A Way Out of the School Reopening Morass??

UPDATE on 6/19/2020 at 11:15 AM: Here is the slide deck preview for the next Board Meeting: Fall 2020 Learning Plan – Public Version

It was accompanied by the following note:

Attached is a preview of the schedule that will be on the board agenda for next week. The schedule was a collaboration between the teachers’ union, district administration, and site administration. All groups took into account the feedback from our committee, previous surveys, and schedules presented at the last board meeting. In addition, we took into account school board comments and recommendations.  The presentation will have far more detail, but this gives you a glimpse of the suggested schedule for the school board’s consideration. I believe the board agenda will be posted this evening or Monday.

UPDATE on 6/15/2020: An Addendum has been appended to this post which was made the morning before the Board meeting.  The Addendum briefly describes the outcome of the Board meeting and provides links to a recording of the meeting as well as the slide deck presented to the attendees.

6/11/2020 – This last week has been overwhelming in terms of the number of proposals, counter-proposals, and extensive discussions about how to reopen schools in the fall.  Please see SMUHSD Debating a Change to a Quarter System? and, for those with local Nextdoor access, https://nextdoor.com/news_feed/?post=150484676 for the gory details.

I would like to make a short, relatively uncomplicated proposal and then will step aside.  I do not have children attending school, and my personal work is done completely via Skype since the pandemic, so I will not consume valuable comment time during the Board meeting tonight.

This idea will not need 66 slides!  In fact it will not need any slides at all – just the very short text section that follows!

At the end of last school year, most AP teachers were holding classes via Zoom.  Many non-AP classes were held much less regularly though, due to the rapid school closure and some teachers suddenly having outside care responsibilities during the COVID-19 outbreak.

In the fall, school will resume full time.  I believe, but am not certain, that part of the rationale for the quarter system was to complete certain classes by the end of the first quarter in case there was a “second wave” of COVID-19 in the late October/November time frame.  This might allow a “cleaner” shutdown of school if necessary.

Pardon me, but I still don’t understand, after listening to all of the back and forth, why school can’t resume using the normal pre-pandemic seven period semester schedule with 1/3rd of students in class each day and the other two thirds participating in the exact same lesson via Zoom (or some other more secure platform) from home.  Or we could have only one fifth of students come in on a particular day of the week if the desire is to further minimize group size.

If a “second wave” develops, then we simply go back to 100% of students using Zoom or Zoom alternative from home until it passes, but we do not stop school.

The 1/3rd rotation could have the same group coming in every 3rd day as in the current district slide deck, or, more preferable in terms of reducing teacher exposure, every third week as several of my Aragon students told me was the proposal originally mentioned to them.

A week at school followed by two weeks off would also be an effective “quarantine” to minimize COVID-19 spread in the event that any student was infected.  The week at school allows students to ask teachers questions in person and also gives them at least some “socially distant” contact with their peers.

The rotation schedule on a normal semester plan seems to me to be the most important topic for discussion, NOT the quarter system idea which appears to be a non-starter for very many people (parents AND teachers)!

The other alternative, of course, is 100% online learning that the teachers currently favor due to their health concerns.

Why do we need to develop all of these other complicated proposals with so many downsides and probably other as yet unforeseen consequences???  The Board meeting tonight could be the longest one in SMUHSD history or we could cut through all of this clutter in advance.

If I am missing something, please let me know in the Comment section below or on Nextdoor where I will also be posting a link to this article.  Thank you!



Addendum posted AFTER the Board Meeting:

A recording of the 5 hour long Board meeting is available at https://www.youtube.com/channel/UCW_KpbKc1KYRPUzLZHSxf0A

The quarter system proposal was dropped from the agenda a few hours prior to the meeting and replaced with two other possible models (“Fully Blended” and “80/20 Blended”) developed with substantial teacher input.  The Fully Blended model is discussed by Assistant Superintendent Kirk Black starting at 1 hour 36 minutes (1:36) into the Youtube video above, and the 80/20 Blended model is presented by teacher Jinna Hwang at 1:43 into the video.

