Back to School with COVID – PediaCast 471

Show Notes


  • 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!


  • Back to School
  • COVID-19 pandemic


  • Dr Jessica Williams
    Pediatric Resident
    Nationwide Children’s Hospital



Announcer 1: This is PediaCast.


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.


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. 


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.


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.


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.


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. 


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.

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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.



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.


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.


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.


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.



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?


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.


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.


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.


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. 


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. 


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. 


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. 


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"?


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.


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?"


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?


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


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 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 so folks can see that.


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.


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.


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.


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.


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.


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?


Dr. Jessica Williams: It's a new term for me, too. I was just learning about it. But it's placing a group of children and teachers together for a period of time and keeping together during classroom learning, during lunch, during recess and just kind of minimizing their exposure to other cohorts. You kind of just stick with your group. 

And that helps, for example, if somebody got sick, there would just be a little group of people that were expose as opposed to a bunch of different groups mingling together and that exposure being bigger, if that makes sense.

Dr. Mike Patrick: So, basically have your little bubble of exposure and you stick with that same cohort throughout school time. Every day, you're just with that same cohort of people, which I can imagine is going to be really difficult when you have friends who are at a different cohort. So, I hope the schools at least take that into account a little bit. 

Although then, you wouldn't want people left out, like "I didn't get picked to be in someone's cohort."0 So that actually can just get so complicated.

Dr. Jessica Williams: I know.


Dr. Mike Patrick: But you do understand what you're trying to do there with that, so that's something to consider. As you're thinking about is school safe for my kids, is your school cohorting may be a question a parent would want to ask. And educate yourself if your school is doing that, maybe educate others if they're not. 

Advocate for that if possible. I see the advantage but not without saying, yeah, there's going to be some difficulty with that, too.

Dr. Jessica Williams: Absolutely. And I've heard from kids themselves say, "I'm in this group and my best friend in this other group." It's just it's tough.

Dr. Mike Patrick: Yeah, absolutely. That's when, "Okay, so go home." When we say limit screen time but maybe when you have a friend and you're going to Zoom or FaceTime after school, that's maybe important to keep those connections going for sure. 

And then, what about kids with high risk and medically complex conditions? So it does become more difficult for the parent deciding in that risk benefit thing with them going to school. 


It's also more difficult on the school. Like how do we make accommodations for folks with who are high risk and have medically complex conditions? How do parents go about thinking of what I need to do when that sort of situation exists?

Dr. Jessica Williams: I think what we have to do in the situation is really hone into that medical home for your child and that includes you as parents, your primary care provider. And then, also, the school nurse would be that person that's at the school to kind of advocate for that child. And sort of coming up with an individualized plan for your kid to make sure they are able to accommodated for their specific needs and also be safe and healthy at school, just like all the other children.

Dr. Mike Patrick: That's really great advice. This is not a decision that's made just amongst yourself. This is really a team decision, right?

Dr. Jessica Williams: Mm-hm.


Dr. Mike Patrick: And then part of the team is definitely going to be your primary care medical provider, the school nurse, any medical specialist that you have. And just really talk to everyone involved in your child's care and get their input and opinions as you go about making that decision. And realize that everybody has your child's best interest in mind.

And each person really is looking at the risk and benefit based on your child's medical condition, what the school is able to do in terms of distancing and to provide an educational experience for your child. But also, I think it's important to acknowledge that these are difficult decisions. And parents are not alone and we want to come around and support and help in any way that we can, as your child's medical providers.

Dr. Jessica Williams: Right.

Dr. Mike Patrick: And then, events outside of the classroom, this is another thing that comes up. And I know I hear are we live fairly close to a high school and the marching band has been out, practicing distance, but it still sound great. 

Hilliard Darby High School, we'll put a shout out to them. But they're out there doing their thing. How can we make those kinds of activities outside of the classroom, sports, band, theater, choir? How can we make those safe for kids?


Dr. Jessica Williams: In those situations, because these are group activities, trying to use outdoor spaces for as long as the weather is great is what I always recommend. Because I've gotten questions about these too, like "Should I put my child in organized sports so that my child can have interaction with other children, which will help with their development? So they're not always at home with me looking at a screen and learning remotely."

