How to Keep Kids Healthy as the Country Reopens

CHRISTIANE AMANPOUR: Now, we have been covering the ongoing political fight over children returning to school this fall amid this pandemic. And now the medical community is weighing in, with the American Academy of Pediatrics issuing its own guidance. Dr. Sean O’Leary is vice chair of that organization’s Committee of Infectious Diseases. And here’s our Hari Sreenivasan talking to him about what we know and what we don’t know about how children are affected and the challenges that — posed to reopening schools.

(BEGIN VIDEOTAPE)

HARI SREENIVASAN: Thanks, Christiane. Dr. O’Leary, thanks so much for joining us. I want to ask kind of a relatively simple question here. What is the position of such an important organization of pediatricians when it comes to school reopenings? Because, in the past 10 or so days, we have kind of heard two different things that have confused certainly a lot of parents. I just want to look at a couple of these statements here. First was: “The AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school.” And then it was: “Schools in areas with high levels of COVID-19 community spread should not be compelled to reopen against the judgment of local experts. A one-size-fits-all approach is not appropriate for return to school decisions.” Lots of people are in lots of different places around the country. Some have high rates of COVID infections right now. Some do not. What should we do, according to pediatricians?

DR. SEAN O’LEARY, VICE CHAIR, AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON INFECTIOUS DISEASES: Yes, I mean, we’re in a situation right now in the U.S. where we’re stuck between two really not very acceptable choices, having kids either at home because of COVID-19, or having them in school in places where COVID-19 is circulating widely. The AAP’s position really came out of the concept of a lot of the schools and districts were looking for guidance around how to safely reopen schools, I think we’re all on the same page with pediatricians, educators, et cetera, that children learn best in school. And I don’t think that’s really ever been in debate. What we were seeing was that, in a number of districts, in May, even, they were already making the decision to go to online or hybrid models. And, clearly, those had negative impacts on children in the short period of time that schools were closed in April and May. So, that was where — that was sort of the starting point for the guidance. On the other hand, though, we also need to make sure that everyone is safe. That includes students, teachers and staff. So where — in places where the virus is really circulating widely, as we’re seeing in a number of the Southern states right now, it may not be safe to open schools to in-person learning in a meaningful fashion in terms of having every child in school, because, if we’re seeing significant outbreaks in the surrounding community, there’s no question we’re going to see outbreaks within schools, no matter how many mitigation measures are in place.

SREENIVASAN: It totally makes sense that a one-size-fits-all policy won’t work for the entire country, given our diverse geography, our diverse public health status in the context of this crisis. How does a school district prepare for having an influx of students come into classrooms? I mean, is it a certain number that they’re looking for in their community, if the infection rate is below X, then let’s go ahead and proceed, and, if the infection rates goes above X in a week or two weeks, then we have to scale back? When you are working with school districts and pediatricians are advising them, what’s the rule of thumb?

O’LEARY: I think the most important thing I could say about that is, we really need to do everything we can locally, and within states, as a country, to drive infections down right now, if we want to safely reopen schools in the fall, because if the virus is circulating in a month the way it is right now, which in many cases it probably will be, it’s really probably not going to be safe to have a large population of students congregating. On the other hand, if we are in places where the virus has low or very minimal circulation — and there are various ways that public health officials measure that — I think it is going to be safe to have a lot of children in school. And so that means with plenty of mitigation measures in place, such as cohorting students, limiting the — or setting the space between the students, mask wearing for most students, probably certainly the older students, certainly protections for the teachers and the staff, with as much physical distancing as possible between adults, mask wearing by adults when they’re anywhere near other people. Remember that the adults — children certainly can get sick with this illness, but the adults are at the highest risk.

SREENIVASAN: So, tell me a little bit about that. What does the science show now about how likely children are to get it, to transmit it? Because that’s really one of the core questions that people have, is, if I send my child back to school, what’s the risk that my child gets sick, but also what’s the danger that my sick child poses to perhaps their immunocompromised or older teacher?

