September 20, 2020

The worst is yet to come (Part 3): Is this the right time for in-person instruction in colleges?

The worst is yet to come: (Part 1), (Part 2)

Image by Syaibatul Hamdi from Pixabay

In two weeks, Northampton Community College will reopen its doors. For some, this is an exciting time, for others it’s rather a worrying time.

NCC’s plan for reopening was developed by a committee chaired by Vice President and Chief of Staff Dr. David Ruth and Dean of the School of Allied Health & Sciences Dr. Judy Rex, along with members of the college’s nursing department and with guidance from St. Luke’s medical staff, according to Brad Drexler, director of marketing and communications.

Among the various instructional formats that NCC will offer in the fall, “hybrid,” a mix of 50% face-to-face and 50% online classes, is deemed a safe option by its authorities. The devil’s advocate could argue that even if the entire hybrid course format consisted of 995 minutes of online classes and five minutes of in-person instruction, this short time is enough to spread infection in the classroom.

“Colleges are deluding themselves,” wrote Michael J. Sorrel, Ed.D. for the University of Pennsylvania and president of Paul Quinn College, a historically Black school in Dallas, Texas. Like NCC, the population he serves is “economically vulnerable, of good people who have been underserved and largely ignored.” Dr. Sorrell, a Black man himself, is serious about the pandemic not being well understood.

The essential question his team asks is, “Do we serve the students and families who appear at our door each fall, full of hope and faith?” Reopening schools for in-person classes is rather a disservice. He’s against “gambling on human lives.”

Sorrel is quick to point to two factors, fear and acquiescence, pressing for college reopening. Fear for the financial damage of an empty campus; many colleges cannot survive upon online-only format.

However, Dr. Sorrel warns, “If a school’s cost-benefit analysis leads to a conclusion that includes the term ‘acceptable number of casualties,’ it is time for a new model.” In his view, exploring options to avoid financial disaster are not synonymous of bad leadership.

The other reason forcing higher-education leaders into questionable decisions is “their refusal to stand up to the unrealistic expectations of many faculty and staff members, students, alumni and other stakeholders.” Sorrell is clear about one thing: “If you are a college president right now, not everyone is going to like what you do. But if you are fair, honest and transparent, you will be respected; and its always better to be respected than liked.”

Because this crisis was mismanaged from the start, inexorably a price has to be paid. “Life is going to be hard for the foreseeable future [even harder because of the mismanagement]. For college students, those sacrifices will include long periods of remote learning,” Sorrell said.

Recent developments at powerful, financially stable institutions seem to be aligned with Sorrell. Harvard, Princeton, Stanford, Columbia are not holding in-person classes for undergraduates.

Even at the K-12 level, online-only will be the mode, for example at the private St. Andrew Episcopal School, attended by Barron Trump. Dr. Sanjay Gupta, CNN’s medical expert, chose the remote option for his three teen and preteen girls. California mandated remote learning for elementary, middle and high school.

Institutions in Florida are fighting to avoid operating on the hybrid format. In a letter to Governor DeSantis, the faculty union urged him to direct college campuses to reopen this fall with online-only courses.

Pointing to the number of fatalities from the Department of Health, United Faculty of Florida Vice President Jaffar Ali Shahul-Hammed said something memorable: “When you see this data, please know these are not numbers. They are human beings, daughters, mothers, fathers and loved ones and in some cases, lone breadwinners of their families.”

(This insensitivity with human losses, considering them just numbers is what Tess Wilkinson-Ryan, law and psychology professor at the University of Pennsylvania calls “’psychophysical numbing,’ this confounding juxtaposition of the mathematical and the existential where Americans live now.”)

At a Congressional hearing on Aug. 3, Dr. Fauci said “we should try as best as we possibly can” to reopen schools for both the psychological and physical welfare of children and to avoid the effects closures will have on families, but without compromising the health, the safety, and the welfare of the children, of the teachers and secondarily of their parents.” 

K-12 reopening is a topic for another time. But “not compromising the health, the safety and the welfare” applies equally to college students and will be discussed here.

For that, it’s worth reviewing some aspects related to the current knowledge about COVID-19 and some of the socio-economical aspects of minorities in the Lehigh Valley (the Allentown-Bethlehem-Easton metropolitan statistical area) and the catastrophic implications that getting infected will bring to students and their families.

I. Medical, social and financial implications of being infected by COVID-19

Science has made progress on understanding COVID-19 in the last nine months. Additional symptoms have been identified, hypotheses have been formulated and companies are rushing to produce a vaccine.