Using outdoor spaces is the number one thing that I talk about. Just because you're outdoors, not necessarily in a small space with a large group of people. 

With band and choir and all these other things, if you have to go inside, limiting the group size and maximizing the space size is important. And then for instructors that are in there, having them wear mask because they're provably instructing rather than playing instruments, like for example, is very important. 


But yeah, as far as these events, making sure you can do it outside is pretty important. But if you have to go outside, spread out.

Dr. Mike Patrick: Absolutely. And I love what you said that the coaches and directors and teachers who are all involved in outside the classroom activities, it's really important to set an example and to wear your face covering, maintain physical distancing, wash your hands. Do all the things to protect yourself and also to be a good role model for your students and your student athletes.

And then, eye protection, if your district is allowing closer to what you would consider contact sports where you're really are in each other's faces, then eye protection may be important as well. And listen again to your local public health officials, right?


Dr. Jessica Williams: Oh, yes.

Dr. Mike Patrick: Another question I get asked a lot is, is this really a problem for kids? We're not hearing a lot of severe COVID disease in children, but we do know that they can get it. Do they still transmit it to others or do they just keep it to themselves when they get sick?

Dr. Jessica Williams: I think this is something that the medical community doesn't completely understand just yet and that's something that we are still learning about even here at Nationwide Children's. I think it's safe to say that spread by children is possible, just as it's possible with adults. 

But as we're figuring it out, I think it's important to still do the safety measures that we have enforced, which is physical distancing and face coverings. But it is something that we are trying to figure out still. We don't completely have all the answers just yet, unfortunately, but it's an ongoing process. And as we're figuring it out, it's important to try to be safe as possible.


Dr. Mike Patrick: And I think one thing that folks don't always understand is that not all studies are created equally. And what you can do with the data that you get from a study and how you interpret it, how you incorporate it into recommendations really depends on the quality of that study. 

And there have been some studies recently that suggest that there is a lower risk of transmission from young children, but those studies are based on really small sample sizes. So we're not looking at a large number of kids and also in places where overall community transmission is low to begin with.

But what happens when large numbers of kids are infected? We don't know. And then, when you have a high-risk teacher in a classroom of 15 kids who were physically distanced, if multiple of those kids all do have mild COVID, is it possible then that teacher could get infected?


And these are questions that we just don't know the answers to. And as much as that frustrates us, that's where we are right now, trying to better understand this. We're seeing science really live out. And recommendations are going to change based on what we find out from good large studies, as they do become available.

But in the meantime, I would think as we want to care for and protect each other, we have to assume that young kids can transmit this to adult just as easily as anyone else. Because if we're wrong about saying that it's less likely, then we can really hurt people. And so best practice is just to assume that children can transmit COVID as easily as adults, at least until we learn more. 

And so, when you're around young kids, still face coverings, physical distancing, hand washing all going to still be very important.


This is going to get a little more gray area. As we think about COVID testing, because if we can test with the good test that's both sensitive and specific, so it's going to pick it up when COVID is there. It's not going to tell us COVID is there, when it's not. If we have good testing, then we can better isolate for a while until those people who are positive are the negative and can reduce the spread of this. So how do you go about figuring it out which kid should be tested for COVID?

Dr. Jessica Williams: It's interesting because different institutions... Of course, I'm a resident here at Nationwide Children's but I also have a community site where I do some work at too, as part of the residency curriculum. And everyone has their different algorithm for who they test. 

So I guess a good rule of thumb that I've learned is that we're not typically recommending screening of asymptomatic children, unless that child is in a household where there's a known positive exposure. 


But for the most part, if these children that come in that have symptoms that are consistent with COVID, which is kind of difficult because a lot of the symptoms are similar to symptoms that you get with other viruses or other illnesses. And these symptoms are fever, runny nose, coughs, sore throat, you lose your sense of taste or smell, you have vomiting, you have diarrhea. 

Those children are more likely to be screened and should probably get a COVID test. Especially if this child is going to school, you really want to make sure that they're tested. And we know that they have a negative test before they're able to go back to school again.