O’LEARY: In terms of what we know about kids getting infected, the thing that is fairly clear is that kids are less severely affected with this virus than adults. That doesn’t mean they don’t get sick. That doesn’t mean that some don’t get very sick. But it’s clearly much more severe in adults, particularly older adults and those with certain medical conditions. In terms of their risk of getting infected, what also appears to be the case anyway — and I say this today — we’re learning more every day, and this may change in the coming days as we learn more — but what appears to be the case is that children, particularly younger children, are both less likely to get infected and less likely to spread the infection than adults. And that does play a role in sort of how we think about having kids within the schools. So, what I mean by that is there’s this — there’s all this controversy around the distance between students. And that was one of the things that we tried to clarify a little in the AAP’s guidance. CDC says six feat, if feasible, within schools between children. In a lot of settings, that’s not really feasible. So, when you look at the incremental gain that you get from six feet, as opposed to five feet or six feet, and the alternative of having a six-foot distance is having children at home, rather than in school, there are so many downsides to having the kids at home. I mean, we can go into that, if you would like. But there are many, many downsides there. And so, is the incremental gain of, say, six feet or five feet or four feet or even three feet, is it worth it, and particularly if you can get the old the older children to wear masks? There is some evidence that three feet is actually pretty good. Six feet is better, but three feet is pretty good.

SREENIVASAN: Let’s talk a little bit about some of the health effects that are not so great if children are stuck at home doing remote learning. I mean, I think a lot of parents have started to figure some of this out, one, how difficult teaching is at home, how, actually, it’s hard to get education into your children at the same time. But what are some of the downsides to having children at home, from a health perspective?

O’LEARY: Let’s start with a few of the studies that we have already seen come out. So, some of the things we have seen are that, one, we have seen obesity come — we have seen obesity increase, even in the short period of time that kids were at home. We have seen food insecurity issues with kids. We have seen increases in rates of mental health issues, including anxiety, depression, suicidality. So, those are a number of things that already are a problem in society. We don’t have enough behavioral health support already. With those increasing, it’s just a perfect storm for a really rough time for a generation of children. Besides that, I really think — I have been thinking through this all along. How is this going to impact the most vulnerable among our children and families, right? How is it — these children who are already at risk, who gain so much from being in school, when they’re — when children living in poverty at home, where — there are so many problems with having them in the home when parents are trying to work or the parents have to be at work, they don’t have child care. I don’t even know how that plays out. And I know, certainly, our district here in Denver is trying to consider backup plans for how we can handle that if schools have to be closed, but it’s just — it’s an unfolding tragedy, for sure.

SREENIVASAN: So, Doctor, there seem to be two things kind of playing at the same time. One is, I can hear whatever the public health experts say, and then there’s my perception of fear…

O’LEARY: Yes.

SREENIVASAN: … which drives a tremendous amount of decision-making. Until there’s something close to a vaccine, there’s still a massive hurdle to overcome of just how scared parents are for their children, understandably so.

O’LEARY: Yes. Yes.

SREENIVASAN: How do doctors deal with that?

O’LEARY: Yes. So, I mean, I do want to go back to the point that that, in general, children do seem to do better with this virus than adults. I mean, I think that is fairly well known. I don’t think that’s going to change. I mean, we already — we talked about some of the uncertainty around that, but I really don’t think that’s — I will be surprised if it turns out that kids are more severely affected than adults. I think that’s probably not going to happen. The way I have been thinking about this for my own children, because we will be facing this decision as well about having the kids in school, is that the — in a normal year, they are exposed to lots of different respiratory viruses. We see surges in hospitalizations, we do see, unfortunately, a number of deaths in children from respiratory viruses every year. And what we saw with the surge in hospitalizations in children with coronavirus was actually probably a little less than what we see in a typical, say, influenza year, where we have hospitals at capacity, children’s hospitals at capacity with kids suffering from influenza. So, when I think of it in that — in those terms that, yes, this is something to worry about, it’s absolutely something to pay attention to, for the children themselves, the risks that we accept as a society normally are probably in the ballpark of the risks that we are going to be accepting for our children with COVID-19. There was a study that came out several weeks ago that tried to compare the morbidity and mortality of COVID-19 in children to other things we normally accept in society, including influenza, including trauma, those types of things. And the mortality from COVID-19 — this was, I believe, done in Italy — was actually quite a bit less than those other things that we normally accept, so, knowingly or unknowingly. So, that that’s one of the frameworks I have been trying to think about it as, as a parent. I may be wrong about that. It may turn out, as more children are infected, we see that it is more severe. But I think that’s the best we can do right now. The other thing that I think we have to keep in mind is that the local public health officials, the state public health officials, the school officials, they don’t want to open schools if it’s not going to be safe. And so — and everyone is working together, at least where I am, to try and make certain that that happens, so putting all these mitigation measures in place. And so if we are at a good place, where the virus is not widely circulating, where there may be some in the community, there may be some level of risk, but not high risk, yes, I’m going to be comfortable sending my kids to school.