A fundamental knowledge has been gained recently: airborne transmission, which means that droplets containing the virus remain in the air. Therefore, the infection risk in crowded, poorly ventilated environments is much higher.

In early July, Rutgers’ microbiologist Emmanuel Goldman (The Lancet) refuted the exaggerated attention that, early in the pandemic, “fomites” — surface transmission — received. Those early studies reporting that the virus could survive hours, even days in paper bags and metal surfaces, were based on the experimental conditions far from what occurs in real-life, according to Goldman. The “fomite” infection via doorknobs, mail, food-delivery packages, bus pols seem quite rare, but not impossible. People should still wash their hands.

Note: This key discovery serves to illustrate what journalist Derek Thompson (The Atlantic) calls the “hygiene theater.” Specific practices, not supported by the latest scientific discoveries, that are used to give people a false sense of security, whereas the real potential of infection is never attacked.

Take the small, poorly ventilated bars and restaurants that get packed. Owners loudly advertise the thorough scrubbing and bleaching taking place, giving patrons a (false) sense of safety. According to the recent update, the real infection agent in those crowded, poorly ventilated spaces would be airborne, not fomite. People should beware of feeling excessively confident.

It is also known now that specific individual and ethnic groups are more sensitive to the infection, namely seniors and Black and Hispanic people.

Many things, however, remain largely unknown and are relevant:

Reinfection occurrence

Even elected officials have advocated for getting infected, since once you get it — the belief goes — you won’t get it again. This has yet to be confirmed. First, recovery may not be that quick. The “haulers” for example, have been carrying symptoms for months. Second, unlike other viral infections, the antibodies that the body produces in response to COVID-19, would last only 90 days, meaning that re-infection is possible after that.

For a planet so anxiously hoping for a vaccine, this is critical news. The last revelation implies that vaccination would prevent infection for three months, needing a new dose afterwards.

Long-term effects

There are preliminary evidences that certain organs, such as brain, heart, lungs and kidneys could be impacted for life, in people who have recovered from the disease.

Yet, among all unknowns, the most alarming is the existence of people who don’t feel sick, nor manifest any signs of the disease, despite being infected. Unknowingly, they continue attending workplace meetings, family gatherings, places of worship — even allowing themselves not to wear mask in such gatherings. This is tragic.

Indeed, recent studies unveiled that as high as 40% of COVID-19 carriers are asymptomatic — no symptoms —and approximately 5-10% are presymptomatic — not yet displaying any symptom, because the disease had just been incubated.

This should be a giant red flag: if approximately half of all cases cannot be detected, any individual or institutional feeling of safety by checking body temperature, is unrealistic.

A note about face masks: frequently, people do not wear masks properly (i.e., below the nose, under the chin or wearing masks deemed inefficient by a recent study, such as fleece, bandana and knitted).

Older professors and staff, supporting personnel and minority-students are at higher risk.

The college population – students, faculty, administrative staff and support personnel (cooks, janitors, security officers) – comprises people belonging to different social and financial strata. Labor compensation, social benefits — pension, health insurance — and residential quality are different. It’s not uncommon that many of the low-income NCC workers and students, with medium to large families, have no option but to live in as cheap as possible, dense places.

Young adults are less mature and prone to higher risks

Typically, young adults constitute the main student body in colleges. In 2018-2019, approximately six in ten (6,000 students) at NCC were in the age range 18-24 (U.S. News).

Julia Marcus, an epidemiologist and professor at Harvard Medical School and Jessica Gold, psychiatrist and professor at Washington University published an eye-opening article (“Colleges are getting ready to blame their students”).

They offer a unique pandemic view, from the young adults’ side. First, young adults get depressed after long months of loneliness, not seeing their friends. Second, young adults have not enough maturity (as a faculty or administrator would) to manage risks. At this age, they tend to take riskier approaches, psychology recognizes. Third, specifically on COVID-19, young adults, young bodies seem to have an increased resistance to the virus [but not invincibility!] which boosts their self-confidence, encouraging higher risks.

The point that Marcus and Gold make is crucial: “College campuses that are reopening for in-person instruction are banking on the personal responsibility of students to make it all work.” They’re skeptical of such an approach. Marcus, who had worked in AIDS epidemiology for many years, knows firsthand the futility of trying to prevent infections by prohibition (abstinence). Prohibitions will be broken.

A realistic approach should rather take into account a worst-case scenario, in which prohibitions will be broken and, upon this supposition, develop optional plans.

