People place enormous confidence in public health authorities. Just the name “public health” suggests someone who is devoted to, well, the public’s health. Unfortunately, people who call themselves public health authorities oftentimes have undisclosed conflicts of interest which render their advice anything but healthy to the public. For example, when Dr. Frieden was New York City Health Commissioner, he served at the pleasure of Mayor Bloomberg. If he had done anything to displease the Mayor, he would have been out of a job. So, when he advised keeping the schools open, was he doing it because he believed that no children would get sick and die or because Mayor Bloomberg told him that closing the schools would hurt New York City’s economy? We don’t know what was in Dr. Frieden’s mind. But we do know what happened: children got sick and died. Similarly, when Dr. Frieden strongly argued (some would say ordered) that schools stay open throughout the United States this Fall, was he saying that because he thought kids would not get sick and die or was he doing this because the White House told him that closing schools would hurt the US economy? Again, while we don’t know what was in Dr. Frieden’s mind, we do know what happened: kids got sick and died.
Dr. Michael Osterholm warned of the negative consequences of a pandemic for many years. He founded the Center for Infectious Disease Research and Policy (CIDRAP) which is associated with the University of Minnesota. This had been a reliable source of information on influenza and pandemic issues. All of information on this site is free and open to the public. However, a new site, called CIDRAP Business Source, was created a couple of years ago. This appears to be a for-profit business aimed at top executives. Peter Sandman, a highly paid PR consultant, played a key role in its creation. Dr. Sandman’s list of customers is heavily weighted towards large multinationals. Access to CIDRAP Business Source costs $897 per year. They also hold very expensive conferences. How much money do Drs. Osterholm and Sandman receive from large multinationals? Its hard to know. Does receiving money from large multinationals while giving advice to the public on what protective steps to take during a pandemic constitute a conflict of interest? In my opinion, yes, it does.
One of the big concerns businesses have about a pandemic is absenteeism. If too many people stay home, businesses will lose money, perhaps a lot of money. However, social distancing is well-established as the most effective strategy to limit the spread of the virus before a vaccine is available. And closing schools is the most effective of all social distancing methods.
From Glass et al. (2006) Targeted Social Distancing Design for Pandemic Influenza. Emerging Infectious Diseases:
For influenza as infectious as 1957–58 Asian flu (≈50% infected), closing schools and keeping children and teenagers at home reduced the attack rate by >90%
From Markel et al (2007) Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic. JAMA.
Those cities acting in a timely and comprehensive manner appear to have benefited most in terms of reductions in total EDR [weekly excess death rate]. For example, St Louis, which implemented a relatively early, layered strategy (school closure and cancellation of public gatherings), and sustained these nonpharmaceutical interventions for about 10 weeks each, did not experience nearly as deleterious an outbreak as 36 other communities in the study …
But we really don’t need these studies to know that school closures and other forms of social distancing are the most effective methods for slowing the spread of the virus. When schools let out in the summer, the number of infections with H1N1 went down. As soon as schools started up again, the infections, and deaths, immediately increased. This should be obvious to anyone paying attention.
So, we have a clear conflict between what is best for business and what is best for public health. Businesses will make the most money if the schools remain open and people continue to work normal hours. The public health is best served by closing schools. This will increase absenteeism as at least one parent will have to stay home with the kids.
Dr. Osterholm was asked about school closings in an interview on NPR yesterday with Larry Abramson:
Dr. MICHAEL OSTERHOLM (School of Public Health, University of Minnesota): Children are going to transmit the influenza virus whether they’re in school or not.
ABRAMSON: Dr. Michael Osterholm of the University of Minnesota says school closings cause huge problems. That has to be balanced against the slim chance that a closing will slow the spread of the flu.
So who was Dr. Osterholm representing in this interview, the public’s health or the businesses that pay him? We don’t know. There is no indication in the interview that he disclosed his conflict of interest.
Public health authorities are apparently spending a lot of time thinking about the impact of school closures on business profits. Here’s a suggestion, spend a little bit of time reading the stories of the children who have died from this virus, most of whom got it in schools. You won’t find this list at the CDC or CIDRAP.
But you can find it at PFI_Forum where Homebody and many others have painstakingly combed through news reports to put it together, oftentimes with keyboards stained with tears: US Child Deaths – August and September