But it's also important to remember in this cases, if you do have a child that gets a COVID test, that even if they have a negative test, it's important to remember that it's just that at that point in time that that child had their test, COVID-19 was not detectible at that specific time. Because the next day, they could still become positive that day, but you just don't have the data because you didn't test in the day after, if that make sense.


Dr. Mike Patrick: Yeah, absolutely. So even if they test negative but their symptoms are worsening, then that maybe an instance where, well, maybe we need to test them again to make sure that it's not there. And then, the other thing is it may take a little while before the results come back. 

And so, if you get that test, you're saying, "Well, there is a good possibility that this could be COVID." And so you really want to isolate and stay away from others until you get the result of that test back, which maybe several days but that's still going to be important because you don't want to be spreading that and then potentially infecting a high-risk person.

So how are those test then getting done? And again, this may be different from one community to another. What are the options of where you can get a COVID test if you do think that you have symptoms consistent with that disease?


Dr. Jessica Williams: Within the Columbus community and all the Nationwide Children's clinics, these primary care offices, most of them have access to COVID testing that they end up sending to main campus to be tested. You can also go to urgent cares if you're feeling sick and they also have access to testing. 

And then there is a drive-thru option here at Nationwide. And if you go to your primary care providers and say they didn't have access to testing, they can set up an appointment for you to go to the COVID-19 testing drive-thru here at Nationwide Children's, which is a nice option because you don't have to get out of your car. It's quick and easy. You just drive right thru, they do a swab and then you get a call back, as to whether your test is positive or negative. 

So, there's tons of options. And then, also Columbus Public Health Department has free testing as well.


Dr. Mike Patrick: And I think it's important, if you want to do the drive-thru testing here at Nationwide Children's Hospital, you do need to talk to your provider first and get an appointment to go in and have an order to have the test done. So that then your physician can get the results back and share those with you. You don't want to just show up for that. You really do need to get an appointment.

And then, other children's hospitals may be doing similar things. For folks who don't live in Central Ohio, you can always check the website of your local children's hospital. And then, always just call your child's medical provider. They're going to know what available in your community, what the hours are for the health department, if they're doing it, whether they have COVID testing. 

Or wherever it's available in your community, your provider is going to know how to get you connected with that. So please do use that resource. It's going to be really, really important.

So, let's say a family, a child has fever and a cough. They get that COVID test and it comes back positive. This is something that really could happen in your clinic. What do you tell that family that they need to do with that point when they have a positive COVID test?


Dr. Jessica Williams: We've already talked about how guidelines and everything has been changing so much day by day. We know that if somebody is positive, we want them to be isolated. And that means quarantining at home and trying to minimize the spread or getting anybody else sick. 

So that can be sometimes for two weeks or longer just until that child or anyone stops having symptoms. But really, at the end of the day, contacting your local health department for further guidance is also very important thing to do.

And it changes between communities, so that's very important to be in contact with not only with your primary care provider, but also with the health department for guidance on how to proceed.


Dr. Mike Patrick: Yeah, absolutely. Very important. And your provider is going to know what the most current recommendations are. I think right now, as we sit on September 1st, 2020, we're recommending you isolate for ten days. You make sure that symptoms are improving and that there's no fever for at least 24 hours without the use of fever-reducing medicine. Then, you don't necessarily need a negative test at that point. You would just say just say you are not contagious anymore, just like with any other viral illness. Again, based on what we know right now.

Then we also hear about, "Well, can you have two negative tests 24 hours apart?" And in some communities, they may be saying that that's an okay way to go. But it's still going to be important if this happens to your family is to talk to your doctor, see what the local health officials in your area are recommending at that particular time, because a month from now, it may very well be different.


And then, once you are clear to return, you still need to follow the same rules as your fellow students. So it's not like, "Oh, I had it. I don't have to wear a face covering anymore." That is not the case.

Dr. Jessica Williams: No.

Dr. Mike Patrick: You still need to wear face coverings, physical distancing, hand washing because the reinfection possibility is sort of unclear right now. And there have been some cases where they can tell that it's really is a new infection because the genetics of the particular virus is different from the first virus that a person had. 

But what we don't know is that second infection, are you as contagious? So does your immune system, even if the virus is there, it takes care of it quicker? Maybe there's a less viral load and so you're not as contagious with the second infection. 

