Latest news with #BrownUniversitySchoolofPublicHealth
Yahoo
15-05-2025
- Health
- Yahoo
Overdose deaths fell by 30,000 last year — declining in every state except two
Overdose deaths in the U.S. plummeted by nearly 30,000 year-on-year - the largest decline ever recorded. An estimated 80,391 people died from drugs in 2024, according to provisional Centers for Disease Control and prevention data. That marks a decrease of 27 percent from the 110,000 deaths reported in 2023. 'I would characterize this as a historically significant decrease in overdose deaths,' Brandon Marshall, a Brown University School of Public Health epidemiologist, told The Washington Post. 'We're really seeing decreases almost across the entire nation at this point.' Deaths fell in all states but two: Nevada and South Dakota. They declined in all major categories of drug use, including stimulants and opioids. The health agency credited President Donald Trump's actions during his first term, saying that Congressional support since 2017 has enabled it to expand critical data systems and strengthen overdose prevention capacity across all states. Notably, the overdose-reversing drug naloxone has become more widely available. 'These investments have empowered us to rapidly collect, analyze, and share actionable data — enabling communities to better understand the specific drivers of overdose in their area and tailor prevention strategies to meet their unique local needs,' the agency added. 'Since late 2023, overdose deaths have steadily declined each month — a strong sign that public health interventions are making a difference and having a meaningful impact.' However, overdose remains the leading cause of death for American adults between the ages of 18 to 44, the CDC noted, 'underscoring the need for ongoing efforts to maintain this progress.' Annual overdose deaths are still higher than they were before the Covid pandemic, and a recent study revealed that a quarter of children in the U.S. have at least one parent with a substance use disorder. The announcement also comes following major cuts to federal funding and research at the hand of the Trump administration, sparking concern among researchers. 'I don't see how it can be sustained, with the kinds of deep cuts that they're taking to many of the programs that have been driving these reductions,' Traci C. Green, an epidemiologist at Brandeis University, told The New York Times. 'Now is not the time to take the foot off the gas pedal,' Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco, said. With reporting by The Associated Press
Boston Globe
14-05-2025
- Health
- Boston Globe
US drug deaths plunged in 2024. Trump cuts may reverse that, experts warn.
Advertisement The progress comes after drug deaths, which had been rising for more than a decade, soared to staggering levels during the coronavirus pandemic, surpassing 100,000 each year starting in 2021. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up 'I would characterize this as a historically significant decrease in overdose deaths,' said Brandon Marshall, a Brown University School of Public Health epidemiologist who studies overdose trends. 'We're really seeing decreases almost across the entire nation at this point.' The data published Wednesday charts a dramatic decline in deaths during then-President Joe Biden's final year in office. The Trump administration has espoused hard-line rhetoric on fentanyl, declaring traffickers a top national security threat and citing them as a key reason for launching trade battles with China and allies Canada and Mexico. The administration has also touted large fentanyl seizures and asked Mexico to allow the US military to conduct counternarcotics operations on Mexican soil, a request denied by that country's president. Advertisement The CDC, in a statement, noted that Trump during his first administration declared the opioid crisis a public-health emergency in 2017. The declines since 2023 are a 'strong sign that public health interventions are making a difference and having a meaningful impact,' the agency said. 'Despite these overall improvements, overdose remains the leading cause of death for Americans aged 18-44, underscoring the need for ongoing efforts to maintain this progress.' The White House Office of National Drug Control Policy, in an April statement of policy priorities, emphasized curbing the flow of illicit fentanyl, along with expanding access to treatment and research into cutting-edge technologies to identify and address emerging drug threats. But public health advocates are raising alarm that the Trump administration is undercutting those goals with plans to gut federal funding that helps states pay for overdose antidotes, addiction treatment and other measures. A survey conducted by the nonprofit research firm Rand published in May suggests that more people may be using illicit opioids than previously estimated, underscoring the need for better monitoring. In a letter to Congress on Monday, more than 300 academics warned that the Trump administration's proposed cuts to the Substance Abuse and Mental Health Services Administration and CDC could 'undermine the hard-fought progress we have made, especially in overdose prevention.' Experts also worry Republican plans to slash Medicaid could leave former drug users without access to medication, forcing them to turn to street drugs, said Chad Sabora, a drug policy expert who helped organize the letter. 