The Importance of Being Honest

Sometimes we have to sacrifice for public health. But don't deny the sacrifice itself.

1As summer draws to a close and Covid continues to rage across the US, I really, really do not envy parents of kids under 12. It sounds like kids will be able to get vaccinated soon-ish, but at the moment, parents are facing an impossible choice: Send their kids to school and risk them contracting and potentially spreading a novel disease, or keep them home and suffer all of the attendant consequences — learning losses, social isolation, potential loss of parental income, and on and on. This is only exacerbated in areas where profoundly irresponsible and cynical Republican politicians have banned mask and vaccination mandates for schoolchildren, putting their own reelection campaigns over the health and lives of their constituents.

But navigating these impossible questions — and not just for parents, but for the public more broadly, and for policy-makers specifically — isn’t helped by denying the complicated reality. Which is why I’ve been so troubled to see a bizarre push from some proponents of stricter anti-Covid measures (a group I’m generally a member of) to downplay the real and devastating downsides to at-home learning, among other Covid protocols. Yes, downplaying or even denying all the bad that comes along with keeping kids home may strengthen your “side” in the debate against the ghouls who are still in pandemic-denial while their unvaccinated neighbors drop like flies. But good public health decisions aren’t made by taking political sides. They’re made by evaluating the evidence, weighing risks, and looking at the total impact of any decision.

The impulse to downplay inconvenient outcomes of one’s own position has been in full force throughout Covid, and with the school reopening + Delta, it’s gotten even more extreme. I keep hearing, for example, that wearing a mask is no big deal and anyone who complains about masking is probably a Covid denialist reactionary. This is pretty weird, because it seems to me to be obviously, demonstrably true that wearing a mask is an inconvenience and a personal and cultural sacrifice — it means you can’t fully read other peoples’ facial expressions, it impedes basic human interactions, it makes you break out, it irritates your face, it fogs up your glasses, and I find that when I wear one I start to feel a little disoriented after a while, especially inside under bright lights. Wearing a mask sucks! But it sucks far less than giving someone else Covid, or getting Covid yourself. And so of course, in scenarios where people are not all fully vaccinated and infection rates are high, we should continue wear masks inside. I wear masks inside and I think indoor mask-wearing for essential activities should be mandatory (I also think vaccines should be mandatory for inessential activities, like dining out).

But you can make that case that mask-wearing is worth the burden without denying that mask-wearing is in fact a burden. And even better, you can focus on more effective ways to reach your ideal goal — less death and disease — via less burdensome measures.

We’ve long seen this in other areas of public health. Lots of people find that wearing condoms, for example, is burdensome — it’s not as pleasurable as sex without them. Sexual health advocates and researchers could deny that that’s true and berate people who express that view, or they could offer a compelling reason to wear condoms — they are the most effective way to prevent contracting HIV and other STIs if you’re sexually active — while also working hard to come up with better ways for people to have sex without contracting a deadly disease. And that’s exactly what they’ve done: There has been a long-standing push for designing a better condom, and also a hugely successful effort to develop a whole variety of HIV-related technologies: today, treatment for HIV that means diagnosis is no longer a death sentence; we have a prophylactic pill that reduces the probability of contracting HIV by 99 percent; and we may even have a vaccine for HIV very soon.

You can probably see the parallel to masking and Covid. Mask-wearing still the best option in a lot of scenarios. But noting that it’s a wildly imperfect and burdensome option, wanting better options, and demanding that those better options be available to more people (and that people make use of those better options where they can), is not the same as being anti-science or indifferent to public health.

There are similar lessons when it comes to school closures. It might be the right public health decision to maintain remote learning in some areas with high infection rates. It might also be the right public health decision to get the vaccine approved for under-12s ASAP, require all education staff to be vaccinated, and send kids back to school (mandatory vaccinations for educators and staff, as New York City is doing, seems like the minimum of common sense). Maybe reopening schools even without full vaccination is the best path forward, on balance, given the relatively low death rate of kids from Covid. I don’t have kids, but if I did, I imagine I wouldn’t feel super confident about the argument that Covid has only killed a few hundred kids; I imagine I’d also be incredibly desperate to have my kids back in school so that I could work and not risk permanently derailing my career. So I have nothing but empathy for the parents who say there’s no way in hell they’ll send their unvaccinated kid into a room of other unvaccinated kids while Covid continues to kill younger and younger people; I also have nothing but empathy for the parents who say that their kids need to be back in school as soon as humanly possible, and that we should be focused on getting them vaccinated. I don’t know the perfect solution when it comes to kids and school in the time of Covid; that’s outside of my pay grade.

What I do know is that we make bad decisions when we are simply reacting against a perceived enemy or wrong person. And I know that public health officials, politicians, experts, and those of us in media stand to lose public trust when we deny the glaringly obvious.

One thing that is glaringly obvious: School closures and at-home learning has been largely devastating for students and their families (and mostly their mothers). That’s true even though a bunch of reactionary bad actors who don’t give a damn about human life also say that school closures and at-home learning has been largely devastating for students and their families.

And it is profoundly unhelpful, and mind-bogglingly dishonest, to say, as one prominent public health professor recently did, that being out of school for a year (or two) is no big deal because a century ago, there wasn’t really much in the way of mandatory schooling, and so young people simply not getting a high school education is not an “unknowable scenario” but a well-known fact of human history. This same professor — who is often quoted as an expert in prominent publications — pointed out that a lack of mandatory schooling “was normal life for most of human history.”

That’s true! Lots of really less-than-ideal things were also part of normal life for most of human history, including women commonly dying in childbirth, endemic child abuse and neglect, and couples having more than a half-dozen children and expecting several of them to die before they reached adulthood. That is all certainly normal by any read of the historical record. But that doesn’t make it desirable, or even acceptable in the modern world.