Moreover, according to the authors, colleges that blame and punish the rule-breakers are shooting themselves in the foot. The full cooperation of offenders is essential to obtain the list of party attendees and friends, thus tracking accurately every and each potential spreader. Without their help, the crisis will worsen. 

The handicap of not having health insurance

The lack of health insurance is affecting millions of people at a time they need it the most, i.e., during this pandemic. Kaiser Foundation estimated that 27 million people have lost their health insurance. This touches a nerve at home: many NCC students and their families, NCC support workers and even adjunct professors lack health insurance.

The unfair cost of hospitals

Often, infected people who stay at home get worse. When, as an example, the lack or air becomes intolerable, they need to be taken to the ER. There, they receive basic treatment and monitoring of vital signs in real time. If no improvement is verified, they remain in the hospital. Several days may elapse and, if the condition worsens, intubation may be the alternative. None of these steps get a free ticket. To give you an idea, an 11-mile ambulance ride from home to the ER will cost you $1,470 [a service that is run by the Bethlehem Township volunteer Fire Company].

Hospitals in this country are unique, they’re non-profit, which confounds many people. The non-profit status gives them tax exemption (no property tax, no state or federal income tax, and no sales tax) with a commitment to give free assistance to the community at some point. The extent to which they provide that assistance is hard to track. Six in ten community hospitals are non-profit. But do not be mistaken, they do profit (Medical Economics). Such extraordinary profit translates into new constructions (highly visible in the Lehigh Valley), shiny equipment, generous executive compensations, political contributions and lobbying (some $400 million in the last 10 years). Any attempt to regulate the industry has failed precipitously.

Early in the pandemic, last April, CNBC reported that the price of COVID-19 hospitalizations averaged $30,000. A second report was more specific: “Those who are hospitalized with coronavirus can expect to pay anywhere from $42,486 to $74,310 if they are uninsured or if they receive care that’s deemed out-of-network by their insurance company, according to recent analysis by independent nonprofit FAIR Health. For those with insurance who are using in-network providers, out-of-pocket costs will be a portion of $21,936 to $38,755, depending on the cost-sharing provisions of their health plan.”

One thing that healthcare institutions provided for free during the pandemic, getting the media attention, was providing free tests (likely the cheapest service on the hospital’s list price).

Given the secrecy that surrounds healthcare prices in the U.S. (healthcare is the only American industry in which the consumer knows the price afterwards), two examples are given here.

In the pre-COVID-19 era, St. Luke’s Hospital’s practice with low-income patients was charging the bill to Northampton County through an organization called PATHS, provided that the patient had qualified for assistance. In one major surgery, negotiations between the county and the hospital reduced the bill by 81%, and the county paid the remaining one-fifth of the bill ($90,000).

A similar discount percentage (20%) was obtained for another surgery, hemocolectomy. Negotiations between the hospital and the patient’s insurance company, BlueCross BlueShield, resulted with a nearly $20,000 bill, 20% of the total, paid by the insurance company (the patient copay was around 2.5% of the final bill).

The scary question is: what if the patient doesn’t have the county or a health insurance company to negotiate the final hospital bill delivered to the patient, respectively $470,000 and $103,000? This is the nightmare that seniors living on social security face: their homes may be the only earthly possession to pay the hospital bill.

Back to COVID-19, assuming that the patient gets better at the hospital, they’re sent back home; with good luck they will recover within weeks and return to work, if that option is available.

However, the hospital bill is there and worse, if the patient is uninsured, thousands of dollars remain to be paid.

The high cost of death

If things turn for the worse and the patient dies, however, there is another set of bills that relatives are responsible for. A price survey by Funeral Arrangements Guide found that $7,775 is the average funeral cost for an adult in Bethlehem.

“This is based on the most commonly selected items for a traditional funeral including a casket and vault. However, it does not include cemetery costs in Bethlehem. A grave space, a grave marker and opening/closing the grave can easily cost another $1,500 to $2,500. Therefore, a typical traditional funeral and burial cost is likely at least $9,000.”

Either way, if the COVID-19 patient recovers or dies, low-income families, as is the case of approximately 3,600 NCC students, will be liable got hospital / funeral bills for years to come.

It will never be justifiable mandating the students to take risky hybrid classes. The humanitarian side should prevail.

II. Minority communities in the Lehigh Valley

Out of 672,000 people in the Leigh Valley, approximately 144,000 are Hispanic, which is the largest minority group. In this discussion they’re taken as representatives of other minorities.