Here is a copy of the revised Return to School slide presentation given at the meeting that includes these two new models: L_1_RevisedReturnToSchoolPresentation_0

The decision was made to flesh these plans out further and bring them back to the next Board meeting on 6/25.

What do people think about these proposals?

I remain concerned by the reduction in class time and the use of “asynchronous learning.”  As I said on Nextdoor:

… sorry, but the idea of a student watching a lecture at home without the ability to ask an immediate question of the lecturer just rubs me the wrong way. One can call it by the fancy term “asynchronous learning” but I would prefer a simpler term – “bad teaching!”

This denigration of lecturing in current education philosophy has gone to an extreme. No one enjoys simply being talked AT, of course, but then why assign Khan Academy and prerecorded lectures where there is no possibility of interaction? There always seems to be a curious parallel reduction in teaching effort along with many of these “progressive education” methods like, for example, CPM math.

In fact I wrote an article about this problem earlier: Why a “Sage on the Stage” in a Classroom is not always a Bad Thing .

This asynchronous learning problem can be fixed if the teacher is accessible with a reasonable turn-around time via some kind of instant messaging system such as the one in Canvas mentioned by Kevin in the comments below or via other forms of IMs or cellular texts.

Please post your comments following this article below (or on Nextdoor at https://nextdoor.com/post/151832244 if you can access that post – note that the Nextdoor post is not accessible in all parts of the SMUHSD while this blog is).  You must scroll all the way down to the “Leave a Reply” box to reply to the article directly or click the “Reply” link following a particular comment to respond to that comment.  This forum is moderated, so comments will not appear until approved.

The WordPress software that runs this site requires that you enter an email address in order to comment, but your address is not checked for validity nor displayed, and I do not collect or use this information.  Also, you will not receive emailed comments on the article from other people unless you check a box in the form to request this.

Thanks as always for your participation!

SMUHSD Debating a Change to a Quarter System?

Updates in reverse chronological order are at the top of this post.  Please scroll down to read the original post first if you have not already done so.

UPDATE on 6/10/2020 2:05 PM – Two articles on the school reopening controversy have appeared in the San Mateo Daily Journal.  These articles are copyrighted, so you need an account to access them.  You can see one free story per month without an account or three per month with a free account.  Otherwise if you don’t want to pay for a subscription, you’ll have to pick up a free hardcopy at a newsstand or store.



UPDATE on 6/15/2020 at 10:20 PM after ones on 6/9/2020 at 5:20 PM and again on 6/10/2020  at 2:35 PM

(6/15) Mr. Binetti has revamped his website once again and has restored the deleted videos mentioned immediately below.

(6/10) I wrote the two paragraphs below yesterday evening.  Mr.Binetti overnight removed his previous four videos and his list of research references and on 6/10/2020 only has a single video designed to get people to sign his letter.  This change looks extremely bad in my opinion as he did this switcheroo AFTER receiving evidence countering his position.  This is intellectually dishonest and appears as simply an attempt to promote his petition drive!!

(6/9) In another thread on Nextdoor at https://nextdoor.com/post/151144511, a series of videos on a site called https://www.startnormal.com has been discussed. They are made by a San Carlos resident.

In his first three videos, he tries to make a compelling case using research studies that COVID-19 will not spread in schools, but then has to backpedal in his fourth video when viewers presented him with two cases in which spread did happen. He concludes that we don’t yet know why it happened in those two cases, but the scores of other studies still say that school transmission is not likely. I am just passing this on in the interest of looking at all sides of the issue. He also is running a petition drive to reopen schools normally. If interested, I would encourage you to watch all four videos first before you make a decision to sign.

UPDATE on 6/9/2020 at 10:30 AM – There is an online petition for those opposed to the quarter system available at https://www.ipetitions.com/petition/smuhsd-vote-no-on-the-quarter-system-proposal.

UPDATE on 6/9/2020 at 5:00 AM – The following note, posted late last night by Anne Pesquie, is from the Nextdoor discussion on this topic available at https://nextdoor.com/post/150484676 for those who have Nextdoor access in the mid-SF Peninsula area.  I am trying to post the most important excerpts from that very lengthy and deeply nested conversation here.

