An Israeli school lesson

The Washington Post had a very good article this morning, describing the disaster that ensued when Israel abruptly reopened all schools – with full student cohorts – in May. There are some very instructive points in the article for the US:

·        In early May, the country’s daily new infection numbers had fallen from around 750 a day to under 100. Given that Israel’s population is about 1/100 the size of the US population, this would be the equivalent of under 10,000 new cases a day here (vs. yesterday’s number of 48,529).

·        At first, only students in grades 3 and under returned, along with older students facing exams. Since young kids are both less likely to spread Covid-19 than children over 10, and more likely to have trouble with remote learning, this made sense.

·        However, the government abruptly decided on May 17 to reopen all schools at full strength. The reasons were the same ones that Trump and DeVos are using as justification for reopening US schools at full strength: the need to get the economy growing again (although I just read yesterday that manufacturing continues to grow in the US. Evidently manufacturers have figured out how to reopen safely, since otherwise the workers wouldn’t be there).

·        Meanwhile, the rest of the country had already reopened – e.g. people were flooding to malls, bars and restaurants.

·        To quote the article “That same day, a mother phoned a teacher at Jerusalem’s historic Gymnasia Ha’ivrit high school. Her son, a seventh-grade student there, had tested positive for the virus. By the next day, the school confirmed another case in the ninth grade. Ultimately, Israeli officials said, 154 students and 26 staff members were found to be infected.”

·        “The Education Ministry had issued safety instructions: Masks were to be worn by students in fourth grade and higher, windows kept open, hands washed frequently and students kept six feet apart whenever possible. But in many Israeli schools, where up to 38 children squeeze into classrooms of about 500 square feet, physical distancing proved impossible.”

·        “Then a heat wave hit. Parents complained that it was inhumane to make children wear masks in steaming classrooms where open windows nullified the air conditioning. In response, the government exempted everyone from wearing masks for four days, and schools shut the windows.

·        “That decision proved disastrous, experts say. “Instead of canceling school in those days, they just told the kids ‘OK, well you have to stay in the class with the air conditioning on and take your masks off,’ so you have no ventilation really,” said Dr. Ronit Calderon-Margalit, a professor of epidemiology at Hebrew University-Hadassah Braun School of Public Health. “You have the ideal circumstances for an outbreak.””

·        “Seeking to contain the contagion, the Education Ministry vowed to shut any school with even one Covid-19 case. It ultimately closed more than 240 schools and quarantined more than 22,520 teachers and students. When the school year ended in late June, the ministry said, 977 pupils and teachers had contracted Covid-19. But the Health Ministry, lacking the infrastructure and resources, did not make contact tracing a priority. In the Gymnasia case, Professor Waxman said, nobody even identified which buses the students had ridden on to school.”

·        At least one teacher died (again, that would be like 100 dying in the US).

·        By late July, 2,000 people were being infected every day, which is like 200,000 in the US – in other words, Israel is currently worse on a per capita basis than the US. While the superspreading event at the high school didn’t help the problem, it’s certainly true that reopening the schools isn’t by itself responsible for the whole problem.

·        “Public health experts worldwide have coalesced around a set of guidelines for reopening schools. A major recommendation is to create groups of 10 to 15 students who stay together in classrooms, at recess and lunchtime, with teachers assigned to only one group. Each group has minimal contact with other groups, limiting any spread of infection. And if a case of Covid-19 emerges, one group can be quarantined at home while others can continue at school.

·        “Other key recommendations include staggering schedules or teaching older students online, keeping desks several feet apart, sanitizing classrooms more frequently, providing ventilation and opening windows if possible, and requiring masks for staff and students old enough to wear them properly.”

The main takeaway for me from this story is that, if the schools had simply continued their effort to reopen on an incremental basis, and if they had resisted doing something really dumb like shutting the windows and dropping the mask requirement during the heat wave, rather than simply closing the schools, they might have at least avoided the outcome of people seeing the schools reopening as a debacle.

If we want to avoid that, we need to do the same thing. If we don’t listen to Trump and some governors who advocate for total reopening, but we do something like New York, where they are essentially opening at half strength – and they’re only doing this because their case growth numbers have dropped significantly – we can at least have a situation where there’s incremental progress being made toward opening schools fully. So maybe next year they really can be reopened fully.

But only if the virus is finally controlled. Otherwise, they’ll never reopen fully. Nor will the economy.

The numbers

These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into the projected numbers – they are all projections based on yesterday’s 7-day rate of increase in total Covid-19 deaths, which was 5%.

Note that the “accuracy” of the projected numbers diminishes greatly after 3-4 weeks. This is because, up until 3-4 weeks, deaths could in theory be predicted very accurately, if one knew the real number of cases. In other words, the people who are going to die in the next 3-4 weeks of Covid-19 are already sick with the disease, even though they may not know it yet. But this means that the trend in deaths should be some indicator of the level of infection 3-4 weeks previous.

However, once we get beyond 3-4 weeks, deaths become more and more dependent on policies and practices that are put in place – or removed, as is more the case nowadays - after today (as well as other factors like the widespread availability of an effective treatment, if not a real “cure”). Yet I still think there’s value in just trending out the current rate of increase in deaths, since it gives some indication of what will happen in the near term if there are no significant intervening changes.

Week ending	Deaths reported during week/month	Avg. deaths per day during week/month	Deaths as percentage of previous month’s
March 7	18	3
March 14	38	5
March 21	244	35
March 28	1,928	275
Month of March	4,058	131
April 4	6,225	889
April 11	12,126	1,732
April 18	18,434	2,633
April 25	15,251	2,179
Month of April	59,812	1,994	1,474%
May 2	13,183	1,883
May 9	12,592	1,799
May 16	10,073	1,439
May 23	8,570	1,224
May 30	6,874	982
Month of May	42,327	1,365	71%
June 6	6,544	935
June 13	5,427	775
June 20	4,457	637
June 27	6,167	881
Month of June	23,925	798	57%
July 4	4,166	595
July 11	5,087	727
July 18	5,476	782
July 25	6,971	996
Month of July	26,649	860	111%
August 1	8,069	1,153
August 8	8,306	1,187
August 15	8,743	1,249
August 22	9,202	1,315
August 29	9,686	1,384
Month of August	38,371	1,238	144%
Total March – August	195,142

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 158,968

Deaths reported yesterday: 593

Yesterday’s 7-day rate of increase in total deaths: 5% (This number is used to project deaths in the table above; it was 5% two days ago. There is a 7-day cycle in the reported deaths numbers, caused by lack of reporting over the weekends from closed state offices. So this is the only reliable indicator of a trend in deaths, not the three-day percent increase I used to focus on, and certainly not the one-day percent increase, which mainly reflects where we are in the 7-day cycle).

II. Total reported cases

Total US reported cases: 4,862,513

Increase in reported cases since previous day: 48,529

Percent increase in reported cases since 7 days previous: 10%  

III. Deaths as a percentage of closed cases so far in the US:

Total Recoveries in US as of yesterday: 2,448,295

Total Deaths as of yesterday: 158,968

Deaths so far as percentage of closed cases (=deaths + recoveries): 6%

For a discussion of what this number means – and why it’s so important – see this post. Short answer: If this percentage declines, that’s good. It’s been steadily declining since a high of 41% at the end of March. But a good number would be 2%, like South Korea’s. An OK number would be 4%, like China’s.

I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com