with Paulina Firozi

Should students returning to school this fall be kept six feet apart? Or is three feet sufficient? And is it even feasible to keep children, particularly young ones, socially distant?

Where schools land on those questions will determine their capacity for giving kids in-person instruction during an uncertain fall semester. States in the South and West are struggling with a renewed surge of covid-19 patients, setting new hospitalization records daily and forcing medical workers to add new intensive care beds and special air-flow systems.

The question of how to open schools, already under intense discussions in local districts, erupted this week as President Trump criticized the federal government's own guidance and threatened to cut off federal funding to schools if they don't fully reopen.

Pediatricians agree that it's best for kids to be in school, and the science is clear that kids only rarely die of covid-19, the disease caused by the novel coronavirus. But the president's stark choice – reopen or bust – isn't helping a problem that already has school administrators and teachers wringing their hands around the nation, trying to balance the risks to teachers if they teach in-person classes and the risk to students if they don't.

Government officials and health experts are issuing differing advice on how distant kids should be from one another.

While the nation’s leading group of pediatricians has said keeping desks three feet apart is sufficient, the Centers for Disease Control and Prevention recommends six feet of distance. 

And while many school districts are so far going by the current CDC recommendations, some states have issued guidance for three feet of distancing, while other states aren’t requiring any particular social distancing in schools at all. 

Public schools in New York City are presenting parents with several different learning options based on the federal guidance of six feet. But Massachusetts officials have said schools can reopen with just three feet of distance between children. Michigan isn’t recommending any social distancing in schools, according to a 63-page plan released last month by Gov. Gretchen Whitmer (D).

The lack of consensus is particularly evident in Virginia.

Several school districts in Northern Virginia are giving parents the option of either sending their students to school just two days a week or learning remotely full time. These districts, which include Fairfax, Loudoun and Arlington, based their decisions on the federal guidance of six feet of distance.

Yet Virginia quietly revised its guidance this week to three feet, reflecting a recent recommendation from the American Academy of Pediatrics. That could give schools in the state more leeway.

Matt Jones, education reporter for the Daily Press in Hampton Roads, Va.:

If, for example, a school can fit half the students into a classroom, it would mean kids could be at school two to three days a week. But that would drop to one or two days a week if only one-third of students can be present at a given time.

Sean O’Leary, who helped write the AAP recommendations, told the New York Times that having kids six feet apart versus five, four or three feet would result in only incremental gains not worth the downside of having to keep kids at home.

“When you consider the overall health of children and really the community at large, adhering to a six-foot rule, which would mean having a lot of kids at home, may not be in the best interest of overall health,” O’Leary told the Times. “Something has to give.”

Regardless of the distance between desks, getting kids to socially distance will be tough on teachers.

As a mom of kids aged 2, 4, and 5, your Health 202 author is accepting tips on how to teach young kids to socially distance. All parents know this is exceedingly difficult. Put kids in a classroom together, and it may be nearly impossible for teachers to enforce the rules for hours at a time.

“‘Keep your hands to yourself’ doesn’t last very long,” said Will Swaim, president of the California Policy Center, a conservative think tank. “To ask teachers already facing tremendous challenges in schools to monitor social distancing, appropriate mask techniques, is absurd.”

Swaim said he wants officials to pay more attention to data showing kids are rarely sickened by or die of covid-19. No one in California under age 18 has died of it, according to the California Department of Public Health. 

Swaim also pointed to research suggesting kids don't spread the virus as easily — although experts say more study is needed to fully understand the role of children in asymptomatic transmission.

The Trump administration is making clear it wants kids back in school, period.

Trump supercharged the debate by threatening to cut off federal funding to schools if they don’t fully reopen and slammed the CDC guidance as “tough” and “expensive" – insisting it was forcing schools to do “very impractical things.” 

A few hours later, Vice President Pence defended the president’s comments and stressed that schools should do everything they can to hold in-person classes in the fall. 