Possible but we don't know. I mean, this is still ongoing. We're still learning about this virus. So the best thing still is to say, since we don't know, let's assume that if I get it again, I am contagious and a risk to others and still take care of one another by wearing these face coverings, physical distancing, washing our hands. Even though we may not be as contagious the second time around which is, again, let's assume that we are. That's how we care for one another.


And then, you mentioned significant exposure to COVID who maybe another reason to test like if you are asymptomatic, but you have significant exposure, what constitutes significant exposure to this virus?

Dr. Jessica Williams: Significant exposure, it will be different depending on what community you're in. And it's usually defined by the local health department in your area. But it usually includes the length of exposure to somebody who have a positive COVID test. 

And then what kind of protective behaviors were used at the time of that exposure, were you physically distanced with that person? Were you wearing a face covering, a mask, face shield? Do that exposure have a test that was absolutely positive and while they were symptomatic and around you? As opposed to somebody who had a negative test but was exposed to somebody else that was positive and that wasn't in the room.


So, it's really like a finicky definition but usually the length of time, what protective things were you using and if that person was absolutely positive with a COVID-19 test.

Dr. Mike Patrick: Almost always, if it's someone positive in your household, you're going to meet the criteria of being close to them, being around them for long enough period of time, and you probably weren't using PPE. You aren't constantly wearing face coverings, physical distancing, hand washing while you're inside your home. So that's almost always going to be a significant exposure. 

But yeah, it really does there is some wiggle room there in terms of how, I mean, in the beginning it was, well, if you're around them for more than ten minutes and then it became 15 minutes is probably okay. 

But again, it depends on your local health department and what criteria that they're using. And again, that just sort of illustrate how fluid this is as we continue to learn more. And people are going to have some different opinions about what constitutes significant exposure.


So closeness, length of the exposure, and then the use of personal protective equipment during that exposure kind of factor in to this. But ultimately, let your medical provider and local health officials determine whether it was a significant exposure or not, right?

Dr. Jessica Williams: Right.

Dr. Mike Patrick: And then, once you determined that there is a significant exposure, if COVID testing is available, great. Although you may not become positive right away, so that becomes even if you're negative, if you start to have symptoms, you really ought to get tested again. Because you may just not of have enough of the virus in the back of your nose, and how well that swab was done can come in to play a little bit.

But right now, the general guideline is if you have a significant exposure and maybe you can't get a COVID test or the results are going to take too long to get back, instead of isolating for 10 days, quarantine for 14 days. Just give yourself a little bit more time to see if that virus is going to be there.


I think in most places, it's significant exposure, kind of stay away for 14 days, watch for the development of symptoms especially if you can't get a COVID test. But again, that is just now on September 1st for our local community, but things may be different as time goes on and as your location changes as well.

Dr. Jessica Williams: And even if you do get the COVID test, I was going to say, even if you do get the COVID test, they might still suggest that you isolate for the 14 days regardless.

Dr. Mike Patrick: Yes, absolutely. And it kind of depends on which COVID test. Not all COVID test are created equally. And so there are better test than others. And so, what the availability of testing is in your community may make a difference on what the local health officials are saying where you are.

And I know all of this is just so frustrating because we're used to living in a world where there is consensus on medical advice and opinion, or what would seem like there is to be average person. Those of us in the medical community know that there's lot of different ways to do things.


And based on studies sometimes, there's a clear answer, and sometimes there's not a clear answer. And so, we use our best judgment based on our experience and training and what we've seen and all the data points together mixed. We considered it all and then that's what our job as medical professional is, is to come up with recommendations based on our best collection of all that evidence and interpreting it, right?

Dr. Jessica Williams: Yes, absolutely.

Dr. Mike Patrick: And that's part of the reason that it takes 14 years to become a pediatric specialist.

So, let's move on to the classroom. What do you think, and this is a little bit of loaded question and I know that you don't known is going to be able to have the right answer for every school. But what are sort of the possibilities that schools will do if they find out that a child who'd been to school now test positive for COVID?

Dr. Jessica Williams: There's so many different things out there, different guidelines for different communities. That's the recurring theme on all of these answers, I'm sure that you guys who have been listening.