Even though the Hispanic presence in the Lehigh valley is a century old, this group still carries the stigma of low wages and poor living conditions. Indeed, back in 1923, omnipotent Bethlehem Steel decided to hire people south of the border. Then, 948 people “came in the train,” as they would later remember. Earning salaries that even for 1923 were unfair, living in “labor camp” wooden barracks in Hellertown they were looked upon with suspicion.

Never were they afraid of exhausting work though. Mexicans were given the hottest work, believing “they can take it.” “In 1930, when a professor from a California university asked a Bethlehem Steel executive about the work habits of the Mexicans, he was told that they were brighter than the Slovaks and the Windish. If some people think the Mexicans are dumb, they should see some of our Irish,” the Steel’s man added condescendingly,” wrote Frank Whelan in The Morning Call.

In 2017, Hurricane Maria devastated Puerto Rico and many people left the island. Two hundred families sought new life in the Lehigh Valley. It’s worth noting that Puerto Ricans are citizens of the United States, as determined in 1917 by the Jones-Shafroth Act. Born with the same rights as any other Americans, they’re prevented of getting good jobs due to the lack of technical skills and English-language command. Hispanic people born in various other Latin American countries have also called the Lehigh Valley home.

An article in Lehigh Valley University’s Brown and White in 2018 (“Language barriers, industry changes contribute to Lehigh Valley unemployment”), pointed to the need for Hispanics to learn English and continue their education. NCC is playing an important role in providing skills to Hispanic people and other minorities. 

One hundred years after Mexicans’ arrival, substantial changes haven’t taken place in the Lehigh Valley. On Aug. 12, The Morning Call reported “Lehigh Valley minorities, particularly Hispanics, plagued by inequality, study finds.”

“Minorities, particularly those living in the region’s urban cores, have lower education levels and lower paying jobs, less access to transportation and are less likely to own their own homes than their counterparts. Hispanic residents trailed other groups in almost all categories measured by the report by the Lehigh Valley Planning Commission. “It is absolutely systemic racism,” said Becky Bradley, executive director of the commission.

Sixty-four percent of Hispanics don’t own a home. Affordable housing is increasingly harder to find for low-income families. The growing cost of living, stagnant wages (it’s hard to get by with $7.25 / hr., Pennsylvania’s minimum wage, among the lowest in the country.)

A large percentage of the Hispanic community struggles to survive with the minimum wage, as is the case of janitors, cleaning people, busboys, dishwashers. 

In recent years, the Lehigh Valley has become home to the warehouses of prominent corporations. More than a third (5,845) of the 16,700 people working in local warehouses are Hispanic. For Hispanic people with no training or college degree, a job that pays $13-$15 / hr. is a great opportunity to improve conditions for their family. Usually, those who are already employed will bring in relatives.   

COVID-19 disrupted this. Hispanics had to decide between risking getting sick (continue working) or quitting, in which case they could not get unemployment.

Another round of difficulties. Again.

III. Is it possible to avoid hybrid instruction at NCC?

“In the moment we’re in right now, I think it’s incredibly important to say out loud and mean it, Black lives matter,” President Erickson told The Commuter on July 5. “NCC has always prided itself on being a caring community and we hear loud and clear the challenges our students are going through right now because of the COVID crisis,” he told lehighvalley.com a month later.

Such a formidable statement resounds in this tragic time. Inequity in healthcare is one of the major hurdles minority communities struggle to overcome. Responsible students believe that this is a time when any attempt to hold classes in other format than online/ remote only is not morally justifiable. The place of learning should not be the place where the vulnerable, the minority, could contract a deadly virus.

Out of 20 students at NCC, 11 are white and eight are constituted by Black and Hispanics and one belongs to another minority group. Despite the significant minority presence among students, it is underrepresented on all levels at NCC.

In 20 staff and faculty, 15 are white, one is Black, one Hispanic, and 3 would correspond to undisclosed, multiracial and Asians. Out of 19 people in the President’s cabinet, 17 are white and two are black. The only Hispanic cabinet member, Chief Diversity Officer Scott Blair, who is from Venezuela, resigned last week. Blair accepted a new position at DeSales.

NCC’s reopening plan was approved by its 15-member board of trustees, which is also devoid of minority representation.

Likely, having more minorities represented proportionally in such plan-decision-making bodies could’ve helped to advocate against taking risks such as hybrid-class format, because of the health, financial and educational hardships and devastation that an infection will bring to minority students and families.

