Each November while I am teaching, I prepare for infection. As someone with lifelong respiratory disease and immune challenges, I know a respiratory infection lies in my near future. I teach at an institution with 60,000 students and over 30,000 faculty and staff. I know that am going to get sick, and every year I do. In my 21 years at my current job, I have had well over 60 rounds of antibiotics, a dozen or more rounds of prednisone. And those are the good years, when I don’t get the flu and pneumonia.
This year I got the flu. It was not a surprise. 24 hours after my first session with a class of 33 (in an elegant classroom far too small to hold us), I got the first of what would be several notes from students letting me know they had just been diagnosed with influenza. Within four weeks 20% of the class had contracted the disease. Influenza is scary for me every time: it brings back traumatic memories of childhood asthma and nightmares of suffocation that all lifelong asthmatics know well. This one was a little scarier, because the day I was diagnosed, the Chinese government had just quarantined Wuhan, a city of 11 million.
Though this was one of the worst flu seasons in recent decades, it still pales in comparison to the 2009 H1N1 outbreak, in which the total number of infections surpassed even the 1919 Spanish influenza (although, thanks to modern medicine, the deaths were dramatically fewer). In 2009 my wife and youngest son contracted the H1N1. I remember how hard it was to get students to take the dangers of the disease seriously, and how surprised I was that the university took no meaningful measures to mitigate its impact on the classroom. But we got through it, and in the end there were only 52 deaths in my state from the flu, with only a couple of them in the 15-24 age group.
COVID-19 is not the flu, of course, and unlike the flu which we have been studying in its many forms for more than a century, the novel coronavirus is by definition unknown. For example, without a history of any kind we don’t know how the summer heat will effect it, what immunities are provided by surviving the disease, or many of the factors contributing to the growing number of variations in the virus’s impact on individuals. But we do know some things that suggest parallels to the flu are worth pausing over.
Seasonal flu is regularly the 8th leading cause of death in the U.S. each year. For those over 65 (and younger than 1) it is especially deadly, with risk increasing steadily with age. However, for the college-aged population, the mortality rates of the flu are relatively low. Here are some numbers from the CDC:
In 2017 influenza accounted for 190 deaths among 15-24 year olds. (By comparison: there were 782 deaths for ages 35-44; 2013 deaths for ages 45-54). The previous year saw 189 deaths for 15-24 year-olds. We don’t yet have numbers for this year’s severe flu season, but the deadly 2009 H1N1 season resulted in mortality numbers more than double the average rate, with 418 deaths for 15-24-year olds. Influenza is not a reportable disease, meaning these numbers are almost certainly below the actual flu deaths for any given year, but it is a useful reminder of the risks we face every winter when we go to work, school, places of worship, sporting events, etc.
Numbers for COVID are of course very rough as the disease unfolds, but unlike influenza this virus is being tracked as no virus in history before has been. The CDC reports the total deaths among 15-24 year olds due to COVID is currently at 59, roughly a quarter of the estimated deaths from this year’s severe flu. All the available evidence suggests that for most college-aged individuals, they are in the safest age group to be in terms of mortality and long-term debilitating impacts from COVID. Why, given our willingness as a society (and as educational institutions) to accept a couple of hundred deaths a year due to flu, are we not willing to accept lower numbers for COVID for the same age group?
The answers to the above question (which is not rhetorical) are varied. Here are a few:
- Knowing as little as we do about COVID, it is irresponsible to bring back more than 90K individuals to residential and educational spaces that make social distancing difficult and frankly unlikely.
- While young people may be relatively safe with regards to the disease, the same is not true for older faculty and staff, particularly those over 60, where risks of death and severe complication ramps up considerably.
- College students are mobile, returning home on weekends, creating increased vectors that will negatively impact our home community and many communities beyond—including those ill-equipped to manage a sudden uptick in cases.
All three of these are valid. But again, let’s consider the flu. We knew early on this year that the vaccine was largely a miss, and that our region was going to be hit by both Influenza A and B strains at the same time. While we did not know how severe the flu season would be, we knew it would be worse than the usual number of deaths and debilitations—and we knew that having students on campus would increase the risk both for our students and staff, but also for the families and communities to which they would be returning. We knew it, and we accepted it. Because the influenza and its devastations are the opposite of “novel”—so familiar that we don’t blink at them and indeed struggle to even get people to vaccinate despite knowing that doing so most years reduces risk exponentially.
