticosteroids and recover pretty well. Most of them recover. Unfortunately, a few you die, but most out if they're treated properly. Then there are the teenagers and above and those are just like adults. You get infected, some people get really ill, it depends on your underlying conditions; is there a heart condition, is their asthma, are they overweight?
Increasingly, because of the way this virus is now being spread through social interactions over the summer, a very large portion of people who are being inffected are young people. Now, I'm not so young, so I consider young people anybody under 50. Anywhere in the age of 20 to 50 is a major demographic being affected.
Because it's such a major group being affected, many of those people fall ill. The majority don't fall ill but a large number because the number is so large of people being infected up to 50,000 per day, 40 to 50,000 per day in the US that we know about. The number could be 5 to 10 times higher than that that we don't know about.
A number of those are falling ill and filling up hospital beds. Just because you're 20 to 50 doesn't mean you're out of the woods when you are infected, especially if you have any other associated condition that might be a risk.
Emily Paisner: Yes, we're seeing a lot of that in colleges right now and seeing how quickly it can spread and get out of hand. Talking about schools, and it's fall, it's traditionally back to school season where everyone's gearing up and excited, but this year is very different than anything we've ever seen before.
Many schools are using a hybrid learning model, a mix of in-person and remote instruction. They're dividing, my school is doing this, dividing kids into cohorts to lower the risk and minimize the number of kids that are in school at a given time. Do you think that this is a good middle ground in terms of giving kids the in-person learning that they need while also keeping our teachers safe?
William Haseltine: It could possibly work in a green and yellow zone. It cannot work in an orange or red zone. A lot of our experiments are now being done in orange and red zones. We are going to see a lot of infections and some disease, especially amongst the older teachers and amongst children with high-risk profiles, that is virtually inevitable.
One of the reasons for that is that to manage that kind of system, you need real experts. Many of our public schools are under-resourced. The teachers are stressed. They don't have the training that you would need to enforce these disciplines. What we're finding in colleges and universities is that the students are disobeying what they have been told to do.
They're having parties, they're getting together when they shouldn't, they're breaking their pod restrictions and we can't be surprised by that. Until you're about 25, your brain hasn't really fully matured into understanding how to evaluate risk. There's good evolutionary reasons for that, but it's something that we have to understand.
What has been happening around the country as we are in the early stages of this massive social experiment is there are a lot of new infections taking place. Now, fortunately, most young people don't fall ill, but the people they can come in contact with may fall Hill and some of them may die. It's pretty serious what's going on now in our educational institutions.
I take that K through 12 right on through graduate education is a really serious problem. The reason let me point out is serious is because we have such a high level of infection. Let me put it in a different way. How many people walking around in the United States at this very moment are likely to be contagious. That number is between a million and a million and a half.
That is a lot of contagious people. You can calculate that number in some very simple ways. If there are 40,000 people a day being infected, they might be infectious for about 10 days. That's 400,000 people right there, but we know we're not catching all of them. We're catching between, let's say, 1 in 5 and 1 in 10. That puts the number much, much higher of people walking around with the infection who are potentially contagious.
Emily Paisner: What I find really interesting is that at the beginning of our conversation, you talked about how we should be checking the levels of cases in our communities on a regular basis. The school system is asking parents to make decisions about what type of learning environment they want their kids to be in for several months, certain quarters.
You have to lock in your decision in order to save your child's spot in that whatever cohort you've decided to put your kids in, whether that's fully remote or hybrid or fully in person. That really does put parents in a really challenging situation.
William Haseltine: Yes. My advice would be pretty simple. If you're in an orange or red zone, do everything virtually. If you're in a yellow zone, consider your family risks and consider how competent you believe your school authorities are. Competence in schools, as you well know and we know, is not equally distributed across all the public schools. Many public schools are in very poor facilities. The classes are overcrowded and the general condition of the public school and its operations are poor.
That would be an indication to keep your child at home. If you can, there are serious issues because many times when you have that profile of a public school, you are in a community where most of the people have to go to work to survive. They can't afford to do remote work. They can't afford to stay home. Those are really difficult situations or situations that we as a nation have to confront if we want to protect our young people.
Emily Paisner: What sort of questions should we be asking of our schools that they're doing to keep our kids safe? What should we be asking them to do?
William Haseltine: We should be asking them to test themselves frequently, do spot tests of classes. There is a new method, which is-- not a new method, but an interesting method, which is to check the sewage effluent from individual schools that will tell you if there's COVID in this school and that's being done now, as some basically testing the sewage for virus.