'It will equal more people dying,' he said. Advertisement What explains the drop? The opioid crisis began decades ago with highly addictive prescription pain killers flooding states. Users later turned to cheaper street heroin, which was largely replaced by fentanyl manufactured by Mexican organized crime groups with precursor chemicals sourced from China. The synthetic drug can be up to 50 times more potent than heroin. No single reason explains the sudden drop in deaths, researchers and health officials stress. The Biden administration credited seizures of fentanyl at the southern border, arrests of high-level Mexican drug traffickers and cooperation from Beijing to crack down on unscrupulous Chinese companies exporting precursor chemicals. The administration also expanded access to addiction treatment medications such as buprenorphine, which wards off opioid withdrawals, and the overdose reversal drug naloxone. It also embraced harm reduction organizations that have saturated communities with free naloxone, fentanyl test strips and sterile needles to users. Fewer deaths 'don't just happen overnight. And that's why we can credit them to the Biden administration's work,' said Sheila P. Vakharia, deputy director of research and academic engagement for the nonprofit Drug Policy Alliance. Experts also believe that the illicit drug supply, at least in some regions, may be shifting to include less fentanyl. Other drugs added to fentanyl - such as the tranquilizer xylazine - may prolong the sedating effect and stave off opioid withdrawal so that users consume less fentanyl each day, researchers theorize. Declines in deaths may also reflect the grim reality that fentanyl has killed so many regular users that there are fewer people at risk of overdose. The trajectory of deaths 'can't keep going up. It has essentially to kind of burn itself out,' said Caleb Banta-Green, an addiction expert and drug researcher at the University of Washington School of Medicine. Advertisement During Biden's first three years, the death toll topped 100,000 each year. Deaths during a 12-month period peaked in June 2023 at a staggering 114,670, making the rapid drop nationally all the more remarkable, said Nabarun Dasgupta, an epidemiologist at the University of North Carolina at Chapel Hill. He stressed that deaths had been falling in certain regions where fentanyl had been entrenched for longer. 'Americans have responded to the overdose crisis with powerful community efforts, from every small town to large city. What we are seeing is the fruit of all that collective labor. These local efforts are the heart of overdose prevention,' Dasgupta said. A state-by-state look The CDC data released on Wednesday is not definitive; final death statistics lag because toxicology testing often takes months to complete. Deaths involving stimulants such as methamphetamine and cocaine - which users increasingly take alongside fentanyl - also decreased, the statistics show. Two states, Nevada and South Dakota notched slight increases from the previous year. But nearly all states showed declines in 2024. States such as New Hampshire, West Virginia and Ohio recorded declines of 35 percent or more. In Washington state, where fentanyl became entrenched years later than on the East Coast, suspected drug deaths dropped by nearly 12 percent, after years of increases, for a total of 3,167. In King County, home to Seattle, health officials distributed 124,700 naloxone kits in 2024 and opened three vending machines for people to obtain the medication, fentanyl test strips and other supplies. County officials and the University of Washington Department of Emergency Medicine also debuted a hotline for doctors to prescribe buprenorphine through free telehealth sessions at any time of day. The city's mayor in August announced an investment of nearly $3 million in opioid litigation settlement money to increase capacity for inpatient treatment. Advertisement But the state health department's top medical officer, Tao Kwan-Gett, urged cautioned. Washington overdose deaths fell through much of 2024 but spiked during the final four months of the year. 'It's too early to say that we're seeing a sustained decrease,' Kwan-Gett said. 'I certainly hope we are, but I think we have to continue being vigilant.' The encouraging statistics in Washington and nationwide belie the heartbreak of addiction - and death. Among the victims nationwide in 2024: a 17-month-old Los Angeles boy who ingested fentanyl during a child welfare-monitored visit with his mother; a 15-year-old girl who fatally overdosed on fentanyl at her Georgia high school, nine people who fatally overdosed in Austin, during one day. In Seattle, former movie set designer Wade Paradise battled an opioid addiction for years after taking prescription pain killers. He was largely estranged from his family, living in squalor and suffering from myriad ailments, according to his daughter, Nathalie Paradise, 24. She said Wade Paradise had struggled to get addiction treatment because of problems with health insurance. In December, he died at age 68 in his home from a pill made of fentanyl. His death received little attention but for Nathalie's GoFundMe page in which she recalled cherished childhood memories of summer swims in a lake and bargain hunting at thrift stores - and detailed his addiction. 'I didn't want it to be a secret anymore. I felt like the people in his life deserved to know the truth,' she said in an interview. 'I also have a lot of friends who use drugs, and I hoped that by sharing my story, it might encourage them to stop.' Advertisement
Forbes
01-05-2025
- Health
- Forbes
Avoidable Deaths Decrease In High-Income Nations And Increase In U.S.
