Back to School with COVID – PediaCast 471

Posted by Dr. Mike on September 1, 2020

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Description

Dr Jessica Williams visits the studio as we consider the new school year in light of the COVID-19 pandemic. We explore in-person vs remote learning, group activities, viral testing, quarantine, returning to class after COVID… and more. We hope you can join us!

Topics

Back to School
COVID-19 pandemic

Guest

Dr Jessica Williams
Pediatric Resident
Nationwide Children’s Hospital

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.

It's Episode 471 for September 1st, 2020. We're calling this one "Back to School with COVID". I want to welcome all of you to the program.

0:00:57

So, summer does not last forever, although there are certainly days when I wish it would. The students have been out of the classroom longer than any other period in modern time, with many children in the United States learning and then vacationing from home since March. Despite what we hear in the news, most communities are doing a great job of flattening the curve with a few hiccups and exceptions.

Early in this pandemic, I will remind you that we heard over 2 million Americans would likely die without some extraordinary efforts, and those efforts being closing schools and businesses, physical distancing, wearing face coverings, washing our hands and surfaces, and limiting non-essential travel.

Public health officials told us if we did these things, we could get the number of American deaths down from over 2 million to around 600,000 by the end of the year. The end is not over yet, but we are sitting in around 183,000 deaths from COVID here in the United States on September 1st, 2020, which is still a lot of deaths. Especially when you compare it to a typical flu season, which results in about 20,000 to 30,000 deaths each year.

0:02:15

So nearly 200,000 which is where we may be by the end of the year, that is a lot more than the flu but it is certainly a whole lot less than the 2 million deaths that were expected without our efforts. So, we've done better than expected. They are thinking we could get from 2 million to 600,000. We're probably going to be at about 200,000.

So together, we have saved millions of lives so far. Let's not forget that. It's a noble thing that we have accomplished.

But now, the seasons are changing and as much as we want life back to how it was before the pandemic, we can't do that quite yet. SARS-CoV-2 is still lurking out there and that has been evidenced by the rapid rise and numbers and deaths in locations that reopen earlier than recommended and in places that have ignored the advice of local health officials.

0:03:16

So, we have to remain cautious and careful and yet, the return to in-person instruction is important for kids because schools provide lots of opportunities that go beyond the digital classroom. I mean, there are friends and meals and physical education, sports, art, music, choir band, activities and opportunities that do not translate as well with remote learning. So, it's important to get kids back in school while still respecting our current climate which includes an ongoing coronavirus pandemic.

So how can we best do that? Well, to some degree, the answer is going to be different depending on your location and the state of the virus at a particular time in your particular community. And yet, there are some global principles that we can generally apply across the board and tweak as needed as situation changes and our knowledge of the virus and its transmission and treatment advances.

0:04:16

Today, we're going to talk through many of these issues that surround reopening of school during COVID-19. We'll talk about options for the new school year and how parents can go about deciding the route to take when they are offered a choice.

Do we do remote learning? Do we go back to in-person classes? Do we do the hybrid model? How do we decide what's best for our family?

Who needs tested? What to do if your child test positive or if another child and his or her class or a teacher test positive? When and how long should your child quarantine? When does an entire class or school need to quarantine?

And here's a spoiler alert. There are not a lot of concrete answers for these questions, which many will find frustrating at first. But by using our critical thinking skills and the advice of local public health experts, it is possible to forge a path forward as we approach the new school year.

0:05:13

To help us explore all of these topics, I have a terrific guest joining me, Dr. Jessica Williams. She is a pediatric resident at Nationwide Children's Hospital. And she cares for young patients and their families in our primary care clinic and throughout the hospital. She will be joining us shortly.

First, I do have a few quick reminders for you. It is time to start thinking about your flu shots. September and October are really great months to get your annual flu vaccine.

Of course, we want to prevent influenza every season, including this season, not only because the flu can make us very sick or the thousands of previously healthy people die from the flu each year. But also, because any illness this particular flu season with fever and cough is going to make you and those around you worried that your symptoms could be caused by COVID-19.

0:06:05

You're likely going to need a COVID test, which can actually then to some degree put you at risk of exposure, because others who really do have COVID will possibly would be in the facility where you are getting your COVID test.