Most people don't realize that this virus is not only breezed out, it is excreted in the faeces and it's transmissible that way as a matter of fact. You can tell whether there's virus in the school by testing the school affluent every day, and that would be a very good indication. Are the schools having large classrooms or small classrooms? Are there children in pods? Are the pods really enforced?
To enforce a pod is not just the school. The schools that do that demand that the parents provide information about what extracurricular activities the child may be in. Is there a social activity that the child may engage with or the family may engage in? The pods are rather inclusive and intrusive into your personal life. If you're really going to have a pod in a school, that pod includes everybody that child will encounter.
They can't have afterschool friends that aren't in their pod. The family can't socialize. The parents cannot travel outside of the state. Those are all restrictions that most people aren't aware of when they're thinking about what a pod might be. Pods are really serious, self-isolating groups. If a school isn't insisting on that degree of integrity of the pod, there is no point in having the pod. I would guess that most schools are not doing that. Some are, most are not.
Emily Paisner: I would agree with you. [chuckle] At the time of this recording and our conversation, there are more than 6.3 million confirmed cases of COVID in the US and more than 190,000 deaths, which is just shocking. Sadly, we are leading the world in both metrics, not ones that we want to be leading in.
These numbers are far exceeding those of other nations and other nations have been successful in stopping the spread of this. What can we learn from some of these other countries in containing the virus and reopening the schools?
William Haseltine: The major lesson is to isolate those people who might be contagious, and not focus on those people who are what's called PCR positive or viral RNA positive, which is what we've done. We've basically had a program where we're trying to identify those who are worried and those who are ill with COVID by testing. That isn't a public health strategy. That is a medical strategy.
A public health strategy is what the successful other countries have done. What they do is they focus on who might be spreading a virus, who might be contagious, and making sure that those people are isolated from others. What would that look like in the United States? With over a million people at any one time in the US being contagious, contact tracing is extremely difficult.
The way it was done in those countries is a few people were identified, all of their contacts were identified, and isolated regardless of test status. That's how they did it. They isolated everybody who could possibly be contagious, and that stopped the epidemic, even lowering the epidemic in Wuhan within two months, brought it down to zero. That's how you do it from public health perspective.
Now, because we have so many people infected, we could do that with new technologies that are basically a saliva-based home test, that should cost about 50 cents to $1. If we did that every three days for everybody, we would be able to identify those who are contagious. If we then did the next step, which is support people in family isolation for 10 to 15 days, give them the support they need, supplement their income if they need it, provide medical assistance if they need it, we could stop this infection like they have done in many other countries.
Within about two to three months, it would no longer be a problem. Even if a vaccine is improved by the end of the year, it will be at least a year before it has taken its full effect. That's the most optimistic prediction. We need to do something in the meantime and I think that's what we'll do. If we do that, we can go back to school without worry.
I have offices in Shanghai and Beijing and Singapore, and those places these kids are back in school. No problems. We could do the same. Now in India, they're back in school, but they have a problem that's at least as big as ours, or even worse. It really depends how you take care of your entire country.
We in India are doing very badly. Other countries are doing better because they've taken a very different approach. They've taken the approach of containing those people who are likely to be contagious.
Emily Paisner: Knowing that we are not doing everything we can or should be doing here, what is your view on when you think we will safely be able to have our kids back in school? As parents, what should we be realistically setting our expectations for?
William Haseltine: Let's hope by the time we're talking next year this time, we have a program in place to identify those contagious, we have a way of preventing transmission through vaccines are other methods, and we've driven every part of the country to very light yellow to green. I think it's going to take at least another full year. This year is going to be difficult.
Emily Paisner: I just think that's helpful for parents as they're mentally trying to prepare for the year ahead. We've covered a lot today. I truly appreciate your expertise here. As we wrap up, can you just share the one most important piece of advice you would want to leave our listeners who are primarily working parents with?
William Haseltine: It's your responsibility to take care of yourself and your kids by understanding that the weather out there can be inclement, and you've got to take and rigorously take the necessary precautions to protect yourself and your family. Take this seriously.
Emily Paisner: Professor Haseltine, thank you so much for your time today. We really appreciate it.
William Haseltine: My pleasure. Thank you for the opportunity.
Outro: Thanks for listening to this episode of Equal Parts. See you next time.
Emily Paisner: Wait, before you go, I just want to tell you a little bit about Care Work by care.com. They work with some of the world's largest companies to offer family care benefits to their employees. If you're one of the lucky ones who already has care benefits at work, use them. If you don't, ask for them. It's a real lifesaver. To learn more, visit care.com/careatwork. Again, that's care.com/careatwork.