Avoidable deaths are decreasing in high-income nations while they're increasing in the United States. It's a worrisome trend, which is partly responsible for the growing gap in life expectancy between the U.S. and its peers. During the COVID-19 pandemic, U.S. life expectancy took a bigger hit than its peers, as the graph below shows. The figure also depicts how U.S. life expectancy was stagnant between approximately 2010 and 2020, unlike other wealthy, industrialized nations. And prior to 2012, beginning around 1985, the upward slope in life expectancy growth was flatter in the U.S. There are many factors that have contributed to this trend, one of which is greater numbers of avoidable deaths in the U.S. compared to its peers. Avoidable mortality refers to deaths that ought not to occur in the presence of timely and effective healthcare, including prevention. Clinicians often examine causes of death to determine whether they could have been avoided by some kind of public health measure. Avoidable deaths in most high-income countries around the world are going down. But in the U.S., avoidable deaths have been on the rise for more than a decade, according to a new study by researchers at the Brown University School of Public Health and Harvard University. They analyzed mortality trends across all 50 U.S. states as well as 40 comparably wealthy nations. The researchers compared mortality data and found that between 2009 to 2021, avoidable mortality in the U.S. worsened, while it improved elsewhere, with the exception of the 2020-2021 time period during COVID-19. Lead study author Irene Papanicolas, a professor of health services, policy and practice at Brown University's School of Public Health, told Medical Express that the findings published last month in JAMA Internal Medicine suggest unresolved issues in the American healthcare system, in which gaps in public policy may be contributing to worsening health outcomes. Take, for instance, rising road traffic fatalities since the early 2010s in the U.S. (while these have been diminishing elsewhere), continued very high levels of gun deaths and illicit drug overdoses, higher rates of suicide as well as maternal and infant mortality and illnesses preventable by early detection and treatment, such as cervical cancer and ischemic heart disease. The researchers found that deaths from a variety of different causes are rising in every U.S. state, with considerable variation across states. The cited study found that between 2009 and 2021 avoidable deaths in the U.S. increased from around 20 to 44 per 100,000. On the other hand, in most high-income countries around the world, these kinds of avoidable deaths have been decreasing during the same time frame. Other countries saw about 14 fewer avoidable deaths per 100,000. In European Union countries, the reduction was even greater, with an average of almost 24 fewer deaths per 100,000. Clearly, it's not simply a matter of number of dollars spent on healthcare, given that the U.S. spends more per capita on healthcare than every other high-income country. Perhaps where or how that money is spent that is the key issue. And as Papanicolas said, referring to policy debates that have occurred across multiple presidential administrations, 'there's been a lot of discussion about preventable deaths in the U.S. such as drug-related deaths or suicides, which do account for a big proportion of this trend. However, we found that deaths from nearly all major categories are increasing." Under the new Trump administration, Secretary of Health and Human Services, Robert F. Kennedy Jr., has promoted the idea of making Americans healthy again, advocating for things like eating healthier and limiting exposure to potentially harmful food additives. However, his MAHA vision doesn't address gun violence, motor vehicle safety, maternal and infant mortality, mental health, certain harm reduction factors related to illegal drug consumption and a host of other items contributing to avoidable deaths. And HHS budget cuts may worsen the situation going forward. A conspicuous example of this is a proposed plan by the department to eliminate a relatively small, but effective $56 million annual grant program that distributes the opioid overdose antidote naloxone to first responders across the country. And what could further exacerbate the problem is the fact that the Trump administration doesn't appear to be focused on measuring certain avoidable deaths. As an illustration, the Department of HHS laid off the entire 17-person team in charge of the National Survey on Drug Use and Health. And the Centers for Disease Control and Prevention have gotten rid of divisions that oversee databases on things like accidental deaths and injuries, including fatal shootings, poisonings and motor vehicle crashes. Moreover, there is now considerably less federal funding for tracking HIV and other sexually transmitted diseases, all of which are preventable. What's not measured can't be properly addressed with tangible policies.