Update 06/08.
All teachers from the district received (finally) an email from the superintendent communicating about the possible new blended/quarter schedule.

One hour later, they also received an email from a group of teachers (from multiple high schools) stating that even after talking with Dr Skelly for two hours, regarding an alternating schedule for the fall semester that would avoid blended/quarter system, it seems that his decision is already made to fully support the blended/quarter system.

On the email, this group of teachers shared their plan, “a 80/20 remote/blended model with room for on-campus support”, which is not “perfected or complete” and “does not necessarily mean 100% of our faculty is behind it”. (link below)

Teachers, parents, students who disagree with the district’s plan at least can sign a petition “What is the Best Instructional Model Amidst the Pandemic?”

plan=> https://docs.google.com/presentation/d/1jZu_UOpwI5opT9LRdypp2trwzSWOn2hh7f057rhdBEE/edit#slide=id.p

petition=> https://docs.google.com/document/d/1MKLliR5ludJq70SWuVwxp99h-rbOeoSzZyHCfXckWE0/edit

They concluded by “Other parent and teacher groups have been working hard on their own proposals for alternatives. This is not to go against any of that work, but hopefully to combine our conversations and work together to find a better solution.”

personal side note: This is not a leak, I asked permission to put it online.

I should note that the Superintendent is in the position of having to navigate through all of the conflicting interests on this issue.  The final decision will be made by the Board.  In the recent Credit/No Credit decision, the Board, by a narrow margin, sided with the teachers’ position.

Once again the teachers and a significant number of parents are at odds.  The factor that will finally tip this issue will be health threats to the teaching staff in my opinion, but I will not be speaking at the meeting, just observing.

Anne also posted this eye-opening story about what happened in Israel after school reopened.

Parents should remember that “essential workers” are still supposed to be protected from health threats!  Teachers did not sign up to deal with potentially life-threatening work on a daily basis.  Even doctors and nurses work (or are supposed to work!) with protective equipment, and they can attempt to isolate ill patients and limit their movement.  Teachers have no comparable control in a school setting when it comes to possible asymptomatic spreaders!  Incoming temperature checks are their only defense and will they all be issued N95 masks??!

The Board may very well decide in favor of a 100% online learning model to begin the year, but try to stick with a reasonably normal school day and semester schedule.  This will make the teachers happy, and the parents may go away at least relieved that they didn’t get the quarter system!!  That would be a very clever use of a straw man argument, wouldn’t it?!??


UPDATE on 6/8/2020 at 4:00 PM – A PDF of the full Return to School Committee Presentation can be downloaded by clicking on this link and has been inserted into the Board Meeting Agenda in the Attachments section just before agenda item L.2.  It is a massive slide deck (66 slides – 52 in the main part plus an Appendix of 14!!), and I am concerned that this could turn into the longest Board meeting in SMUHSD history…

UPDATE on 6/6/2020 at 9:00 PM – An open letter from members of the Return to School scheduling subcommittee opposing the Quarter system has been added to the Comments section below.

UPDATE on 6/6/2020 at 3:05 PM – The Board meeting agenda and attendance information has been published at https://www.smuhsd.org/Page/2235.  The Agenda item appears to be L. 1. but the presentations will not be attached until Monday, so it is difficult to know what the Board will actually see at this time.  There will also be significant business conducted before this agenda item.

UPDATE on 6/6/2020 at 7:45 AM – A letter from Craig Childress, the president of the SMUHSD Teachers Association to the Superintendent and the Board has been posted in the Comments section following the article.  Teachers are advocating for 100% Distance  Learning in the Fall.  An additional slide deck on the issue is also included below.

UPDATE on 6/5/2020 at 8:00 AM – A PDF version of the slide deck (without the excessive animations in the original) has been received and added to this article below.

Original Post on 6/4/2020 – A report on Nextdoor yesterday evening indicated that an “internal Return to School subcommittee for scheduling” … “is planning on moving to a quarter system (9 weeks of 3 classes with finals) and dispensing with the semester system in ALL HIGH SCHOOLS in the district as a way to reduce teacher exposure to Covid in the classroom.”