Of course, we're going to do our best to keep sick folks apart, make sure everyone is wearing face coverings but the possibility of exposure remains. And that exposure can be prevented by avoiding the flu altogether this year, which is more likely by getting you annual flu vaccine.

They are highly recommended. So please do consider getting your flu shots earlier rather than later. Now is a good time to start thinking about it. Sometime this month or early next month would be ideal to keep you protected throughout this winter from the flu, because it's just another thing you just don't need to worry about. Just get those flu vaccines.

Also, I want to remind you, you can find PediaCast wherever podcast are found. We are in the Apple and Google Podcast apps, iHeart Radio, Spotify, SoundCloud, and most other mobile podcast apps for iOS and Android.

0:07:06

If you like what you hear, please remember to subscribe to our show, so you don't miss an episode and please consider leaving a review wherever you listen to podcasts. So that others who come along looking for evidence-based child health and parenting information will know what to expect.

We're also on social media and love connecting with you there. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply search for PediaCast.

We also have a Contact link over at pediacast.org if you would like to ask a question or request a topic for a future episode of the program.

Also, I want to remind you, the information presented in each and every episode is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So, let's take a quick break. We'll get Dr. Jessica Williams connected to the studio and then we will back to talk about back to school with COVID. That's coming up right after this.

0:08:11

[Music]

Dr. Mike Patrick: Dr. Jessica Williams is a pediatric resident at Nationwide Children's Hospital. She cares for young patients and their families in our Primary Care Clinic and throughout our hospital, which includes answering lots of questions about the return, the in-person classes and remote learning. That's what she's here to talk about today, back to school with COVID.

So let's give a warm PediaCast welcome to Dr. Jessica Williams. Thanks so much for stopping by today.

0:09:04

Dr. Jessica Williams: Thank you so much for having me.

Dr. Mike Patrick: I really appreciate you taking time out of your busy schedule to be here. So, I mentioned that you are a pediatric resident. Tell us a little about yourself and what that means. What is the Pediatric Residency Program at Nationwide Children's?

Dr. Jessica Williams: I'll start off with me. I'm from Boston, Massachusetts, originally and then I came to Ohio about five years ago and did my medical school training at the Ohio State University, College of Medicine.

Dr. Mike Patrick: Go Bucks!

Dr. Jessica Williams: Yes.

[Laughter]

Dr. Jessica Williams: And that's a four-year program and then I applied into pediatrics for my residency and that is a three-year program. I'm a categorical pediatrics resident. I'm now a second year.

Residency is awesome. It's hard work, especially your first year, but as I'm going through it, I'm learning a lot about primary care, about hospital medicine and different specialties. And then, hopefully in the end, I'll either specialize in between emergency medicine and neonatology. Or, I'll probably do primary care, urgent care. I'm all over the place, but at least Nationwide gives us a good breadth of knowledge.

0:10:15

Dr. Mike Patrick: Yeah, and there's so many areas within pediatrics that are so rewarding and really fun to practice. And it's funny because as you mentioned those things, those are the things I was interested in as well.

There was a time when I thought, maybe I would be a neonatologist, emergency medicine was in the mix. I did practice general pediatrics for quite a while. And so those are all great wonderful things. And, of course, we wish you the best of luck.

For those who may not understand what kind of training goes into being a physician. So, you did undergrad. Where did you do that?

Dr. Jessica Williams: I went to school at Trinity College in Connecticut.

Dr. Mike Patrick: Okay, and so that's four years?

Dr. Jessica Williams: Mm-hm.

Dr. Mike Patrick: And then medical school is another four years. You're in the midst of your pediatric residency now which is another three years. And if you do specialize, then that's a fellowship Em/Peds, which most of those are another three years.

[Laughter]

0:11:10

Dr. Mike Patrick: So now we're talking 14 years of training. And I point this out because we see so much stuff on social media these days, and everyone is an expert on medical opinion and sharing things. And really, it takes a long time to start to hit your strive and really feel comfortable looking at data and making decisions on the fly. This is not an easy thing, right?

Dr. Jessica Williams: Absolutely. It takes a long time. That's why training is so long.

Dr. Mike Patrick: Yeah, absolutely. And for folks who want to know more about the Pediatrics Residency Training Program here at Nationwide Children's Hospital, I will put a link in the show notes for this episode, so folks can find it and get more information about it.