Yahoo
17-04-2025
- Health
- Yahoo
The Disaster of School Closures Should Have Been Foreseen
Of the many mistakes made in the COVID era, none were as glaring as prolonged school closures. The damages go beyond loss of learning, a dire consequence in its own right: Millions of families, both children and parents, still carry the scars of stress, depression, and isolation. The closures began at a time of understandable panic, but that was only the beginning of the story. On February 25, 2020, Nancy Messonnier, the director of the CDC's National Center for Immunization and Respiratory Diseases, led a press conference to address the developing coronavirus crisis. Messonnier warned the public that, without vaccines, non-pharmaceutical interventions—things like business closures or social-distancing guidelines—would be the most important tools in the country's response. 'What is appropriate for one community seeing local transmission won't necessarily be appropriate for a community where no local transmission has occurred,' she said. The school closures that would be implemented the following month—and that endured through the end of the school year in nearly all of the roughly 13,800 school districts in the United States, in regions that had wildly different infection levels—showed this directive was not followed. At the time of the initial closures, in mid-March, COVID was spreading quickly, but large areas in the U.S. were absent any known cases. Still, to the extent that a planned response to influenza was an appropriate universal pandemic guide, these closures were aligned with the CDC's most recent update to its pandemic playbook, released in 2017. According to that document, an initial two-week closure of schools would be sufficient to fulfill a first objective of buying authorities time to assess the severity of the pandemic. Given the news being reported of care rationing in northern-Italian hospitals, following this plan was not unreasonable—and, as part of broader stay-at-home orders, it may have had some effect on disease transmission. 'Italy spooked us,' Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, told me. 'We did not want to be Italy. The governors all saw China and Italy lock down and decided to follow their example.' Indeed, had China not locked down, perhaps the rest of the world might not have done so either. China, governed by an authoritarian regime that rules the country with tremendous top-down power, does not share the same attitude toward personal liberties as Western democracies. And neither the CDC's pandemic playbook nor the pre-2020 consensus within the public-health field favored a lockdown of society of the breadth that we would experience. On a countrywide scale—from both an epidemiological perspective and a human-rights perspective—closing all nonessential business, closing all schools, prohibiting most social interactions and nonessential travel, and so on, was not considered feasible or wise. Because we initially lacked the ability to test, Nuzzo said, shutting schools, along with other facets of society, did make sense at first. The problem, in Nuzzo's mind, was not closing down in March; it was that there was no plan beyond that. By 'no plan,' Nuzzo was referring to two interrelated problems: all the potential harms of closures, and the challenge of unwinding interventions after they'd been implemented. In Messonnier's press conference, she mentioned the CDC's 2017 pandemic report directly, said that school closures were part of the plan, and recognized that they were likely to be associated with unwanted consequences such as missed work and loss of income. 'I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe,' she advised. 'You should think about what you would do for child care if schools or day cares close.' There was no mention of how the government might aid families during school closures, or, for example, about what a single parent with a job as a cashier in a grocery store and a 4-year-old at home was supposed to do. Rather, in just one line amid a lengthy speech, people were told to simply 'think about' it. To government officials and many others at the time, this was a regrettable but entirely reasonable approach—a presumed temporary loss of wages and child-care issues were lower-order concerns compared with the coming onslaught of a pandemic. Yet what was positioned as a secondary issue—a mere abstraction, warranting just a brief mention—led to catastrophic consequences for millions of children, and their families. A year later, my kids, along with tens of millions of other students, were still trudging through remote learning, either as their exclusive form of schooling or through so-called hybrid schedules during which they could attend classes only part time. (Meanwhile, bars, restaurants, and all manner of other businesses had long since reopened, as had many private schools.) Teachers in much of the country had been prioritized for vaccines—making them eligible for protection before some other, more vulnerable populations—yet schools in half the country still weren't open full time, and in many