The Nextdoor post can be found here, but Nextdoor access depends upon your neighborhood location, and people outside of the distribution area and those without Nextdoor accounts will not be able to view it.

I have checked with several parents who I know, and they have not received any notifications as of this AM.

Comments on Nextdoor state that the change to a quarter system

“is most likely to be presented as the “best option” at the Board of Trustees meeting next week on June 11 after being discussed minimally in subcommittee. Anyone interested should attend the meeting virtually (Zoom info will be available here): https://www.smuhsd.org/Page/2235 to find out more and write to Dr. Skelly and board members (emails here: https://www.smuhsd.org/Page/2231) in order to understand and share opinions.”

I should add that the Board is very likely stuck between a rock and a hard place on this issue as often happens.  I do not know what kind of feedback that they are getting from teachers about their concerns regarding contracting COVID-19 when school resumes.  I wrote about this critical safety issue near the end of my article Will “Online Learning” Work?  Please keep this important issue in mind when expressing your opinions if you attend this meeting.

The community needs to work out a solution that balances all needs to the best of its ability.  No one will walk away completely happy.

Students have also told me that an option of having every student attend school one week out of three has also been discussed (1/3 of students at school each week followed by two weeks of online learning).  I am not sure why this rotation was chosen versus having one third come in every third day (too confusing for the kids?? Do they want each cohort to stay out for two weeks to see if they subsequently come down with COVID-19??  Other reasons??)  Hallways will supposedly also have one-way markings to reduce problems between classes.

Given the equity issues that I also discussed in Will “Online Learning” Work?, it might make sense to have students without Internet access attend school full time or else these students will quickly fall irretrievably behind.

Alternatively, there have been some GoFundMe campaigns for homeless people and families on Nextdoor.  In light of the current racial strife in our country, perhaps our community should seriously consider a fundraising drive for SMUHSD, SMFCSD, or whatever your local district is, and provide technology to ALL of our students.  It would be preferable for a fund to be set up directly in each district for this purpose instead of giving cuts of valuable education dollars to “middle men.”

This might be the single best action that we could take to improve race relations in our community.  After all, education “is the only valid passport from poverty.

Here is a PDF of the slide deck for the Return to School subcommittee meeting scheduled for 9:00 AM on 6/5/2020:

Quarter System Schedule Options

After the meeting mentioned above I received the following slide deck with sample schedule information.  This appears to supplement the material above:

Sample Schedules Quarter Schedule

The Statement on the fifth slide of this second deck from Amy Johnstone, the Burlingame HS PTO President, describes several reasons for students to return to school and ends with “And I do believe that educators are an essential business workforce.”   It is both interesting and concerning:

The Spirit of Our Work
“It feels like there is an assumption that DL is the safer choice. But when campus closed, many of our most vulnerable students and families went dark – we had no eyes on them and minimal communications. DL addresses curriculum and academics but our schools are so much more than that – they are places of nutrition, mental health, mentoring and mandated reporting. Sometimes our campuses are the safest place for our students. We can control the school environment, based on science and best practices, and adapt as needed. Not every home environment is providing that level of stability, safety and responsiveness. I do believe that for some of our students, every minute they spend on campus is safer and better for them. And I do believe that educators are an essential business workforce.”
– Amy Johnstone, BHS Parent, PTO President

As I stated on Nextdoor the opposing sides need to proceed cautiously if we are to resolve this issue:

I noted, in a different school reopening discussion on Nextdoor, some statistics from the San Mateo-Foster City School District indicating that 1 out of six teachers were in the 50 years old and above category, a higher risk group for severe COVID-19. I do not know the numbers for the SMUHSD teachers, but would not be surprised if it is similar.

Parents have a legitimate concern to get the best education possible for their children (and this is unlikely to happen via 100% distance learning), but many parents also want to be able to go back to work themselves and not have to watch their kids.

Teachers nearing retirement may be very hesitant to expose themselves to possibly serious disease.