Let's turn our attention to your primary care clinic where you take care of kids and families. What are you hearing from parents as the new school year gets started? What concerns do they have that they're voicing to you?

0:12:07

Dr. Jessica Williams: A lot of families are just scared in general of it being a pandemic. They're nervous about having their kids leave their homes, especially when back in March, we send kids home from school. So now, with the pandemic still going on, how should I send my kid to school? Is it still safe when there's still pandemic? So a lot of families are afraid in that respect.

I'm also hearing a lot of concern about remote learning and keeping kids on a schedule at home. And then, if they do choose to keep their kids at home, are there outlets or other ways that they can interact with children in a safe environment? I'm hearing that a lot.

Dr. Mike Patrick: I mean, really, there's a whole gamut of emotion and I think that the most important thing to convey to parents is that you're not alone in feeling that. So when you're feeling anxious, depress, angry, all of those feelings, I mean, everybody is feeling that way right now.

0:13:06

Dr. Jessica Williams: Absolutely. That's real tough. It's uncharted territory for sure.

Dr. Mike Patrick: Absolutely. There's so many options right now for returning to school and learning this fall from in-person classes. Some schools, that's the only thing that they're doing. Others have a remote option.

Some folks have to choose between the two, others have hybrid models. And in instances where families have a choice, one of the things that I've been asked a lot is, "What should we do?" And often, it's not even from my patients. It's from friends and family texting me, like the school says, "We can do this or this. Well, what should I do?"

How do you go about helping parents decide which option is best for their family?

Dr. Jessica Williams: I always try to tell them that one size doesn't fit all. And there are options for a reason, it's all what they feel comfortable with for their specific child. There's a lot of different options and I know they're there for a reason. None of them are wrong. You just have to decide what's best for you. That's what I usually tell them.

0:14:08

Dr. Mike Patrick: Yeah, absolutely. And as you think about those, you can be so conflicted and go back and forth and back and forth and think, "It's really going to be best if my kids around other kids and that socialization process is so important. And then, all the different things that schools offer, art class and music and school lunches. And on the other hand, I'm really fearful. Maybe my child does have a chronic medical condition. And that it's better that you have to put that layer on top of it."

And then there's also just risk tolerance. Some families just are more tolerant for risk than others and that's not a good or bad thing. It's just another way that families are different.

And one thing that I really told folks is listen to your gut. Make a decision and then once you make a decision, don't look back. I mean, don't look at like, "Well, what if I should have done this." Just make the best decision that you make and move forward. And I think that that's important for families because it's so easy to second guess yourself.

0:15:05

Dr. Jessica Williams: Absolutely. And I think the other thing is to remain flexible because even if you have that in-person option, there is a possibility that we might go completely remote and there might be an option. So, I think the other thing is to remain flexible in your options.

Dr. Mike Patrick: And then, being in constant contact with the school and if your situation changes, then it won't be a surprise to them, hopefully. And they can help you adjust to whatever you need to do.

As we move forward and talk about returning to school and remote learning in the face of COVID, I do want to point out that right now, it is September 1st, 2020. And the things that we talk about and any recommendations that we might make along the way are based on information that we know in September, early September, knowing the things are probably going to change. And so just listeners, please do keep that in mind.

0:16:03

And the most important is going to be to pay attention to your local health officials. And if they're telling you something different than what you're hearing from us, they know what's going on in your community. And, of course, we have listeners all across the country and so each community is going to be a little different.

So please really do pay attention to your local health officials, in terms of recommendations because they may vary from one community to another, which make sense in a fluid situation like this.

So let's talk face coverings first because this has garnered a lot of controversy. And I think some of it stems from the fact that in the beginning of the pandemic, the medical community was saying that face coverings and face masks are not necessary. Which to me was sort of crazy because then why am I supposed to wear a face mask in room where kids with communicable diseases?

And so, they're not 100% effective, especially if it's not an N95 type face mask. But we know that they do offer some help. And I think that the medical community was, really, the basis behind that was we just don't have enough face mask for everybody. And we want those frontline workers to have access to them first.

0:17:17

And so, it wasn't explained that way very well. And so, then as we started to get more and more of a supply and we figured out, hey, you can make home face masks and they can be effective, again, this fluid learning in all of these, the recommendations changed.

