It’s painful to admit it, but it’s true: The last time Oakland kicked San Francisco’s ass this thoroughly was the ’89 World Series.
To wit: On the cusp of winter break, every Oakland Unified School District student attending class received a pair of at-home covid tests. Throughout the break, parents were sent numerous and detailed messages reminding them to administer one of those tests three days before the first day of school and the second on the Sunday before school resumed. And, for those parents who didn’t do this — or who left on vacation before the tests were handed out — there was an additional stopgap: Rapid testing was available on school campuses on the first day of school.
All told, some 41,000 tests were disseminated to Oakland public school families. Some 21,000 results were uploaded to a central system. And, on the first day of school, nearly 1,000 students and staff stayed home because they’d tested positive for Covid-19.
No, taking the tests was not mandatory. Uploading the results was not mandatory. But, bottom line, in Oakland, free tests were put in families’ hands. Families were given every opportunity and many reminders over the break to administer the multiple free tests. Some parents may have ignored this — and, perhaps, some pathological person knowingly sent sick kids to school. But, by and large, tens of thousands of parents and kids followed the rules: Students and staff showed up having tested negative, or stayed home.
“It really worked the way we wanted it to,” said Oakland public school spokesman John Sasaki. “Pretty close to 1,000 people were informed they should be staying home and getting better, and not coming to school. And that’s great for adults, and great for students.”
Students in Berkeley, Marin County and Contra Costa County were also provided with at-home tests. Students in San Francisco were not. So it’s unclear if things worked out the way the San Francisco Unified School district wanted them to. Hopefully not, because that, too, would be pathological.
San Francisco public school parents were not provided at-home tests for their kids but, on the eve of school restarting, they were encouraged to get kids tested, nevertheless. This is a terrible message to send, especially because it came at a time when testing centers resembled the Coronet Theatre during Star Wars’ opening weekend, and when tracking down test kits in stores felt like a dystopian hunt for a Tickle-Me Elmo.
Well, that wasn’t fun for this San Francisco public school parent. It was even less fun than watching, in person, as Dennis Eckersley beat Brett Butler to the bag for the final out in ’89. I have asked the school district to explain the thought process behind its actions (or, more accurately, inactions). I have not yet received an adequate response. It warrants mentioning that Oakland Unified has a contract with Primary Health and San Francisco Unified contracts with Color. Regardless, that doesn’t get to the thought process. Not providing tests for kids coming back from winter break is something a district does — and then must explain.
The district has also not responded to my queries over whether it’s accurate that, as the teachers’ union claims, San Francisco Unified “opted out” of a state program that would’ve provided it with more than 100,000 tests. The tests were purportedly sent regardless, and have since arrived, many days late and dollars short.
Multiple doctors at the University of California, San Francisco, told me they expect omicron cases to peak in mid-January, and hospitalizations to peak a couple of weeks later (because of widespread vaccination and because omicron is, statistically, “milder” than its predecessors, hospitalizations remain lower than during the surges of yesteryear, even as cases rise exponentially).
“Let’s just plan on a month of being miserable,” UCSF infectious disease and AIDS specialist Dr. Monica Gandhi said last week. “It’s going to be a mess.”
Adding to that mess, and because of it, schools may yet close down, as they have nearby. But every expert contacted for this story, and I spoke to nine doctors, advised against doing this proactively, unless there were simply not enough teachers for schools to remain open. The doctors did not foresee schools becoming a more fertile transmission ground than society writ large, let alone the bars, restaurants and sporting venues that also remain open (and reopened well before San Francisco schools).
“The highest-risk behavior is not in-school behavior, but out-of-school behavior,” says UCSF pediatrician Dr. Lee Atkinson-McEvoy
Stanford infectious disease specialist Dr. Jake Scott adds: “I don’t think schools should ever be shut down for the sake of controlling community levels of covid. Schools have not been driving the pandemic, and closing schools should be the very last resort.”
The problem is that omicron is running rampant in society writ large. Society writ large is where we all live; teachers, too. That makes it hard to staff a school.
“We still need to mitigate covid, even if we are transitioning toward a seasonal endemic phase; we are not quite there yet,” Scott continues. “If every teacher is out sick, schools will be closed.”
Scott, meanwhile, describes San Francisco public schools’ testing decision — the decision not to provide free at-home tests prior to the break and then urging parents to test their children — as “irresponsible.”
“Mitigation strategies are important, and at-home testing is an important tool,” Scott continues. “And it’s important for us to provide these tools. It should be free, and it should be widely available.”
Like the free tests provided to his child and Atkinson-McEvoy’s children, all of whom are Oakland Unified students.