For myself, an asthmatic on the cusp of the higher-risk 55-64 demographic, I go to work each winter knowing that doing so might kill me. I also know that if another H1N1-type year came along, my university would afford me the opportunity to teach online along with various accommodations to reduce contact with students and colleagues. And indeed, I am confident that this year similar accommodations will be available to faculty, staff, and students who are high-risk for severe COVID cases should we return in the fall.
In terms of the question of broader vectors beyond the campus community, such projecting and planning strikes me as the work of state and national health officials. This year, we shut down our campuses in March to allow our hospitals to prepare for the rapid increase of COVID patients, to allow manufacturers to produce masks and other protective equipment, and to allow testing to ramp up. We did not do these things to stop the virus, but to slow it down. In many parts of the country we have slowed it sufficiently that testing and hospital capacity is where it needs to be to manage cases. In others it is not yet there, and closures and distancing remain necessary. In still others, the worst may yet be to come. This is where state and national health officials and scientists can and must make the decisions about what the system can handle. If a return to campus in the fall is followed by a sudden rise in cases that overwhelm state hospital capacities, university officials will be ordered to return their campuses to distance. But as long as the hospitals and testing can keep pace, we owe it to our young people to work towards giving them the college years they have worked so hard for should they choose to accept those risks.
My youngest son is to be a sophomore this year at the university where I teach. He lives in a tower dorm that is pestilent on a good day. And he wants to return more than anything, and has already decided he will take a year off if there is no in-person college this coming year. I am fine with his returning to campus in the fall, even as I know his risk of being exposed to COVID increases in doing so. He also risks being exposed to the flu, to drugs and alcohol, and to all the other factors on campus that increase a student’s risk of traumatic injury and death. Each year, several of our students die. They die from suicide, lonely and lost in a massive institution. They die from violent crime. They die from alcohol or drug overdoses. They die by getting hit by a car crossing High Street. They die falling off construction equipment or drowning in the campus lake. When I sent my son off to college last year, I was afraid for him, because I know well all the risks that come with college. But I accepted those risks because I know also how important college was to him and how hard he was working towards the career to follow. I accept those risks because that is what we do: we let our children go further and further from us into increasingly dangerous waters.
Yes, sometimes they die too soon. But what is the alternative? Do I keep my son in my house into the future, knowing he will be safer under my roof from the dangers of violent crime, vehicular accidents, and disease? Were I to do so, I would be regarded quite rightly as a monster. We have numerous representations in popular culture of such parents: Mrs. Bates in Psycho, Mrs. Lisbon in Virgin Suicides, Margaret White in Carrie. These representations exist in part to remind us that our jobs switch over the course of our years as parents from keeping our kids safe to, quite literally, putting them at risk. The alternative is to risk them ending up like Norman Bates, the Lisbon girls, or Carrie.
There are other issues I could address, including my more selfish desire to save jobs that will inevitably be lost if my university remains locked down next year. But honestly those are secondary to my desire to allow my students and my son to make their choices and take their chances. Unless it changes dramatically, COVID will almost certainly not kill them in any higher numbers than any of the other risks that come with going to college. College is after all at least in part about risk: being exposed to “dangerous” ideas that destabilize long-held beliefs being exposed to new people, some of whom are dangerous; and stepping away from what is for most students a space of shelter, sustenance, and security into an unmapped landscape that opens onto a future all the more uncertain in the wake of 2008 and COVID-19.
The world this generation is entering into is more unknowable than anything my generation had to encounter. I can’t protect my children or my students from that future, but we can care for them, be there for them, and help arm them with as many tools as possible in our short time with them. To do that right and do it well, we need to be on campus, where students have office hours, counseling sessions, academic and residential advisors, student groups, and, yes, a major research hospital. Some students will die this coming year, as they do every year. And, as we must and as we should, we nonetheless open our gates the following year to more students, knowing some will die. Because we know the vast majority will live fuller and better lives because of the risks we enable them to take.
Jared Gardner is a professor and patient at the Ohio State University.