places weren't open at all. While federal public-health officials made recommendations regarding schools, the actual closures were carried out at the state and local levels, in response to misplaced public fears and aggressive campaigning by teachers' unions. Randi Weingarten, the high-profile head of the American Federation of Teachers, said in a February 8, 2021, New York Times article that she hoped things would be 'as normal as possible' by the following fall. Class-action lawsuits in multiple states had been filed on behalf of children with special needs on the claim that the conditions of IDEA—a federal law that requires certain services (such as physical and occupational therapy, supplemental aids and equipment, etc.) for children with disabilities—were not being met in remote-learning models. [Read: Where all the missing students?] Opinion pieces with titles such as 'Remote School Is a Nightmare. Few in Power Care,' had been appearing in major news outlets since the previous summer. Working parents, especially mothers, were dropping out of the workforce in staggering numbers because of child-care obligations during the pandemic. An analysis by the U.S. Chamber of Commerce found that nearly 60 percent of parents who had left the workforce had done so for this reason. The psychic toll on parents and children was never—and can never be—calculated. It won't show up in statistics, but it was real for millions of families. And millions of children, especially those without resources for tutors or parents to oversee them during the day, were losing ground with their academics. Worse, they were suffering from isolation, frustration, and, for an increasing number of them, depression from spending their days alone in front of an electronic screen. Untold numbers of other children became 'lost,' having dropped out of school entirely. Those in power who advocated for school closures were not adequately prepared for these consequences, which were still pervasive a full year into the pandemic. But they should have been. The damaging effects of school interruptions were not unforeseen. They were explicitly warned about in the academic literature. Exhibit A is a 2006 paper called 'Disease Mitigation Measures in the Control of Pandemic Influenza,' in the journal Biosecurity and Bioterrorism, written by Nuzzo; her mentor (and global eminence on disease-outbreak policies), D. A. Henderson; and two others. 'There is simply too little experience to predict how a 21st century population would respond, for example, to the closure of all schools for periods of many weeks to months,' these authors wrote. 'Disease mitigation measures, however well intentioned, have potential social, economic, and political consequences that need to be fully considered by political leaders as well as health officials. Closing schools is an example.' The authors went on to warn that closures would force some parents to stay home from work, and they worried about certain segments of society being forced to bear an unfair share of the burden from transmission-control policies. They wrote: No model, no matter how accurate its epidemiologic assumptions, can illuminate or predict the secondary and tertiary effects of particular disease mitigation measures … If particular measures are applied for many weeks or months, the long-term or cumulative second- and third-order effects could be devastating. Nearly a decade and a half before the pandemic—in a stark rebuke to the approach championed by the CDC, White House Coronavirus Response Task Force coordinator Deborah Birx, and other powers that be—the paper had called out the major harms that would come to afflict many families in our country as a result of school closures. Yet, from the spring of 2020, health officials who directed our pandemic response ignored many of the consequences they must have known to expect. Or, at the very least, they failed to provide adequate information about them to the public. The officials had opened a bottle of medicine while disregarding the skull and crossbones on the warning label. And the portents were not just in Henderson's and Nuzzo's paper. A 2011 paper by researchers from Georgetown assessed the decision making behind—and the consequences from—several hundred brief school closures enacted during the 2009 H1N1 pandemic. The authors noted that the child-care costs to families were substantial, and that hardships from closures were inequitable. 