It is very hard to see how these differing interests can be reconciled without significant compromise. If teachers are pressed too hard, the District might lose some valuable experienced staff who decide it is safer to just retire despite taking a possibly lower retirement income. Everyone loses in this scenario.

On the other hand if teachers press for distance learning and don’t follow through, there will also be a lot of upset. Parents report elsewhere on Nextdoor that the actual online effort between teachers in various schools (and even between teachers at the same school) is unfortunately wildly variable. Explanations given, like some teachers having to also take care of their own kids, are not heard sympathetically by, e.g., nurses who are risking their lives daily but also have kids who need watching.

Reconciling these issues is going to require a serious, yet calm and rational discussion that unfortunately seems to be less common lately. I hope the community does itself proud in this regards. I would not be surprised if part of the reason for the limited distribution of the plans so far is precisely a fear of such contentious debate.

Please scroll down to the Comments section to see a letter from the SMUHSD Teachers Association President to the SMUHSD Superintendent and Board of Trustees.  Other material will also be included below as it arrives.

AP Exam takers lost network connectivity in some cases !!!

I had three of my tutoring students take the Calculus BC exam yesterday. All of them felt well-prepared, but ONE out of THREE lost their network connection which made it impossible to finish.

(UPDATE: Instead of the reasons given in the Chronicle article below, the problem might be due to system overload near the end of the exam – uploading of results near the end of the test bogged down and the exam timer closed the test before the uploads could complete.  This is an unproven but plausible hypothesis given that the College Board may not have had enough students to load test the system before the real exam was given. More in the Comments section following this article.)

Apparently they were not alone according to the San Francisco Chronicle.  I found this article this afternoon while reading Diane Ravitch’s blog.

The College Board claims that this happened to only 1% of test takers.


From the Chronicle article:

“A Twitter post on Wednesday from the company’s official account said, “While more than 99% of students successfully submitted their AP exam responses today, some who didn’t told us they had trouble cutting and pasting their responses. We took a closer look and found that outdated browsers were a primary cause of these challenges.”

It advised that people who had issues submitting their exams update their browsers to the latest version of either Chrome, Firefox, Safari or Microsoft Edge.

The College Board also posted a link to a new troubleshooting page.

An earlier Tweet from the organization suggested that the problem had to do with the interface not accepting the default format of iPhone photos and that images would have to be converted to the widely-used digital format known as a jpeg.

The messaging did not sit well with the Twitter account’s followers who, in the replies thread, accused the College Board of “blaming the students” and said, “This is disappointing.”

The technical problems affected students across the country.”

My opinion on the AP system is well known…

Will “Online Learning” Work?

The COVID-19 pandemic required the abrupt closure of schools and an almost overnight shift to attempts at online education.

Implementation has been very uneven, and, combined with cries about “equity problems,” led to the cancellation of grades for spring semester 2020 locally and at many places across the nation.

How can we make school work going forward? This *in-depth* article examines the many behind the scenes challenges of which parents may not be aware and discusses possible ways forward.

Continue reading “Will “Online Learning” Work?”

Excellent article in “The Economist” on COVID-19 vaccines!

4/20/2020 – If you read only one thing today, this should be it:

Can the world find a good covid-19 vaccine quickly enough?

Note – The Economist requires a subscription for full access, but one can get a free account with access to five free articles per month. Personally, I find this magazine to be one of the most informative that I read regularly.

Despite the name, it covers news from all around the world, providing information most Americans will not encounter elsewhere, in addition to business/economics. Its coverage of science and technology is insightful (the above article is an excellent example), and it also reviews books and the arts.


Parents Protest Against Credit/No Credit Grading in SMUHSD

The following is from the April 9th San Mateo Daily Journal:

The proposal to temporarily postpone issuing letter grades in the San Mateo Union High School District alarmed some school community members who opposed adopting a credit system for the semester disrupted by COVID-19.

The district Board of Trustees initially scheduled a meeting to discuss the credit proposal Tuesday, April 7, but pushed the session back until Thursday, April 16, to further examine the issue.

Concerned parent Andrew Soss shared fears that students earning good grades would see their semester’s hard work wiped away with a broad stroke from officials adopting the credit system.

