I have a sign in my files which is pre-designed in case I should ever need to print it and place it on my door. It is one of many similar contingency plans I maintain just in case conditions should become such as to require immediate action on my part. Unlike most of the other contingencies which I maintain standing plans for, this one has actually happened to me before.
Here is a screenshot of the sign in question:
As you can see, this sign is designed to help enhance our house’s notably robust health precautions. Given the fact that I am not only immunocompromised, and thus more vulnerable to infections of all sort, but also physically disabled in such a way that makes treatment of acquired infections all the more difficult to treat, these relatively mundane precautions really are a matter of life and death.
In a perfect world, this would be a non-issue. In such a world, the appearance of any kind of infectious disease in a community, such as, to pick a relevant example, my high school, would result in an immediate and coordinated response to isolate and care for those affected, and to ensure that the disease is never allowed to spread. In such a world, the burden of ensuring that the sick receive adequate treatment to, if nothing else, avoid further spread of contagion, would be shared among all those potentially affected, which is to say, among all those that use community services and participate in community life.
Work would be provided for students who missed class, and absences due to illness would not be held against student advancement. Students would be encouraged to stay home and recover when sick, minimizing the overall impact of infection on the entire population. In such a world, it would be easy for me to attend school without fear of contracting illness and being hospitalized for a prolonged period, or worse, owing to the complications of my legally recognized disabilities.
Of course, this is not the world we live in. In our world at the present time, students rarely, if ever, stay home when contagious, or even when attending would be detrimental to their health. Having spent a considerable amount of time in my school nurses’ office, I can state categorically that it is vastly more likely for a given sick student to be sent home forcibly by the nursing staff than to be voluntarily taken home by parents, even when said students already have a clinically high fever and are obviously contagious. There are, of course, plenty of solid reasons why this is the case. Quite simply, the incentives created by the school administration are to blame.
For starters, ours is a terribly competitive school, where students are advised and compelled not only be parents and peers, but by staff advisors and counselors to take as many advanced placement and honors courses as can be logistically fit into a single schedule, without great regard for student interest or workload capability. This, in addition to a myriad of recommended extra-curricular activities and volunteer work. The nature of such courses is, obviously, to be quite intensive, and often unforgiving.
Furthermore, the fact that so many students, many of whom would probably be better served by courses that are “merely” honors or college-prep, are bumped up into higher echelon courses means that teachers are given the unenviable task of having to weed out those who oughtn’t be enrolled in the first place from those with genuine ability. This is accomplished primarily by a relentless onslaught of busywork designed to be taxing to even the best of students, and sufficiently crushing to those who lack the necessary conviction that they become compelled to drop those courses.
Naturally, this kind of curriculum is rigidly inflexible and unforgiving in such a way that missing one class becomes a major setback, and missing a week (the CDC’s recommended recovery time for seasonal influenza) is an effective death sentence. Teachers, who are as much burdened by the need to keep consistent and challenging curricula as the students are to keep up with it, are either too busy to meaningfully accommodate students who have been ill, or else are so jaded from years of having students cheat and evade work by any means in order to maintain a competitive edge, that they simply cannot effectively empathize.
Subsequently, it remains in the short term rational self interest of each individual student to continue coming to class for as long as they are physically capable, regardless of contagion risk, regardless of the long term harm that such exhaustion wreaks on an ill body. And after all, in the unlikely event that such a normally-healthy student is rendered so wretchedly close to death that they are forcibly removed from class, such a traumatic event will undoubtedly attract sympathy and support from the administration, only then providing the necessary accommodations.
This is, of course, only one part of a systematic incentive system which compels students to maintain their attendance regardless of health. There is still the larger problem of recorded absences. In our school, every absence after a certain number of days must be accompanied by a note from a licensed physician – even if standing orders exist from certified specialists to cover such eventualities. Failure to provide such documentation to the school’s liking results in automatic referral to Child Protective Services. This is still true, regardless of the age of the student. So, an eighteen year old who is completing high school will still require a parent to call in each day with a note from a licensed physician, under threat of referral to CPS.
As noted previously, even where absences are “excused”, actual class accommodations for said absences are never forthcoming. Thus, a culture of working oneself to death emerges, with students extolling the virtues of “working through a cold” unto one another. As with most discussions between adolescents, this naturally evolves into a sort of competitive posturing, with students all working to prove that they are the most devoted, most strong-willed, most likely to prevail against all other kinds of adversity.
And of course, if through this manner of working, one’s rivals should be exposed to some nasty pathogen that causes them sufficient pain to nudge the grading curve into a more favorable state, or else knock them out of the running for valedictorian, it might come to be seen that the proliferation of infection throughout the school is not entirely at odds with one’s own academic and political ambitions. In which case, what incentive is there for a rationally self-interested person to do anything but continue to attend regardless of contagion?
Thus it comes to pass that my school is, as my immunologist calls it, “the germ factory”, with seasonal outbreaks as reliable as the teachers’ quiz schedules. For most students who have normal physiologies and the robust immune systems to defend them, the occasional coronavirus or sinusitis is no great pain. At worst, it means a couple days carrying a box of tissues everywhere. But for me, these remain plan-derailing, life threatening catastrophes that likely end with me in the hospital.
Except as much as I wish myself to be above the stubborn self-damaging habits of my able-bodies comrades, I find myself in the same dilemma with regards to missing class. After all, why ought I to have to isolate myself, when I’m not even contagious? At a certain point, after a certain number of reported outbreaks, the strategic calculus changes enough to justify my own voluntary self-quarantine. This is especially true when the illness in question is a GI bug, which are, for a variety of reasons, my Achilles heel. But until that point, what can I do to balance my own safety against my education?
This is a question without a proper answer. In an ideal world, the burden would not be on me to sequester myself, but on others to ensure that they are not spreading contagious disease. But this is not the world we live in. We live in a world where the right thing to do, and the economically sensible thing to do are at odds. Ideally, this would be set right by a coordinated societal effort to realign the incentives with the morally and socially responsible choice. For the time being, I will keep my sign on the door.