While my colleague Laura Meckler reports that the CDC was already planning to issue new guidelines for schools in the coming days, Pence said Trump's anger was the reason why the agency would issue “a new set of tools” next week. 

“We don’t want the guidance from CDC to be a reason why schools don’t open,” Pence said. “I think that every American, every American knows that we can safely reopen our schools. . . . We want, as the president said this morning, to make sure that what we’re doing doesn’t stand in the way of doing that.”

Vice President Pence said July 8 that President Trump's threats to cut funding for schools that don't reopen are a "determination" to get kids back to school. (The Washington Post)

CDC Director Robert Redfield said it would be “very disappointing” if local officials use the CDC guidelines as a reason for not reopening schools, stressing that young people rarely die of covid-19. 

Earlier in the week, Education Secretary Betsy DeVos told Fox News she is seriously considering withholding federal funds from schools that don’t reopen and told state leaders on a conference call that school districts’ plans to hold in-person classes only a few days a week were unacceptable.

Former CDC director Tom Frieden:

From NPR reporter Cory Turner:

Ben Adler, senior editor at City & State NY:

Ashish Jha, director of the Harvard Global Health Institute:

But parents and school officials are divided about whether it's safe. 

“The president’s allies see his reelection riding on whether Americans see the country as moving past the coronavirus crisis or still mired in it. Schools are a key element: Many parents cannot go back to work if their children are at home,” Laura writes. 

“Still, parents are divided, with some eager to get back to normal and others fearful that reopened schools will put their children and families at risk. An ABC News-Ipsos survey last month found about half of parents of children under 18 were willing to send their children to school and about half unwilling,” she continues. “School officials also are divided. A poll of 1,450 principals released Wednesday by the National Association of Secondary School Principals found just over a third were somewhat or extremely confident in their schools’ or district’s ‘ability to preserve the health of staff and students as schools physically reopen in the fall.’"

Ahh, oof and ouch

AHH: The Supreme Court ruled many employers can opt out of covering birth control for their workers.

In a 7-to-2 ruling, the justices said the Trump administration can allow non-publicly-traded employers and universities to opt out of the requirement if they have religious or moral objections. It expands the ability of employers to claim an exemption from the mandate, which stems from the 2010 Affordable Care Act. The government estimates 70,000 to 126,000 women could lose access to no-cost contraceptives, Robert Barnes reports.

“The decision was one of several that has made the Supreme Court’s term strikingly successful for religious interests,” he writes. “By the same 7-to-2 vote as in the contraceptive cases, the court on Wednesday also ruled for the ability of religious organizations to hire and fire without offending some anti-discrimination laws.”

The Supreme Court ruled in favor of the Trump administration, which allowed employers to opt out of the Affordable Care Act’s birth control mandate. (The Washington Post)

The so-called birth control mandate had been the subject of an intense, years-long legal battle. First, the Obama administration had sparred with religious organizations who said offering contraceptive care to their employees violated their beliefs. Then the Trump administration broadened the Obama administration’s exemption, angering women’s groups, health organizations and Democratic-led states, Robert writes.

Liberal Justices Elena Kagan and Stephen G. Breyer agreed with the court’s conservatives that the administration had the right to create an exemption to the mandate. But in a scathing dissent, Justice Ruth Bader Ginsburg wrote that in the majority opinion "the Court casts totally aside countervailing rights and interests in its zeal to secure religious rights to the nth degree.”

White House press secretary Kayleigh McEnany called the ruling a “a big win for religious freedom and freedom of conscience.”

Planned Parenthood's young activists network: 

Abortion rights group NARAL: 

OOF: A massive effort to develop a covid-19 vaccine will rely on tens of thousands of volunteers. 

Federal officials announced the Covid-19 Prevention Trials Network will undertake an unprecedented effort to test coronavirus vaccines and other preventive treatments. A website has launched that allows volunteers to sign up for consideration when first trials begin this month, Carolyn Y. Johnson reports. 