NCC has done an outstanding communal job in attracting minorities. Erickson’s strategic initiative, “Trek to the Top,” focused on student outreach, a completion agenda, diversity and global engagement, community engagement and leadership in technology, has succeeded in reaching important goals.

A decisive factor, no doubt, has been to charge the lowest tuition rate locally, even lower than Lehigh Carbon Community College. Low tuition is fundamental for a low-income community, desperately needing training and skills to enter the local marketplace.

Hopefully, the $526,683coronavirus relief package NCC has received and a fraction of the current $62 million endowment, the third largest locally (2019 Annual Report) will be wisely allocated, to survive without hybrid classes for the time being, among other financial strategies being explored.

NCC’s online strategy aiming at additional registrations is noticeable. Frequent NCC ads pop-up on the internet (“Education that’s actually affordable. Apply for Free. Northampton Community College”).

Additionally, NCC is capitalizing on its low tuition and fees. Since expensive neighboring institutions — Lehigh University, Lafayette College  — will operate online, their students and parents are delighted with the chance of savings by taking courses similar to the four-year colleges at NCC for a fraction of the cost (an agreement of the Lehigh Valley Association of Independent Colleges allows this option). Fall tuition at Lehigh University is $27,395 (online classes get 10% discount), while NCC’s fall tuition $2,355.

All of these developments are a step forward for NCC reaching the financial strength needed to run online-only classes in the fall, instead of a hybrid format.

NCC’s voices

The NCC community is uncomfortable with the idea of hybrid instruction. Hybrid classes still have an in-person component.  It’s still a risk. Getting infected in the classroom, also puts their families at risk.

Let’s hear a few voices.

Student “M” (Employed at the Lehigh Valley Health Network): “I only worked on COVID units for nine weeks and I’m personally concerned about this fall semester and signing up for in-person classes. While I was working on these units I didn’t even go to the grocery store or gas station. Now that I have to sign up for classes, what happens if I get pulled back to the COVID floors to work? If I work with these patients even if only for one shift, I shouldn’t go to an in-person class for two weeks to protect my classmates. Sadly the pre-req classes I have to take before applying to the nursing program all are lecture/lab classes. So, do I skip a semester until things calm down? I know I’m not the only student struggling with this right now.”
Adjunct “A” (Bethlehem Campus): “I am an adjunct instructor who is slated to teach all my courses online in the fall. Dr. Erickson holds weekly, college-wide staff, faculty and administration meetings where the message and evidence presented has consistently been, since early March, that student, faculty and staff health is the top priority in this crisis. During the meetings, we have learned of rigorous plans for safety accommodations for those few who have returned to work on campuses and that there is a tremendous effort going into the safe return of any students to campus this fall. It is evident that administration and faculty are having these conversations, but again, I cannot make a specific comment on these. I would expect to be able to, given my role at NCC.”
Adjunct “B” (Monroe Campus) is taking all preventive measures but has come to a decision. With no health insurance and no money for hospital bills, if “Adjunct B” gets COVID-19 he will remain at home until the end.
Adjunct “C” (Bethlehem Campus): “I’ve elected to teach only online in the fall and am avoiding every interaction possible, but not everyone seems to share this position of safety or has the option to make this same choice. Our adjunct professors are disproportionately at risk and most of them do not have adequate healthcare offerings through their position here.” We are being more careful than most schools, but NCC has decided to run about 20% of normal classes on ground this fall and decision makers seem to feel confident about their safety measures. I have my doubts that the plan will be able to be effectively executed and there are plenty of doubters among administration as well, but it certainly seems like we are resolved to try it anyway. I have grave concern for what these types of gatherings of young people might do to a community. My expectation is that there will not be on-ground classes by Labor Day.”

The forecast in last sentence is worrisome.

The detailed reasoning in this article on the medical / healthcare topic, as well on the extreme day-to-day vulnerability of minority communities in the Lehigh Valley, having Hispanics as a case-study, aimed at supporting the humanitarian action of not risking lives on hybrid classes.

Above all, the ultimate goal, as humans, should be zero COVID-19 fatalities at NCC.

“As we often say in Black churches — Dr. Sorrell wrote — there can be no testimony without a test. The coronavirus is our test. Whether we pass will not only determine our testimony, but also shape our legacy. May history judge us kindly”

Jesus Zaldivar

Jesus Zaldivar, associate-editor of The Commuter, is a freshman at NCC. Previously, he conducted biomedical / environmental research in South America, Europe and six states in the U.S. (Contact: jzaldivar@spartan.northampton.edu)

View all posts by Jesus Zaldivar →
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