A tale of two public health experts

Rochelle Walensky and Anders Tegnell thought about schools very differently during Covid.

Former CDC Director Rochelle Walensky and former Swedish State Epidemiologist Anders Tegnell are both well-credentialed physician scientists. They both spent a lot of time thinking about the Covid pandemic and issuing guidance in their respective roles. At the same time, they approached the issue of whether to close schools very differently. I think it’s instructive to compare how they both thought about the policy challenge in order to better understand how we might handle schools when the next pandemic arrives.

In a recent interview with New York Times journalist David Wallace-Wells, Walensky explained why she felt schools had to close in March 2020 (emphasis mine):

Early on, we knew flu and other respiratory viruses affected children, and a lot of what we did was take data from meningococcus, flu and other respiratory viruses. So schools closed in March. I will tell you I had three kids at home with me and one of my first academic papers during the pandemic was a modeling study that looked at how we could get our colleges back open. So I was deeply invested in getting kids back to school in my own personal life and in my academic life.

Walensky said she looked at data from past flu outbreaks and decided, because children might get sick, closing schools was necessary. This was effectively Zero Covid-lite thinking, which meant privileging hypothetical infection prevention over all of the social consequences of school closures. To be clear, Walensky was not in a position to influence school closure decisions in March 2020, but I think this nonetheless provides insight into what she would have advised.

In January 2021, Walensky did assume an influential role as CDC director, but she still seemed to believe that slowing the spread — “needed to do a lot of work” — was more important than quickly reopening schools that had been closed for almost a year:

On Jan. 20, I become C.D.C. director, and three weeks later, we had our school guidance. That was really intended to say, “This is a road map for how you get our kids back to school.” We needed to do a lot of work, in terms of we needed buy-in from all of the stakeholders. We needed teachers and superintendents and school nurses and parents and parents of immunocompromised kids. So we did a massive amount of outreach.

Across the Atlantic, Tegnell adopted a different perspective. Speaking to an audience at the University of Galway in May, Tegnell offered a detailed explanation of the Swedish government’s decision to keep primary and lower secondary schools open for children under 16 years of age. He referenced his experience with schools during the swine flu pandemic (emphasis mine):

"And I think the other part was that we had an intensive discussion about school closures during the swine flu pandemic in many contexts and I was myself involved in networks and so on where we discussed that and at that time we tried to collect evidence."

"And there was very little evidence even with flu that it makes much of a difference to close schools. So we really felt quite safe both because we know that the possible side effects the children were gonna get very ill, were very, very low."

Unlike Walensky, Tegnell looked at flu data and, while obviously aware children could get sick, he noted that school closures during swine flu didn’t appear to slow the spread. So, with a new virus that data from China and Italy suggested was even less consequential for children than flu viruses, Tegnell apparently assessed that the costs would exceed the benefits of school closures. Unlike many U.S. public health experts, Tegnell consistently expressed concerns about the potential social consequences of school closures:

"But, also, we even worse so, we knew that, if we closed the schools, we might really have a big problem."

By a “big problem,” he was referring to children leading poorer lives in the future due to learning loss and missing critical developmental experiences.

Finally, Tegnell went on to explain that, because elimination wasn’t going to happen, school closures wouldn’t be sustainable:

"And I think the third part of it, which I think different between different countries, we really had a long-term vision the whole time. We said, 'this is not gonna go away. We're gonna have to work with this for longer.'"

While Walensky was hyper focused on the short-term, Tegnell balanced short- and long-term thinking.

How could two highly educated public health experts interpret the same evidence so differently? Walensky seemed to believe, first, that school closures would have a significant impact on slowing the spread, and, second, that the costs of extended school closures weren’t worthy of consideration. Her thinking was much narrower than Tegnell’s more holistic approach, which also considered the social and economic costs of extended school closures.

Pandemics happen more often than many of us would like to believe. The Covid pandemic occurred just a decade after the swine flu pandemic. When the next pandemic inevitably arrives and we’re dealing with the uncertainty associated with a new virus, will we embrace thinking like that of Walensky or Tegnell? As a society, the choice is ours to make.