Education is part of the picture that improves broad public health. The stats are all pretty well known: Girls who go to school are less likely to marry young and more likely to plan their pregnancies. They are less likely to die in childbirth and their children are less likely to die in infancy. When they reach adulthood, their kids, and particularly their daughters, are more likely to go to school; the more education a woman has, the better her kids do by pretty much all measures. That’s true in the developing world as well as in prosperous and developed nations like the US.

We also know that attending school in person decreases all kinds of less-than-ideal outcomes for young people, including unintended pregnancies and getting involved in criminal activity. And we know that Covid school shut-downs have disproportionately hurt the kids who were already vulnerable — poor kids and kids in under-funded school districts, who are disproportionately students of color, and kids with unstable home lives. Wealthy, highly-educated, and/or well-connected parents certainly felt the strain of Covid school shutdowns, but were able to use their resources to help their kids make it through with fewer problems — they were largely able to set up learning pods, or send their kids to private school.

And they simply had the education, skills, and basic know-how to supplement their child’s learning at home. When one in five American adults is functionally illiterate, you can pretty well bet that a whole lot of parents — mostly parents without college degrees, often parents who are poor — were simply not able to help keep their kids on track when Covid shut down their schools and learning went remote. The kid whose mom is a lawyer or a New York Times reporter or a professor at Boston University is going to wind up with a better at-home education than the average American kid. And these kids of the highly-educated already had a big leg up; they were already the kids winning the race, who were college-bound and clustered in well-resourced schools in the pockets of urban areas where most parents are similarly educated and affluent. They certainly took a hit from Covid, but I’d guess it will turn out to be a relatively small one. The kids who were already struggling, though — who were already on the butt end of American inequality — a lot of those kids have spent the past year tumbling even further down. An appalling proportion of them have simply dropped out and not returned, or have not started schooling at all.

For too many kids in the US, school is the only place they get a consistent meal. School may be the only place where there are adults who read to them, or care about them, or show them any affection. For too many kids in the US, home is unstable, brutal, and dangerous — and when the stress of job loss and kids at home all day is added to an already volatile situation, rates of child abuse skyrocket. When kids aren’t in school and are isolated from their communities, there’s no one to notice. There are real dangers to America’s lax homeschooling rules even in the best of times. Those dangers grow exponentially worse during times of illness and stress and isolation.

You can also pretty well bet that it’s women who will again bear the brunt of school shutdowns, and that this time around, working-class women will be even harder hit as the more affluent women who weathered the last Covid storm are able to afford better work-arounds this time. Already, the women who lost their jobs or were forced to drop out of the workforce were disproportionately single mothers, mothers of young children, and mothers of color. That’s partly because the industries decimated by Covid shutdowns were female-dominated, but it’s largely because mothers without partners and mothers with young kids simply had no good options when schools closed: You can’t leave a little kid at home alone, or even home with you but largely unsupervised, for eight hours a day (or more) while you work. Schools, we collectively learned, are about educating kids, and are also crucial to women’s ability to work outside of the home, being as it is that women are largely still largely charged with childcare, even when nearly all children have fathers (and it’s women who crucial to men’s ability to work outside the home).

When women drop out of the work force, it has wide ripple effects. Boys who grow up with stay-at-home moms grow into men who are more sexist at home and at work than sons of working mothers. Daughters of mothers who don’t work do worse in school than daughters of working mothers; they have less equal relationships and less satisfying and well-paying careers. And working is good for women. Financial independence gives women more of an ability to leave an abusive relationship; it brings with it a sense of accomplishment and purpose; and it fosters important social connections, which may be why working mothers tend to be less depressed than stay-at-home mothers.

What doesn’t work for working mothers — what makes them stressed out and anxious and miserable — is the combination of overwhelming caregiving demands and overwhelming workplace demands. American women were already hanging by a thread pre-pandemic, living in a country with zero support for women and families. School, at least, provided a few hours a day where mothers could work, or go back to work, without paying for childcare. When that ended, this whole sexist house of cards fell down: Kids needed someone to look after them, and men largely refused to give up their livelihoods to do it. So women, the assumed caregivers of the world, did. That came at great personal and hard-cash cost. And we know that once women leave the workforce, getting back in is much more difficult, and they take a permanent, life-long earnings hit.

All of which is to say: Going back to remote learning in the fall still might be the right decision if it’s what’s necessary to save thousands upon thousands of lives, as was true last year. There is no one perfect solution in the midst of the evolving realities of a pandemic.

But it is certainly the wrong strategy to deny the costs of whatever you think is the correct public health decision. It’s wrong for the school reopening crowd to deny the very reasonable fears of so many parents, or to brush aside the reality that “only a few hundred kids have died of Covid” is meaningless when it’s your kid you’re worried about. But it’s also absurd and dishonest — and really, really dangerous — for trusted voices in public health to deny the tremendous costs of shuttering schools because it suits their policy preferences.

I am not on Team Send Kids Back To School Now. I’m square on Team I Don’t Know, which I realize is a very unpopular and boring place to be. But at a minimum, we owe it to consider these big, difficult questions with the depth they deserve, and to approach them from a place of seeking the best solution out of a whole list of bad ones — not from a place of trying to justify our preferences at all costs.

The sacrifices we make to keep each other safe — from wearing masks to driving below the speed limit to requiring vaccinations to wearing condoms to closing down institutions when there’s a high potential to spread a deadly disease — are part of living in a society. But public health mandates must be the result of a careful weighing of costs and benefits. Doing that responsibly means reporting the costs accurately and weighing them against the benefits accordingly, not putting your thumb on one side of the scale.

xx Jill