By Claudia Neuhauser, Ph.D., Associate Vice President of Research and Technology Transfer, Professor of Mathematics, University of Houston; and Brian Herman, Ph.D., Professor, Department of Biomedical Engineering and former Vice President for Research, University of Minnesota and University of Texas Health, San Antonio.

Originally published on Medium- https://medium.com/@claudianeuhauser/staying-remote-for-the-entire-year-may-be-our-only-option-e1a884e9d391

With school starting in the US and the pandemic far from being under control, we are now facing the dilemma we dreaded all summer: If we offer face-to-face instruction, we invite the virus back into our classrooms. If we stick with remote instruction, learning will suffer. Both are bad choices, and we now must decide which is the least bad choice and how to balance the two.

The only weapons we currently have against the spread of COVID-19 are frequent sanitization, physical distancing, wearing face coverings, and washing hands. Even if we had the discipline to meticulously follow these guidelines (which we have seen that we don’t, especially among college students), controlling the spread of COVID-19 with over 75 million students in our normally crowded schools and colleges would be next to impossible if everyone went back to the classroom. Most schools and colleges have therefore opted to offer students a choice between face-to-face and remote learning, and hope that the number of students attending face-to-face classes will either be small enough to prevent outbreaks of COVID-19 or that the plans they developed over the summer will actually work.

Occupancy reduction may have far-reaching consequences. In K-12, it may be uneven and exacerbate existing inequities. There are already signs that family income will play a major role in what students will do this fall semester. This is at least what seems to be happening in Houston’s K-12 schools according to a Houston Chronicle article: About 55–70% of families in affluent districts but only 25–35% in low-income districts plan on sending their children back to school. Those in affluent districts will also have the resources to create learning bubbles and hire private teachers/tutors, whereas those in low-income neighborhoods will struggle with limited internet access.

Occupancy reduction in college is happening as well since many college students are simply opting out altogether. Postponing college for a year may not have any long-term detrimental effects on students but is financially devastating for colleges who rely on tuition income to pay the bills. The latest survey by SimpsonScarborough indicates that 40% of incoming college freshmen are highly likely or likely not to show up for the fall semester. Even top schools are seeing a decline in enrollment: Harvard has reported a 20% decrease after going online.

The pandemic won’t be under control any time soon

The guidance we receive from public health experts only shows that we are not even close to resolving the dilemma that students and parents are facing. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and Neel Kashkari, president of the Federal Reserve Bank of Minneapolis, said in a recent New York Times article that the number of daily new cases must fall below 1 in 100,000 before we can get the pandemic under control.

We are very far from the threshold Osterholm wants to see: 1 in 100,000 translates to about 3,300 daily new cases in the US. We currently see around 50,000 daily new cases. Most won’t know when they are infected and hence will not self-isolate at home but continue to infect others. This is particularly true for young adults, the prime group that is about to go off to college.

In the past six months, we have shown a very limited capacity to deal with this pandemic in a serious way. It is unlikely that we will see numbers that are close to what we would need to effectively deal with the pandemic. It is much more likely that a vaccine will not be available widely for quite some time and that we will spend the next couple of years dealing with tens of thousands of daily new infections until a large enough percentage of the population will have been infected to get close to herd immunity. But since we don’t know how long immunity will last, it is difficult to make any predictions about whether it is even possible to reach herd immunity.

Myocarditis and college football

Most young people seem to show few if any symptoms if they become infected. This has been used to argue that it is safe to open schools and colleges. However, while we have gotten better at treating COVID-19 patients, we also see complications emerging that could result in longer-term health issues, even if they do not lead to death.

The risk of long-term complications is the reason why two of the Power 5 divisions, the Big Ten and the Pac-12, canceled the fall 2020 college football season. Particularly troublesome to them was that healthy and physically strong athletes can suffer from a heart condition that is associated with COVID-19, even if they don’t show COVID-19 symptoms. It’s called myocarditis, inflammation of the heart muscle, and has already affected some college athletes. Myocarditis isn’t a new disease. It happens with other viral infections as well, and it is known that exercise can exacerbate the inflammation. In rare cases, sudden cardiac death can occur. Particularly troublesome is that myocarditis may be quite common in COVID-19 patients, as a small study in Germany, published in July in JAMA Cardiology, seems to indicate.

Considering that there are close to half a million NCAA athletes and about eight million high school students participating in athletics programs in the US, according to NCAA data, schools and colleges may want to follow the Big Ten and Pac-12 conferences and consider canceling athletics at least for the fall semester. And they may not want to stop there. Until we have a better understanding of the long-term consequences of COVID-19, we should not assume that just because children and young adults typically only have mild symptoms, there won’t be long-term health consequences they would have to deal with for decades to come.

Fall semester will be online in most places, and so might be spring semester

The New York Times recently published maps of where schools could start safely. These maps showed that it will not be safe to return students to the classroom in most school districts, and, not surprisingly, we started to hear about outbreaks in schools as soon as they started. Colleges are in no better place, in particular since “[p]eople in their 20s, 30s and 40s are increasingly driving the spread,” as WHO Western Pacific regional director, Takeshi Kasai, said a few days ago, as reported by Reuters.

No frequent testing and contact tracing program can keep the virus at bay once hundreds or even thousands of students, teachers, and staff are mingling together in an environment where the virus is already widespread. College-age students’ desire for social mingling under conditions where virus spread is maximized will quickly overwhelm testing capacity, and contract tracing is proving of limited value due to a lack of will of individuals to even talk to contract tracers. Campuses that had an early start, such as UNC, Notre Dame, Michigan State, and others, already experienced outbreaks and moved to remote instruction after seeing rising numbers of infected and quarantined students shortly after students showed up on campus.

Few students will be able to avail themselves of face-to-face learning due to COVID-19 mandated protections at many colleges. And the few who attend face-to-face classes may not do a whole lot better than their peers in the online version of the course. Sitting in a classroom with other students will likely cause stress and anxiety as students worry about getting infected or bringing the virus back home to their family and community. And what happens when the first college reports the death of a student due to COVID-19 infection? Will they take responsibility for bringing the students back to campus prematurely or will they “pass the buck” and blame the student for not following the guidelines appropriately and being at fault for getting infected and dying?

The most prudent thing to do might be to move to remote instruction for fall. It is unlikely that a vaccine will be available for spring semester and so spring semester may not be much different. We, therefore, should be prepared to continue remote instruction in the spring semester as well and focus our energy on improving remote instruction for everyone.