The full text of the article can be found here.

The SMUHSD Board will hold a public meeting on this topic via Zoom Thursday evening at 5 PM as detailed here.

I strongly encourage parents who have an opinion on this topic to email the Board of Trustees at board@smuhsd.org  before the meeting!!

Postscript – The article above shows just one example of the value that our local newspaper provides to the community.  I signed up for an online subscription for $99 per year to support their work, and I encourage all of you to do likewise.  I have no connection with or financial interest in the newspaper.

The Economy versus Health Care: Government as God

Two important news items came out yesterday (3/23/20) and today (3/24/20):

Time Magazine: President Trump Is Already Considering Defying Health Experts to Boost the Economy

New York Gov. Cuomo: ‘Troubling and astronomical’ coronavirus cases increase urgency for hospital beds

There are points to support both sides of this argument.

If we shut down the economy, the damage could be immense.  Note that China took drastic quarantine steps and is starting to emerge from the pandemic, but no one is sure if there will be a second wave of disease when people go back to work.  By March 6th, the Shanghai Stock Index had almost climbed back to its pre-crash high (but is currently testing new lows for the last year, undoubtedly in reaction to market panics around the world).

If we don’t shut down the economy, the health damage could be immense.  All one has to do is turn on the TV or listen to Governor Cuomo above to realize this.

As in any critical decision, we do not have all of the data we need to know the outcomes.

The government will try to make a cost-benefit decision, and to do this they will have to put a dollar value on human life.  Some lives will be judged more valuable than others.  In hospital triage situations, a person’s remaining life expectancy is a factor in the life-saving decision.

When the government is assuming the role of God, one hopes that we have the “best” people (however one defines that) in the country calling the shots…

But please don’t forget Abraham Lincoln’s words.  Our country is a “government of the people, by the people, and for the people.”  If there ever was a time to make your opinion known to your elected representatives, this is it!

My recommendation – If a decision is going to be made to allow an unknown, possibly large, number of people to die so that others can continue to work, this needs to be a collective decision involving top people across the government, including, at least, the leaders of Congress.  A significant fraction of the country does not trust the President, particularly his tendency to think he is the smartest person in the room and a “strong leader.”

It is in his personal interest not to make this decision without broad buy-in.  If he is wrong and the number of deaths is much higher than he expects, he will go down as the worst President in U.S. history.  Of course, if he decides single-handedly and is correct, he will confirm his genius status.  Does the country want to take this high-stakes gamble by a single individual??


Last night Chris Cuomo gave the following “Closing Argument” on CNN. Cuomo argued in effect that the “Greatest Generation” made tremendous sacrifices during WWII to keep this country and the world free. Will we now ask them to sacrifice themselves yet again? No! He states we are all in this together.

You can also comment by calling the White House directly at 202-456-1111.

Hypothetical Link between some widely used Blood Pressure Medications and Increased Sensitivity to COVID-19 Infection.

The topic of this article is still a hypothesis, and I am updating it as important news comes in.  However it will take some time to confirm or refute it.  People on these medications should take prudent social distancing measures in the interim.  There is no current consensus to change your medications however, and stopping blood pressure medication can be dangerous.  Some medical authorities are already disputing this hypothesis as noted below, but others call for more research.


Last significant update of the main text on Monday, 3/16 at 11:55 AM Pacific Daylight Time.  Please see the Comments section following the main article for additional ongoing details.

A possibly very important article appeared in the Lancet medical journal recently:


In brief, the article states that people treated with specific classes of blood pressure medications (meds that are also used on some people with diabetes) have increased amounts of the ACE2 protein that the novel coronavirus binds to when it attacks lung cells.

The article states “We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.

Note, of course, the word “hypothesise” (sic – hypothesize, unless this is UK spelling – the corresponding author is from Switzerland).  This hypothesis is not proven, but seems very plausible.

This hypothesis is similar to a question that I raised on local social media a few days ago in regards to ACE inhibitors (ACEI), especially lisinopril which causes “lisinopril cough,” at


[Sorry, but the link above will only work for people in my nearby neighborhood location (San Mateo, CA) with Nextdoor accounts.]