SREENIVASAN: You know, I also want to ask about vaccines. ight now, we’re already in an era where the World Health Organization, that says vaccine hesitancy is one of the biggest problems facing the planet. And you already have on social media and other places people saying, you know what, when this vaccine comes out, I’m not going to give it to my kids, I’m not going to take it. You know a thing or two about vaccines. Tell me why that’s not a good idea.

O’LEARY: First of all, I want to mention the importance of making sure kids are up to date on their regular childhood vaccines for the coming year. I mean, you, I’m sure, are well aware of all the measles outbreaks that happened around the U.S. in 2018-’19. That — with our public health infrastructure stretched as it is right now with COVID-19, trying to handle a measles outbreak or an outbreak of another vaccine-preventable disease right now would be — it would make an ongoing disaster even worse. The second piece I should say about that is, if there’s any year that you we’re going to get your child and yourself vaccinated for influenza, this is the year to do it, because it’s difficult to distinguish between respiratory illnesses. In influenza, the symptoms have a lot — that children get have a lot in common with the symptoms that they get from COVID-19. And so, as much as we can do to prevent the spread of influenza this year, that’s going to be crucial. Now, regarding a vaccine for SARS-CoV-2, yes, I mean, that’s a tough question. I think, I will tell you, I have been involved in some of the early discussions on that and some of the planning around how these are rolled out, et cetera. And the first consideration among every person that’s involved in this, from the people running the trials, the people evaluating the trials, is safety. And if a vaccine is not deemed to be safe, it’s not going to be approved for use. The other part of that is, of course, we need to work on our messaging. I mean, I have been saying for years that, as scientists and public health professionals, we need to do a better job communicating the science to the public. It’s not all about the facts. We need to be better able to convey those messages, as opposed to just trying to beat the public over the head with, these are the facts.

SREENIVASAN: Are you concerned about what would have otherwise been routine pediatric care, I mean, the number of visits that children have not taken to doctors over the past several months?

O’LEARY: Yes, that’s a huge problem. We noticed that right away. I work with a lot of — I was a primary care pediatrician for a long time, and I work a lot of primary care practices in my research, and a lot of my friends are in primary care now. And it was dramatic, the drop in both well child visits and in vaccines. So, I think we have been working here locally in Colorado, I think we have been working on it nationally as well, to try and get the point across that, yes, you need to go into your pediatrician. The pediatrician’s office is safe. And you certainly need to get up to date on your vaccines. So, pediatrician’s offices have been very creative in the way that they have made their offices safe spaces. And the fact is that there’s very there’s – – there’s very little transmission within primary care settings of COVID- 19, even when there’s virus circulating within the community. So PPE works. Using face masks works. Physical distancing works. Some clinics have even taken to doing their sick visits outside. So, yes, absolutely, kids need to be going into their pediatrician. I think the other part of that that I will say that I think is crucially important for us to think about as a country is that we’re all aware of all the small businesses that are struggling right now to stay open because of the impacts of COVID-19, restaurants, et cetera. Primary care offices are no different. They are all struggling greatly, and some have even shut their doors already. We really need to support them from a — at a federal level to keep the doors open. There was some funds to help with that in the — with the CARES Act, but they need more. It’s a real problem, because, if — a lot of these practices are on the verge of bankruptcy at this point, and I can’t even imagine what our health care infrastructure will look like in this country if we lose our primary care infrastructure.

SREENIVASAN: All right, Dr. Sean O’Leary of the American Academy of Pediatricians, thanks so much for joining us.

O’LEARY: Thank you very much.