'Officials considering closure must weigh not only the total amount of disruption but also the extent to which social costs will be disproportionately borne by certain segments of society,' the authors wrote. Even the CDC playbooks themselves warn of some of these issues. Both the 2007 original and the updated 2017 report cautioned that school closures could lead to the secondary consequence of missed work and loss of income for parents who needed to stay home to take care of their school-age children. This effect, the latter report noted, would be most harmful for lower-income families, who were also hit hardest by COVID in the first place. With prescience, and comic understatement, the authors noted that school closures would be among the 'most controversial' elements of the plan. Meanwhile, the second of Nuzzo's points—that unwinding interventions is often incredibly difficult, and there must be a plan on how to do so—was also a well-established phenomenon. Just as public-health experts are biased toward intervention, they, along with the public, are also biased toward keeping interventions in place. This is a known phenomenon within the literature of implementation science, a field of study focused on methods to promote the adoption of evidence-based practices in medicine and public health. Westyn Branch-Elliman, an infectious-diseases physician at UCLA School of Medicine with an expertise in implementation science, told me that de-implementation is generally much harder than implementation. 'People tend to err on the side of intervening, and there is often considerable anxiety in removing something you believe has provided safety,' she said. There also is a sense of inertia and leaving well enough alone. It's not unlike legislation—oftentimes repealing a law, even an unpopular one, poses bigger challenges than whatever barriers existed to getting it passed. Although the initial school closures may have been justifiable (even if off-script in many locations), there was no plan on when and how to reopen. Officials repeated a refrain that schools should open when it was 'safe.' But 'safe' was either pegged to unreachable or arbitrary benchmarks or, more often, not defined. This meant there would be limited recourse against a public that had been led to believe this intervention was a net benefit, even long after evidence showed otherwise. The lack of an exit plan—or an 'off-ramp,' as many health professionals would later term it—would prove disastrous for tens of millions of children in locations where social and political pressures prevented a reversal of the closures. [Read: The biggest disruption in the history of American education] Without sufficient acknowledgment of the harms of school closures, or adequate planning for unwinding this intervention, officials showed that their decisions to close were simply reactive rather than carefully considered. The decision makers set a radical project in motion with no plan on how to stop it. In effect, officials steered a car off the road, threw a cinder block on the accelerator, then jumped out of the vehicle with passengers still in the back. No one was in the front or even knew how to unstick the pedal. This article was adapted from David Zweig's book An Abundance of Caution: American Schools, the Virus, and a Story of Bad Decisions. Article originally published at The Atlantic
Atlantic
17-04-2025
- Health
- Atlantic
The Disaster of School Closures Should Have Been Foreseen
Of the many mistakes made in the COVID era, none were as glaring as prolonged school closures. The damages go beyond loss of learning, a dire consequence in its own right: Millions of families, both children and parents, still carry the scars of stress, depression, and isolation. The closures began at a time of understandable panic, but that was only the beginning of the story. On February 25, 2020, Nancy Messonnier, the director of the CDC's National Center for Immunization and Respiratory Diseases, led a press conference to address the developing coronavirus crisis. Messonnier warned the public that, without vaccines, non-pharmaceutical interventions—things like business closures or social-distancing guidelines—would be the most important tools in the country's response. 'What is appropriate for one community seeing local transmission won't necessarily be appropriate for a community where no local transmission has occurred,' she said. The school closures that would be implemented the following month—and that endured through the end of the school year in nearly all of the roughly 13,800 school districts in the United States, in regions that had wildly different infection levels—showed this directive was not followed. At the time of the initial closures, in mid-March, COVID was spreading quickly, but large areas in the U.S. were absent any known cases. Still, to the extent that a planned response to influenza was an appropriate universal pandemic guide, these closures were aligned with the CDC's most recent update to its pandemic playbook, released in 2017. According to that document, an initial two-week closure of schools would be sufficient to fulfill a first objective of buying authorities time to assess the severity of the pandemic. Given the news being reported of care rationing in northern-Italian hospitals, following this plan was not unreasonable—and, as part of broader stay-at-home orders, it may have had some effect on disease transmission. 'Italy spooked us,' Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, told me. 