But they usually say sanitizing the school is very important. Sometimes, schools might be shut down for maybe two to five days as they sanitize the areas that potential exposure that person that tested positive, like cleaning the areas that they were in. 

But it all comes down to communication between that school and the health department to come up with the plan for sanitization and then also to determine who have been significantly exposed and who then needs to be isolated or get a COVID testing, too.

So, it's loaded, like you said. There's a lot of different moving parts but it's open communication between the school and the health department to figure out how to get kids back to school or remote learning or whatever they need to do, so that everyone is safe.


Dr. Mike Patrick: I think the important thing is each school has a plan like, "What are we going to do?" And I'm sure this has been discussed and just sometimes it's not shared with parents. 

But this is where cohorting can be helpful for schools because if a student does end up being positive, then you can just sort of isolate that cohort rather than an entire school. So that would be one of the advantages of utilizing cohorts within the school. 

But they're definitely going to be talking to their local health department about what to do for this particular school, what kind of sanitize, what areas need to be sanitized.

And one thing that parents can do that may help is when your child does become positive while the memories are still fresh, ask your kid in the last couple of days, where in the school have you been? What students had you've been close to? Who are your friends that you'd been talking to?

Just try to really get as much information as you can about your child's day-to-day going-ons and who they'd been around while those memories are fresh. So that then you can tell school officials and local health officials who you've been around. And it makes the contact tracing a little bit easier. 


And then, you may not have to sanitize the whole school, just the areas where the students had been in their cohort can be helpful. But again, we don't want to say this is what a school should do because we don't know. And each individual place may be a little different as we all try to work this through together, right?

Dr. Jessica Williams: Yes, absolutely. And things might change. Things might change.

Dr. Mike Patrick: Yes, absolutely. They probably know. And we can expect that as we learn more as new studies are done, new data comes about that we're going to change, what our recommendations are based on the latest evidence. I mean, that's what evidence-based medicine is all about. And we can expect that to change as time goes by. 

And it doesn't mean we were wrong before. It just meant that we were making recommendations. The best recommendations that we could based on what we knew at that time. And we do know that those change.


I'm going to have some other resources for folks, for both parents and schools over at One from the American Academy of Pediatrics called COVID-19 Planning Considerations, Guidelines for School Re-entry, tons of really great evidence-based information in that document. 

And then the Ohio Department of Health also has a website, COVID-19 Health and Prevention Guidance for Ohio K-12 Schools, also loaded with great information. Even if you're not in the state of Ohio, please do consider using our resource because our local health officials really have put a lot of time and effort into coming up with these guidelines, to try to make the return to school and remote learning as safe as possible. So, I will put links to those in the show notes over at


And then, as I've mentioned before, we'll also have links to the Pediatric Residency Training Program here at Nationwide Children's, and some links on face coverings, the Use of Masks to Slow the Spread of COVID-19, that's from the CDC. 

And then, When and How to Wash Your Hands, another great document from the Center for Disease Control and Prevention. And I'll put a link to that in the show notes as well.

So, Dr. Jessica Williams, pediatric resident here at Nationwide Children's Hospital, really it was a pleasure having you in the show. Thanks so much for stopping by today.

Dr. Jessica Williams: Thanks so much for having me, Dr. Mike. It's been great.



Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.

Also, thanks to our guest this week Dr. Jessica Williams, pediatric resident at Nationwide Children's Hospital.

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Also, let your pediatric providers know. So whoever it is your child sees, their pediatrician, family practice, family medicine doctors, nurse practitioners, physician assistants, all those great medical providers. Please let them know we have a program for them as well. It is similar to this show. We turn the science up a couple notches and offer free Continuing Medical Education Credit for those who listen. 

And by the way, not only for medical professionals directly, but also anyone who is involved in the medical care of kids. So, we're talking pharmacist, psychologist, social workers, even dental professionals. We offer Continuing Medical Education Credit because Nationwide Children's is jointly accredited by many professional organizations. And it's likely that we offer the exact credit you need to fulfill your states Continuing Medical Education requirements. 

Shows and details are available at the landing site for that program, You can also listen to that one wherever podcasts are found. Simply search for PediaCast CME. 


Thanks again for stopping by and until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everybody.


Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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