Fullerton-based family physician Kristine Percy, MD, submitted this “School Closure Now” letter on March 10, 2020. Reprinted with permission.
Dear Fullerton Joint Union High School District board members and Superintendent:
Thank you for listening to me at the board meeting tonight on the subject of the new coronavirus (COVID-19) outbreak.
I urge you to regard this danger with the utmost gravity. Reports from Italy (and earlier, China) this week are extremely alarming (see below for links to articles), as the COVID-19 outbreak pushes the healthcare system beyond the breaking point. People are dying who could be saved within a functioning system (including non-COVID-19 patients who need hospital care for routine reasons).
There is no reason to think that the situation in our state will be any better than in Italy. In fact, given that testing for COVID-19 has been seriously delayed compared to other places in the world, our situation could be worse. Because a substantial portion of cases (generally in younger, healthier people) are indistinguishable from a mild cold or completely without symptoms, there is an opportunity for the number of infected individuals to slowly build in a community. And with testing being severely restricted, doctors release patients who may be infected back into the community.
It is vital that we take action immediately to “flatten the curve” – please see image which represents slowing down & spreading out the outbreak to help keep it within the capacity of the healthcare system. Slowing down the outbreak allows for the healthcare system to adapt and for development of a vaccine. Many thousands of lives can be saved.
Fortunately, there are simple, low-tech means by which we can overcome COVID-19. The virus is not airborne, meaning although you could get it from someone coughing directly on you, as long as you keep about six feet of distance between you and others, you are unlikely to have virus particles land on you from the air.
The virus will land on surfaces in the environment of an infected person when they cough or sneeze or will be on surfaces they have touched. When you touch a doorknob, a desk, water faucet, etc., you can get virus particles on your hands which can cause infection if you touch your eyes, nose or mouth. The virus breaks down in the presence of soap, so vigorous 20-second hand washing will remove virus from your hands. It is not known for certain how long the COVID-19 virus lives on surfaces, but it is thought to be likely less than several days.
If we can prevent uninfected people from being within six feet of infected people, and make sure the healthy don’t touch anything containing virus particles, we break the chain of transmission of the virus, and the outbreak will begin to recede. When people stay home, the virus cannot continue to spread.
The school district has a key role to play in stopping the tsunami of illness and death that is heading our way by moving classes online, as our major universities are doing. Although the young seem to be thankfully spared, mostly, in this outbreak, they serve as a reservoir of infection since their cases are often mild or without symptoms, and they bring the virus home to their parents and grandparents, and they bring it to all the teachers, staff and administrators at the school.
And let’s not forget about kids whose chronic illness make them extremely vulnerable to this infection. With over 2000 students at a high school, we know it’s not possible to have them maintain the proper distance from each other and avoid touching contaminated surfaces. There is not enough hand sanitizer or janitorial staff in the world to make that workable.
The COVID-19 virus outbreak builds exponentially, which means that in the early stages, if the virus doubles every week or so, not much growth is seen, and the curve is relatively “flat.” We are still in that stage in Orange County. We had 2 cases a few weeks ago, then it was 3, now 5 (keeping in mind testing has been extremely limited and there are likely many more cases not coming to attention). But you don’t see much at this stage. Once the curve becomes more vertical, in a matter of weeks, things get bad really fast.
Your healthcare system is barely hanging on at 4,000 cases, and the next week, you have twice as many. It’s hard for us to contemplate something as drastic as school closure, with things looking so normal around us. But with an exponential danger, by the time we can see it, it’s too late.
Luckily, spring break is coming up soon. Let’s start break early. Teachers and administrators can have time in the coming week to get online classes going and ready for students when they come back from break. Please allow and support parents who are ready to take students out right away to do so. And by all means cancel all planned gatherings – concerts, conferences, tournaments, etc., and field trips.
When you look back years (or even weeks) from now, you will be glad that you moved swiftly and decisively at this moment.
I put together a Twitter list of public health authorities, leading clinicians, epidemiologists and health journalists – I find it very useful for quickly getting the latest breaking news on this very rapidly moving crisis – I invite you to join. https://twitter.com/i/lists/1236674326495023105
I also welcome all questions and comments. Thank you very much for your attention.
Kristine Percy, MD