'We did not want to be Italy. The governors all saw China and Italy lock down and decided to follow their example.' Indeed, had China not locked down, perhaps the rest of the world might not have done so either. China, governed by an authoritarian regime that rules the country with tremendous top-down power, does not share the same attitude toward personal liberties as Western democracies. And neither the CDC's pandemic playbook nor the pre-2020 consensus within the public-health field favored a lockdown of society of the breadth that we would experience. On a countrywide scale—from both an epidemiological perspective and a human-rights perspective—closing all nonessential business, closing all schools, prohibiting most social interactions and nonessential travel, and so on, was not considered feasible or wise. Because we initially lacked the ability to test, Nuzzo said, shutting schools, along with other facets of society, did make sense at first. The problem, in Nuzzo's mind, was not closing down in March; it was that there was no plan beyond that. By 'no plan,' Nuzzo was referring to two interrelated problems: all the potential harms of closures, and the challenge of unwinding interventions after they'd been implemented. In Messonnier's press conference, she mentioned the CDC's 2017 pandemic report directly, said that school closures were part of the plan, and recognized that they were likely to be associated with unwanted consequences such as missed work and loss of income. 'I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe,' she advised. 'You should think about what you would do for child care if schools or day cares close.' There was no mention of how the government might aid families during school closures, or, for example, about what a single parent with a job as a cashier in a grocery store and a 4-year-old at home was supposed to do. Rather, in just one line amid a lengthy speech, people were told to simply 'think about' it. To government officials and many others at the time, this was a regrettable but entirely reasonable approach—a presumed temporary loss of wages and child-care issues were lower-order concerns compared with the coming onslaught of a pandemic. Yet what was positioned as a secondary issue—a mere abstraction, warranting just a brief mention—led to catastrophic consequences for millions of children, and their families. A year later, my kids, along with tens of millions of other students, were still trudging through remote learning, either as their exclusive form of schooling or through so-called hybrid schedules during which they could attend classes only part time. (Meanwhile, bars, restaurants, and all manner of other businesses had long since reopened, as had many private schools.) Teachers in much of the country had been prioritized for vaccines—making them eligible for protection before some other, more vulnerable populations—yet schools in half the country still weren't open full time, and in many places weren't open at all. While federal public-health officials made recommendations regarding schools, the actual closures were carried out at the state and local levels, in response to misplaced public fears and aggressive campaigning by teachers' unions. Randi Weingarten, the high-profile head of the American Federation of Teachers, said in a February 8, 2021, New York Times article that she hoped things would be 'as normal as possible' by the following fall. Class-action lawsuits in multiple states had been filed on behalf of children with special needs on the claim that the conditions of IDEA—a federal law that requires certain services (such as physical and occupational therapy, supplemental aids and equipment, etc.) for children with disabilities—were not being met in remote-learning models. Opinion pieces with titles such as 'Remote School Is a Nightmare. Few in Power Care,' had been appearing in major news outlets since the previous summer. Working parents, especially mothers, were dropping out of the workforce in staggering numbers because of child-care obligations during the pandemic. An analysis by the U.S. Chamber of Commerce found that nearly 60 percent of parents who had left the workforce had done so for this reason. The psychic toll on parents and children was never—and can never be—calculated. It won't show up in statistics, but it was real for millions of families. And millions of children, especially those without resources for tutors or parents to oversee them during the day, were losing ground with their academics. Worse, they were suffering from isolation, frustration, and, for an increasing number of them, depression from spending their days alone in front of an electronic screen. Untold numbers of other children became 'lost,' having dropped out of school entirely. Those in power who advocated for school closures were not adequately prepared for these consequences, which were still pervasive a full year into the pandemic. But they should have been. The damaging effects of school interruptions were not unforeseen. They were explicitly warned about in the academic literature. Exhibit A is a 2006 paper called 'Disease Mitigation Measures in the Control of Pandemic Influenza,' in the journal Biosecurity and Bioterrorism, written by Nuzzo; her mentor (and global eminence on disease-outbreak policies), D. A. Henderson; and two others. 