Another Public Health Flaw of Hybrid Class Decision: Failure to Quantify or Estimate Risks and Benefits

One of the principles of public health decision-making, especially when dealing with environmental risks, is that decisions should be guided by an estimation and weighing of the costs and benefits of a project. However, in this case, neither BU nor the School of Public Health offered any estimates of risks and benefits to provide a justification for its decision.

A risk-benefit analysis would have been eminently feasible. As I mentioned in another post, chemistry professor Jose-Luis Jiminez at the University of Colorado has created a COVID-19 aerosol transmission estimator that estimates the probability of infection in a classroom given various parameters. For example, I was able to use the model to estimate infection risk assuming a classroom that is 25 feet by 20 feet, containing 10 students, of whom one is infected and assuming all students are wearing masks. The program estimated that the probability that one student becomes infected over the course of the semester is 11% and that the probability that one student requires hospitalization over the course of the semester is 2%. Such a model could easily be applied across all courses in the school to generate overall risk estimates of morbidity, serious morbidity, and mortality for the semester under a variety of different assumptions. A sensitivity analysis would generate estimates under assumptions ranging from the most conservative to the most optimistic. At least the community would have an idea of the range of potential risks.

Before you think that mentioning death is unrealistic, it has already occurred. The president of the University of Texas announced that a maintenance staff member had died from COVID-19 after presumably contracting the infection during the natural course of his duties at the university. The possibility that the BU president may have to write a similar note to the BU community is not out of the realm of possibility and the risks that this could happen absolutely should have been estimated and communicated publicly before the hybrid decision was made.

Calculating the benefits is even easier. First, there are no didactic benefits to the hybrid approach under pandemic circumstances. As I've argued many times on this blog, there are severe disadvantages to having to teach in a classroom with students sitting in fixed seats six feet apart, wearing masks, anxious, all while you are standing in a mask in front of the class and dealing with students who are online as well as in the classroom. Moreover, it splits the class into two distinct groups, breaking the feeling of class unity. And on top of that, it is impossible to use breakout groups - a technique which I use almost every class session. This is without even going into the logistics, burden, anxiety, and disruption associated with students and faculty having to be tested for COVID-19 weekly, performing contact tracing and isolation, and paying for all of this.

The only benefit of the decision to hold hybrid classes is financial. And for the School of Public Health campus, that financial benefit is solely in the avoidance of admitted students deferring for a year or deciding to attend a different school. Those financial losses are estimable and the estimates should have been publicly disclosed, along with the risk estimates.

The financial benefits essentially come down to tuition money that would have been lost if the School had held off on announcing its course plans for the fall until later in the summer and then announced that it would hold online-only classes (like hundreds of colleges and universities are now doing). The benefits can't be estimated in comparison to having announced last April that we were going to have online-only classes because there was no need to make a decision that early.

It is difficult for me to imagine that we would have lost a large number of students but whatever that number is, the BUSPH community deserves an accounting of the estimated risks and benefits of the two options that were considered. We should know just how much money we are saving in order to sacrifice so many public health, social justice, and racial justice principles.

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