A local doctor, Dr. Raymond Hong who is an allergist, saw this post and commented that he believed that only Angiotensin Receptor Blocker (ARB) drugs increased the number of ACE2 receptor proteins that the novel coronavirus attacks, not ACE inhibitors.  He also thought that this was a very interesting hypothesis that needed additional research.

He cautioned (I added bolding in his quote for emphasis):

“Although this sounds concerning, in no way am I advocating stopping or switching angiotensin receptor blockers (or ace inhibitors) or discussing this with your doctor quite yet. But I agree we should definitely be looking at the patients with severe COVID-19 disease to see what medical conditions they have, and if they have hypertension, what medications they are on. Any positive findings might help spur more caution and studies. There may be multiple factors involved and I just thought I’d respond to your question in a responsible manner.”

Personally, I (Kristofferson) should note that changing medications will NOT cause the levels of these lung proteins that the virus attacks to decrease overnight.  If this hypothesis turns out to be correct (and unfortunately its resolution may take too long to help people currently at risk for COVID-19), my take is that people on these medications should take extra precautions to avoid exposing themselves to sick individuals.  This undoubtedly means hunkering down at home given the latest developments.

This hypothesis could also explain why young people might develop severe coronavirus cases – they might be at risk if they have elevated ACE2 levels as a result of using ACEI/ARB medications.

A new JAMANetwork review article (link added near the end of this article) states that it is possible that either genetics or the high rate of smoking among Chinese men may have increased their ACE2 levels and made them more susceptible to the disease, but, again, this is not yet proven:  “The ACE2 enzyme is expressed in type II alveolar cells, and some unconfirmed data suggest that Asian males have a large number of ACE2-expressing cells in the lung, which may partially explain the male predominance of COVID-19. However, other factors such as a higher prevalence of smoking among men in China may explain the difference in the sex distribution of the disease.”

Dr. Hong has just (3/13/2020 5:45 PM PDT) notified me of the following news:

I think it’s too early to make recommendations about switching. In fact because of social media posts similar to mine, there has been concern about patients stopping their blood pressure medications. The European Society of Cardiology published a position statement to not stop ace inhibitors or arbs as there is no evidence to support this. They stated there is evidence in animals that these medications might even be protective against serious lung complications from COVID-19. So they recommended against making any changes.

Here is the official statement that he notes above:

Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers

This ESC article clearly contradicts The Lancet article and states:

This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection.

Important other expert opinions on this hypothesis can be found in the following link.  Some of these experts say that the jury is still out:

Expert reaction to questions about high blood pressure, diabetes, and ACE inhibitor drugs, and risk of COVID-19 infection

The following shows the tremendous complexity of this whole problem. Here is an interesting tweet from a doctor at Johns Hopkins. This doctor is working on novel therapeutics. He states in the tweet: “My recommended COVID19 treatment algorithm is starting patients who have more than mild symptoms or in high-risk category with: 1. Antiviral (chloroquine or hydroxychloroquine) 2. Losartan or other ARB (combat lung injury). Both proven w/ data, the latter acting on ACE2 pathway.'”  In the thread to his tweet he answers the concern about ARBs increasing ACE2 levels and claims the situation goes into reverse AFTER infection sets in as the viral infection causes ACE2 levels to drop.  Thus ARBs are helpful AFTER the fact: “it is beneficial for these drugs to increase ACE2. The lack of ACE2 leads to pulmonary edema.”  This looks like a case of initially damned if you do, but then damned AFTER if you don’t…

In conclusion, one should clearly not make any changes to your current medications while this debate plays out, but, in my personal opinion, we do not yet know what the final outcome will be, and the pandemic could be over before we do.  That is why I personally advise readers who take these medications to practice “social distancing” with particular diligence until the science is finally settled.

The following excellent JAMANetwork review article (which has section headings on the virus, epidemiology, clinical characteristics, case-fatality rates, screening and testing, clinical care and treatment, and prevention and infection control) just came to my attention via a tweet from Dr. Sanjay Gupta of CNN:


Please scroll down to the Comments section below for further questions and information.