So, San Francisco Unified failed the testing test. The tests weren’t provided to families prior to the break and then families were set on a Hunger Games-like quest to procure one. But the district is not alone in failing to initiate a serious conversation about the evolving role and limitations of preemptive testing as covid becomes an endemic disease.
There’s that word again: Endemic. Essentially, this means that covid will not be eradicated, like smallpox was. Rather, like influenza or colds or certain viral infections, it’s here with us to stay.
That’s a profoundly dispiriting notion, especially as case counts skyrocket — and it’s led many people to lose hope and compare life in early 2022 to life in early 2020. That’s understandable, but it’s also facile. To start with, we have vaccines now. More than 96 percent of San Francisco public school teachers are vaccinated, and every student, too, has had the opportunity to be double-vaccinated. Omicron is far more transmissible than its predecessors, but among the vaccinated and boosted, the consequences of getting sick are, blessedly, rarely severe.
“In terms of morbidity and hospitalization? I compare it to a new strain of flu,” says UCSF’s Dr. George Rutherford, a professor of epidemiology and biostatistics.
The message that omicron is milder than earlier variants is being misinterpreted to the point that people are pondering if they should hold “chickenpox parties” and get themselves infected. To borrow a line from Linus Van Pelt, you can, if you’re stupid. Even if only a small percentage of omicron patients fall seriously ill, it’s a small percentage of a very big number, and could swamp the healthcare system. And the long-term effects of omicron are still little known.
“Even in a good flu, the estimate is 36,000 deaths in the United States,” Rutherford continues. “Bottom line: You don’t want to get this. We need to exercise caution, and testing is part of that.”
But there is a continuum between exercising caution to not catch an endemic sickness and inducing societal upheaval. We do not preemptively test people for colds or the flu. We do not proactively shut down schools or businesses to reduce transmission.
This is the difficult discussion we need to have in the coming months. Dr. Anthony Fauci broached it when he said that the focus needs to be on hospitalizations rather than case counts (“The impact on society should be measured not on how many people are blowing their nose but on how many people are really getting sick,” he told the New Yorker). UCSF’s Gandhi made similar points in the New York Times.
Eventually, Americans will have to accept that covid is going to stay in our lives. We will have to take sensible precautions — masking, ventilation, testing. But if you catch the disease, your vaccination and booster likely enables you and your family to recover in several days and then return to what will now pass as regular life (Unless a diabolical new variant comes along and ruins everything).
You and your family may already have dealt with this. Mine has. Multiple times. We’re dealing with it right now.
Among medical professionals, learning to live with the presence of covid is not a particularly controversial notion (How I Learned to Stop Worrying, and Love the Virus, you could call it).
The controversy comes in when we should do this.
“I do think we need to start thinking about covid as something that is going to be with us for the long term, just as colds and other viral infections are with us,” says Dr. Adithya Cattamanchi, a UCSF professor of medicine. “At what point are we ready to say that we’re not going to be able to prevent cases, but need to minimize the consequences of those cases?”
The midst of an omicron surge may not be the most appropriate (or politic) time to do so. And a monomaniacal focus on testing isn’t helpful, either. “How effective is masking?” Cattamanchi continues. “Can both staff and kids upgrade masks? Is there adequate ventilation in schools?”
There are, in fact, quantifiable measures of how well ventilated a structure is. My questions to San Francisco Unified regarding such measures in its schools have not yet been answered. Nor have questions about school policy regarding where kids take off their masks and eat.
The “sickouts” undertaken by teachers in both San Francisco and Oakland — which, frankly, more closely resemble wildcat strikes — may rankle put-upon parents. But, methods and timing aside, teachers’ demands for additional sick time, more accessible testing or better masks hardly seem to be exorbitant; this is not akin to asking for mass installation of toilet lids.
Doctors, Cattamanchi notes, aren’t expected to bring their own personal protective equipment to work; hospitals provide that. He can’t see why teachers, or any essential worker, should be expected to provide his or her own PPE.
As for enhanced testing availability, that’s not unreasonable, either. Gandhi is of the mind that we should be moving away from testing as covid grows endemic, but she still feels that we, as a society, can’t do that until these difficult discussions have been initiated and explanations have been made.
“If you’re not ready to say, ‘covid is not going away,’ you have to give people tools to try to contain it,” she said.
So, for whatever reason, San Francisco Unified failed this test. And failed to explain why it failed. No surprise there: UCSF’s Dr. Kirsten Bibbins-Domingo notes that messaging has been abysmal and credibility-destroying, from the U.S. Centers for Disease Control on down.
But there’s time yet to make up for it. Or not. Either way, the semester is just beginning. It’s going to be a long one.
Update: Following publication of this story, SFUSD sent this communique.