Today, the News and Observer reported that “North Carolina saw its COVID-19 numbers continue their week-long soar Thursday, breaking records for both single-day reports and hospitalized patients. Hospitals hit a new high point for COVID-19 patients for the third-straight day Thursday with 4,275 — a total that has more than doubled in the last month.” The New York Times reports that Duke Hospitals ICUs are at 100% of capacity — and that is now. Hospitalizations lag cases by several weeks. Meanwhile the Duke dashboard for last week showed this:
The Chronicle correctly reported that this chart says that the “positivity rate” is 5.88% — which is incredibly high — but that figure is misleading. That is the number of positives divided by the number of tests. What we care about is what percentage of people are infected — and the answer is 8.33%. In a class of 40, you probably — right now — would have three infectious people. Breaking that down, of those tested, 635 of 8814 students were infected— 7.2%. The faculty and staff percentage was even worse, 12.875%.
What do the student numbers tell us? These are healthy young adults all of whom are double vaccinated and many of whom are boosted, yet they are getting infected at this rate. The number of breakthrough infections is going to skyrocket and we have not yet reached the peak. That will come soon — over the next two weeks.
Amidst all this, Duke’s administration came up with a stunningly brilliant plan. Restart in person classes! No, you didn’t read that wrong. With cases higher than they have ever been, with hospitals bursting at the seams, with a positivity rate last week on campus of 8.33%, they thought this would be just a dandy time to reopen. Oh, and they’ve been allowing in-person attendance at basketball games, because nothing says ‘academic principle and deep concern for public health’ better than 9000 screaming people in a poorly ventilated auditorium.
Readers who missed this news might think that this is a satire from McSweeneys Internet Tendency or The Onion. Sadly for us, it is the truth. What would better decision making look like?
First, more transparency. The university knew of these numbers last week and didn’t tell us until Monday. They will already have in their hands the preliminary testing results for this week — the announcements make no mention of them. That’s not acceptable. Sure, Omicron is milder and a healthy 20 year old probably feels invulnerable — though what we are learning about long-COVID is worrying. But some members of the university community have young, unvaccinated kids or autoimmune problems. They need prompt, adequate information to make informed decisions. Giving up control of when the information is squeezed out, drop by painful drop, is hard for administrators to do, because they want to manage and massage it and not have us get upset. But right now, this is a matter of public health. If they are to maintain, or rebuild, trust, they need to be more transparent and timely with data and clear about their goals and metrics.
Second, social concern. Duke hospitals are already full. Hospitalizations lag infections by about 2-3 weeks, deaths by 3-4 weeks. We have not yet hit the top of the surge. Everything we can do to flatten the curve — knowing eventually we will all be infected — we should. The university allows the students to attend games in Cameron because “that’s a voluntary risk.” We don’t accept that argument when someone says they are “choosing” not to wear a mask, or to forego a vaccine. Why would we accept it here? Was this decision kowtowing to big money college sports or a cynical attempt to encourage super-spreader events that bring about herd immunity? Neither is attractive. We are not acting like an institutional good citizen in our community. I love the Cameron Crazies. Not the Omicron Crazies.
Third, there is good news amidst this tragedy. Omicron is the vaccine that the vaccine-deniers will not be able to resist and it is mandatory, without Biden or Fauci. The crest is coming. But the drop should be equally fast. If the university can just stay virtual until after Spring break we might have far better numbers and in the process we will be protecting faculty and staff with young kids, or with auto-immune problems or other conditions. Omicron may be milder, but 50% of the surge that is coming is still gigantic and it will hit a health care system that will be under-staffed and wildly overtaxed. Yet if Duke can avoid jumping the gun, relatively soon hospitals will have more beds. We will have more antiviral and monoclonal antibody therapeutics available. Kids under 5 might even be eligible for a vaccine, we just need to hang on.
The graph below from the New York Times depicts New York’s experience. It shows what is coming. Focus on the wave of deaths, 21 days after the infections start to rise. Remember, that graph shows cases as of December 18th. We have not yet reached the peak. The university loves pushing people back into classrooms, loves making fans and donors happy by allowing in person access to games. When they do, they should think of this graph. They are choosing to impose this on vulnerable members of our community. They are choosing to allow super-spreader sporting events, with cavalier disregard for the people — many of them not in the stadium — who will be infected. They are choosing to be irresponsible in vastly increasing the burden on our hospitals — many of which will have staff out because of the illness. When tragedy comes — and it will — let it be recorded that it was their choice. Finally, they are choosing to do all of this by means of an opaque decision making process, with an inadequate exemption procedure that fails to protect all of the vulnerable members of our community and their kids. Universities are supposed to teach people to make good choices. Don’t look to our administration — let us officially name them “the Omicron Crazies” — for a role model.
There is good news amidst the darkness. If we can just hang on 2 months more, we will pass the peak and begin to see the daylight again. Therapies will be arriving in increasing quantities. Hospitals will start to be able to handle their caseload.
We can hope for an end, or at least an endemic, a manageable endemic. Until then, let us hope that the administration will return to its senses and that we will see a more transparent, socially responsible decision making process. The Omicron Crazies don’t deserve our support.
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James Boyle is William Neal Reynolds Professor of Law at Duke Law School.