And so, then that makes science kind of suspect but in reality, changes and recommendations based on science is what we would expect, right? That's how science works.

Dr. Jessica Williams: Absolutely.

Dr. Mike Patrick: So where are we today right now in terms of best practices for using face masks?

Dr. Jessica Williams: I mean, we can talk about how we should be wearing face mask in the community but if we're talking about with children and going to school, all children that are returning to school should be wearing face coverings or mask. There are some exemptions to this, obviously, like if you have a child under two years old, we don't expect them to be able to wear a mask all day.

0:18:15

Those children who are unable to remove a face mask on their own shouldn't be wearing them. Those who have any kind of behavioral and psychological issue and they're undergoing treatment. And them wearing a mask would make them just really, really agitated. Those are children that shouldn't be wearing face mask because it wouldn't be safe for them to do so.

And also kids that have some kind of facial deformity, which would make it difficult for them to breathe. But any other child should be able to wear a face mask and that should help to decrease the viral spread.

Dr. Mike Patrick: So really children over the age of two is what we're saying, so really preschool, kindergarten, all the way on up, because I have heard, well, some district are saying if you're this age or you're in this grade.

0:19:07

But in terms of the American Academy of Pediatrics and sort of the consensus among pediatric healthcare professionals, any child who is in school should be able to wear face covering, except for those exceptions you had mentioned, if you're not able to remove it without assistance, severe anxiety, autism, the facial deformities.

You can do a face shield, and that may be helpful for some of those kids, knowing it's not as effective as a face covering or mask. But it may be an option, especially for those kids who really can't tolerate for one reason or another that snug mask up against their mouth.

Now, one other concern I see is, "Is my child getting enough oxygen when they have a face mask on? What do you tell folks who would tell you that in clinic, like, "I feel like I can't breathe in my face mask"?

0:20:01

Dr. Jessica Williams: It's so different like this is not something that we're used to. I do tell them that, we're not used to have something on our faces. But I do tell them that they will be able to breathe through them.

I also talk about my mask because I always going to rooms with mask now too because that's our standard here at Nationwide. And I explain to them, at least even with my family, friends and everyone, that you're going to be okay. You can breathe through their mask.

The mask is not a suffocating thing. It's not designed to be that way and you will be able to breathe. It will just feel different.

But the whole purpose of wearing it to kind of decrease the viral spread or potential viral spread is very important, especially when we're going to go out in the community and be around other people who maybe asymptomatic or be sick.

Dr. Mike Patrick: Yeah, absolutely. And it is true that it decreases airflow, like you're not going to be able to get as much air in with each breath. Or it may take a little extra effort because you're breathing through fabric. There's some resistance there. But the air that comes through still has the same amount of oxygen in it. So, you're not getting decreased oxygen.

0:21:11

And in fact, it does take some getting used to, that different feel of your breathing. And that I think all of us who have experienced that, who didn't wear face masks for eight hours straight during a shift pre-pandemic, the OR personnel are like, "What?"

[Laughter]

Dr. Mike Patrick: No big deal at all. We've been doing these for years. But for those of us who didn't do that, it really has become a change. But it's so second nature now, it doesn't take long of just doing it that it begins to feel normal.

Dr. Jessica Williams: Right.

Dr. Mike Patrick: And this is a little scary, but there are times when if I'm out, taking a walk and I'm distanced and there's no one around and I don't have a face mask on, I feel different, like it's a different feeling. And I'm hoping that will become the new normal someday very soon. But for right now, it's not, so that we can protect each other and all of us, even our kids.

And sometimes I find that it's the kids in the exam room who have an easier time keeping their masks on than the grownups. Have you seen that?

0:22:08

Dr. Jessica Williams: Yes, sometimes. And sometimes they play with it.

[Laughter]

Dr. Mike Patrick: Absolutely. And there's just these general reminders, mask back on. And we've talked before in this program about some things that families can do like making the face mask fun out of material that your kids like. "What's your favorite superhero?"

And just making it a fun thing, but also instilling some "Hey, we're doing this to help protect each other" because that sense of social responsibility is really important to relay to kids.

And I do have some resources that I'll put in the show notes over at pediacast.org from both the CDC and the Ohio Department of Health in terms of using face mask. They have some patterns for making your own. And just more information kind of a checklist of what you would need to have a good face mask and that's all available again over at pediacast.org so folks can see that.