The network of more than 100 clinical trial sites at hospitals and clinics combines the existing federal clinical trial infrastructure previously set up to test HIV vaccines and treatments. 

“Testing a vaccine is a conceptually simple idea, but it is a careful and methodical process that unfolds through a phased system of trials that grow progressively larger,” Carolyn reports. “Early clinical trials, some of which have reported encouraging results, assess the right dose of the vaccine and monitor for any safety concerns in dozens or a few hundred patients. But the ultimate test of these vaccines will be large trials designed to test whether they are effective at preventing or reducing the severity of the disease.”

In one such late-stage trial, for example, 30,000 people will be randomly chosen to receive an experimental vaccine candidate made by biotechnology company Moderna or a placebo. That is set to start in the second half of the month.

In a statement, Health and Human Services Secretary Alex Azar said the goal is to provide “substantial quantities of a safe, effective vaccine by January 2021.” 

OUCH: Health facilities across the country are still facing a dearth of critical protective gear. 

Hospitals, nursing homes and private medical practices are short on respirator masks, isolation gowns and disposable gloves, the New York Times’s Andrew Jacobs reports. The continued problem has fueled renewed pleas for the Trump administration to intervene, as public health experts insist an aggressive approach by the federal government early on for acquiring and distributing supplies would have spared them some of the trouble. 

Andrew adds: “The inability to find personal protective equipment, known as P.P.E., is starting to impede other critical areas of medicine too. Neurologists, cardiologists and cancer specialists around the country have been unable to reopen their offices in recent weeks, leaving many patients without care, according to the American Medical Association and other doctor groups.” 

State officials say they have been searching for PPE from both U.S. and international suppliers but can’t get orders filled, William Wan reports.

“The specter of equipment shortages comes as other issues that plagued the country’s early response to the pandemic return: surging cases, overwhelmed hospitals, lagging testing and contradictory public health messages,” William reports. “But the inability to secure PPE is especially frustrating, health-care workers say, because it is their main defense against catching the virus.” 

White House officials are downplaying concerns about any shortages. That’s true even as medical groups, nursing homes, governors and members of Congress urge the federal government to help.

“I’m not going to tell you we’re able to meet all demand, but there’s significantly less unfulfilled orders today than in April,” said Rear Adm. John Polowczyk, whom the president tasked with leading the effort on coronavirus-related supplies. “I have not found a hospital system that is in threat of running out. … I don’t have the sense of there being severe shortages.”

In the states

More people are dying of the coronavirus at home in Houston.

As cases of covid-19 spike in one of the fastest-growing hot spots in the country, there is a rise in the number of residents who die at home before they’re able to get to a hospital, ProPublica’s Charles Ornstein and NBC News’s Mike Hixenbaugh report. That could mean the number of cases overall there is even higher than officially reported. 

“The previously unreported jump in people dying at home is the latest indicator of a mounting crisis in a region beset by one of the nation’s worst and fastest-growing coronavirus outbreaks,” they write. “…The uptick in the number of people dying before they can even reach a hospital in Houston draws parallels to what happened in New York City in March and April, when there was a spike in the number of times firefighters responded to medical calls, only to discover that the person in need of help had already died. These increases also echo those reported during outbreaks in Detroit and Boston, when the number of people dying at home jumped as coronavirus cases surged.” 

Many of the people who die at home have not been tested for the coronavirus, and Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston, said there’s “no pressure to call it a COVID death.” 

“The rise in at-home deaths may also reflect people who are afraid to go to the hospital because of COVID-19, and who die of heart attacks, strokes, diabetes and other conditions not tied to the coronavirus, Faust said,” Mike and Charles add. “Ultimately, Faust said, public health experts trying to assess the toll from COVID will need to study how many excess deaths there are in a particular region and whether the demographics of those who died are different from what one might expect.”

It's still an election year

Joe Biden took his latest jab at Trump for what he called a “failure to lead us through this crisis.” 

The former vice president was responding to the news that the United States had exceeded 3 million confirmed coronavirus cases. He urged the Trump administration to ramp up testing even further and to “finally provide science-based leadership on re-opening safely.”

