There Is So Much We Don’t Know

This September, we need to keep schools safe for children and staff.

This is a particularly complex challenge, because we still know very little about the virus causing the pandemic.

According to Siddhartha Mukherjee, this SARS-CoV-2 virus became a pandemic because of some very specific characteristics:

1. It is completely new to humans, so we are “immunologically naive”
2. The virus has a very high capacity to spread.
3. Asymptomatic people carry the virus and spread the virus.

This means that you cannot find infected people by tracking symptoms. You can only find infected people through testing. People cannot quarantine when they do not know they are carriers.

At the immunological level, this virus continues to surprise us with things we don’t quite understand yet.

1. About 33% of people recovering from the disease produce very low numbers of antibodies, which suggests an unexpected immune response.
2. About 40% of individuals have pre-existing T cells against SARS-CoV-2 even though the virus is completely new, and this makes it difficult to predict how the immune system will react.
3. The innate immune cells profoundly dysfunction during an infection of this virus. In addition, some people do not produce an interferon response to this virus. This leaves some individuals highly vulnerable and they “progress to severe disease” as a result.
4. A group of people have “immunological misfiring” where the innate immune cells cause unending inflammation and a resulting severe form of this disease.

We do not have an understanding of why these things happen, or what therapies can be used to treat them.

Even though we have learned so much about immunology over the past century, this virus is teaching us that there is so much we don’t know. There is so much more we need to learn.

With this in mind, how do we design a school system where we can say with full confidence that children and adults are safe from COVID-19?

Since we do not understand what the virus is doing inside a person’s body, we need to question thinking that suggests mild responses to COVID-19 are not a concern. We have no idea what the long term impacts of this virus will be. We are learning that it is more of a vascular disease – resulting in clotting and damage to blood vessels throughout the body – than a respiratory disease (though it enters through the respiratory system).

The public needs to understand how little we know about this virus, and respect it for what it can do to us, and the children who depend on us, to make good decisions about their health and their futures.

Some people who have mild symptoms at the outset of infection continue to suffer with inflammatory syndromes, blood vessel and blood clotting changes, and microvessel/microstructural changes in the brain. Some children who are completely asymptomatic progress to a blood vessel disease that resembles Kawasaki Disease. The virus can cause long term consequences in children.

There may be a group of people who have mild disease now, and then have serious consequences later in life. We just do not know.

“The resumption of normalcy will only happen when there is a resumption of normal health.”

The long term consequences of this disease might be really terrible. We need to understand this in order to really assess risk, and to ensure vaccine uptake when it becomes available.

We can only safely open schools if we understand the high risk to children and those working in schools, and we are 100% attentive to strategies that ensure all public health requirements are met.

References:

Making Sense Podcast with Sam Harris and Siddhartha Mukherjee (paid subscription version)

Featured image on Unsplash by @monroefiles (Gabby Orcutt)