0:23:01

And then physical distancing is the other thing that we talk about. What is the right amount of space that we want to keep between each other?

Dr. Jessica Williams: I'm sure people have heard about physical distancing, social distancing, kind of the active maintaining space between each other to minimize potential spread and just to keep each other safe. And I'm sure they've heard of six feet apart usually. And then there's also this three feet apart that we've heard, too.

Obviously, the ideal distance is six feet apart. But if not possible, we've been told that wearing face coverings and kind of maintaining at least three feet apart. Like in schools, if they're unable to get that six feet apart, they're able to three feet apart, that's still very ideal and important.

Dr. Mike Patrick: I think this is another one of those times when, "Okay, what's the science? Is it three feet? Is it six feet?" But a lot of the decisions that we make in medicine and, really, even just as parents in our daily life is based on risks versus benefits.

0:24:03

And so, if you have a situation where you really can't do, okay, six feet is ideal, but we can't do that in our physical space. So three feet may be good enough, especially if you're wearing face coverings and not going to school when you have symptoms.

But then, the risk, then you look at the benefit of school and you have to really balance that. What's the benefit? What's the risk? Where am I coming out?

And six feet is great and should be what you practice if you can. But with three feet, the benefit of school may still be worth it compared to that risk. On the other hand, three feet without face masks, now the risk is starting to outweigh what benefit you get because you really can get it much more easily, take it home to a high-risk relative and then have a pretty bad outcome.

So, this is something in medicine that, as physicians, we try to walk families through risks and benefits all the time, right?

Dr. Jessica Williams: Absolutely. Yeah, that's a good way to put it.

0:25:00

Dr. Mike Patrick: And then, hand washing is, so we have a trifecta of ways to try to prevent the spread of COVID. Face coverings, physical distancing, and hand washing is really important. What is the best way to teach our kids and to do ourselves to wash our hands?

Dr. Jessica Williams: Even if we weren't in a pandemic, hand washing is very important.

[Laughter]

Dr. Jessica Williams: I mean, just for day-to-day life, I mean, even after using the bathroom before preparing food, before you're going to eat your food, after you cough or blow your nose, you want to wash your hands. But importantly, washing your hands correctly is important.

So usually, what I tell family is you teach your child to wet their hands, get some soap on them and then lather them up and keep scrubbing at least for 20 seconds. Now, how long is 20 seconds? It could seem like a lot of time if you're counting it out loud.

You can sing a song for a couple times. I usually sing the Happy Birthday song. If you sing that twice, it's about 20 seconds.

And then you rinse completely. You dry with like a queen towel. You can do the air dryer as well. And then that's it. But that's the correct way, that at least that 20 seconds of scrubbing in between your fingers, under your nails, to try to get any germs off of your hands.

0:26:16

Dr. Mike Patrick: Yeah, absolutely. Whatever song you hum, whether it's Happy Birthday a couple times through, the ABC song, whatever it is, kind of time what about 20 second is. And then just teach your kids to always sort of hum that song in their mind when they're doing it, so they hit that 20-second mark.

So, soap and water is really the gold standard. Sometimes, that's not available and folks with bad eczema can really dry your hands out if you're washing over and over again. So hand sanitizers can be acceptable but you do want them to have at least a 60% alcohol content and still rub until it's dry, which usually takes about 20 seconds. So that's going to be important.

0:27:00

And then, in terms of when to wash your hands, definitely before you eat, after you use the restroom, after you touch common surfaces like doorknobs and things that lots of other people might be touching, good idea to. And groceries, and when you pick up the mail, things that others could have touched, just wash your hands real quick afterwards. That's really going to do a lot to help prevent the spread of viruses.

And then, if I had to add the number four, it would be stay home when you're sick. Don't go to school with symptoms. If you're not going to be able to get, and we'll talk more about COVID testing, but if you're not able to get a COVID test, if you do have sick symptoms, ten days, stay home for ten days. And then wait until you're fever-free for 24 hours and those symptoms are definitely improving over the ten-day period. So, it's going to be important.

One thing I've heard of schools doing is this thing called cohorting. That's not a term that I had really thought of when it comes to education before. What does that mean and why is it a thing? And why is it important?