“President Trump claimed to the American people that he was a wartime leader, but instead of taking responsibility, Trump has waved a white flag, revealing that he ordered the slowing of testing and having his administration tell Americans that they simply need to ‘live with it,’ ” the presumptive Democratic presidential nominee said in a statement.

His latest call for the administration to step up in its response comes as numerous counties across the nation hit a new high for coronavirus cases this week. 

“More than a fifth of the country’s population now lives in a county where the high was reached on Monday,” Philip Bump reports, adding, “Part of the reason that a fifth of the country’s population is in hot-spot counties is that so many counties hit a new high on Monday. Eighteen percent of counties recorded their highest seven-day average that day, part of the 38 percent of counties that recorded highs this month.” 

There are 71.5 million people who live in counties that reached new highs in newly recorded cases on Monday, and the new surge of cases is heavily concentrated in the South and the West. 

Biden and Sen. Bernie Sanders released a policy blueprint meant to unify Democrats around the presumptive Democratic nominee. 

The pair formed task forces meant to develop policy recommendations in six issue areas, including health care. Sanders (I-Vt.) told NPR the goal was to “move the Biden campaign into as progressive a direction as possible, and I think we did that. On issue after issue, whether it was education, the economy, health care, climate, immigration, criminal justice, I think there was significant movement on the part of the Biden campaign.”

The 110-page policy document includes health-care recommendations such as expanding the benefits and lowering the cost of the public health insurance program Biden wants to implement as an option alongside the Affordable Care Act. The recommendations also insist that “Medicare, not any private health insurance company, would administer the plan,” NPR’s Scott Detrow reports. 

“Washington Rep. Pramila Jayapal co-chaired the health care task force. She's long pushed, like Sanders, for a single, government-run health insurance program, but didn't bring that recommendation to the table in any of the meetings or negotiations,” Scott reports. “Still, Jayapal was happy with the recommendations.” 

He adds: “The task force also called on Biden to pursue requiring employers to offer employees the option to sign up for government-administered health care, rather than company plans.” 

Jayapal said the new policy recommendation may help push any previous Sanders supporters to back Biden. 

Kanye West said he is suspicious of a coronavirus vaccine, calling it the “mark of the beast.” 

West, who in a meandering interview with Forbes said he is planning a late-stage presidential bid this year, said that he contracted the virus in February. He also said he is “extremely cautious” about the idea of preventing the spread of the virus with a vaccine. 

The rapper also said he opposes abortions and claimed “Planned Parenthoods have been placed inside cities by white supremacists to do the Devil’s work.” 

John Wagner notes that West, who said he no longer supports Trump’s reelection, has no campaign organization and has missed filing deadlines in a few key states. 

Coronavirus latest

Here are a few more stories to catch up on this morning: 

On the front lines: 
  • Retail and service workers have had to confront the growing tension between those who are and are not willing to wear masks in public, Abha Bhattarai reports. “Mixed messaging and politicization have turned a public health safeguard into lightning-rod issue. As a result, workers have been berated, even assaulted, by aggressive anti-maskers,” Abha writes.
  • Hospitals are straining to meet the demand from a surge of cases in states across the South and West, including Florida, Arizona, California and Texas. Hospitals are adding new intensive care unit beds and canceling elective surgeries to meet the need, Chelsea Janes, Isaac Stanley-Becker, Lenny Bernstein and Joshua Partlow report.
Moving toward a new normal: 
  • The pandemic has fueled new thinking about how robots may be helpful in a time of social distancing. “The worldwide health crisis has added urgency to the question of how to bring robotics into the public health equation,” Simon Denyer, Akiko Kashiwagi and Min Joo Kim report. “Nowhere is that truer than in Japan, a country with a long fascination with robots, from android assistants to robot receptionists. Since the virus arrived, robots have offered their services as bartenders, security guards and deliverymen.” 

Sugar rush