'There is simply too little experience to predict how a 21st century population would respond, for example, to the closure of all schools for periods of many weeks to months,' these authors wrote. 'Disease mitigation measures, however well intentioned, have potential social, economic, and political consequences that need to be fully considered by political leaders as well as health officials. Closing schools is an example.' The authors went on to warn that closures would force some parents to stay home from work, and they worried about certain segments of society being forced to bear an unfair share of the burden from transmission-control policies. They wrote: No model, no matter how accurate its epidemiologic assumptions, can illuminate or predict the secondary and tertiary effects of particular disease mitigation measures … If particular measures are applied for many weeks or months, the long-term or cumulative second- and third-order effects could be devastating. Nearly a decade and a half before the pandemic—in a stark rebuke to the approach championed by the CDC, White House Coronavirus Response Task Force coordinator Deborah Birx, and other powers that be—the paper had called out the major harms that would come to afflict many families in our country as a result of school closures. Yet, from the spring of 2020, health officials who directed our pandemic response ignored many of the consequences they must have known to expect. Or, at the very least, they failed to provide adequate information about them to the public. The officials had opened a bottle of medicine while disregarding the skull and crossbones on the warning label. And the portents were not just in Henderson's and Nuzzo's paper. A 2011 paper by researchers from Georgetown assessed the decision making behind—and the consequences from—several hundred brief school closures enacted during the 2009 H1N1 pandemic. The authors noted that the child-care costs to families were substantial, and that hardships from closures were inequitable. 'Officials considering closure must weigh not only the total amount of disruption but also the extent to which social costs will be disproportionately borne by certain segments of society,' the authors wrote. Even the CDC playbooks themselves warn of some of these issues. Both the 2007 original and the updated 2017 report cautioned that school closures could lead to the secondary consequence of missed work and loss of income for parents who needed to stay home to take care of their school-age children. This effect, the latter report noted, would be most harmful for lower-income families, who were also hit hardest by COVID in the first place. With prescience, and comic understatement, the authors noted that school closures would be among the 'most controversial' elements of the plan. Meanwhile, the second of Nuzzo's points—that unwinding interventions is often incredibly difficult, and there must be a plan on how to do so—was also a well-established phenomenon. Just as public-health experts are biased toward intervention, they, along with the public, are also biased toward keeping interventions in place. This is a known phenomenon within the literature of implementation science, a field of study focused on methods to promote the adoption of evidence-based practices in medicine and public health. Westyn Branch-Elliman, an infectious-diseases physician at UCLA School of Medicine with an expertise in implementation science, told me that de-implementation is generally much harder than implementation. 'People tend to err on the side of intervening, and there is often considerable anxiety in removing something you believe has provided safety,' she said. There also is a sense of inertia and leaving well enough alone. It's not unlike legislation—oftentimes repealing a law, even an unpopular one, poses bigger challenges than whatever barriers existed to getting it passed. Although the initial school closures may have been justifiable (even if off-script in many locations), there was no plan on when and how to reopen. Officials repeated a refrain that schools should open when it was 'safe.' But 'safe' was either pegged to unreachable or arbitrary benchmarks or, more often, not defined. This meant there would be limited recourse against a public that had been led to believe this intervention was a net benefit, even long after evidence showed otherwise. The lack of an exit plan—or an 'off-ramp,' as many health professionals would later term it—would prove disastrous for tens of millions of children in locations where social and political pressures prevented a reversal of the closures. Without sufficient acknowledgment of the harms of school closures, or adequate planning for unwinding this intervention, officials showed that their decisions to close were simply reactive rather than carefully considered. The decision makers set a radical project in motion with no plan on how to stop it. In effect, officials steered a car off the road, threw a cinder block on the accelerator, then jumped out of the vehicle with passengers still in the back. No one was in the front or even knew how to unstick the pedal.
