Duke experts discuss pandemic challenges in the classroom
Duke health experts discuss how schools can safely reopen, and the educational and psychological challenges that students and teachers are facing.
for joining us to take zoom just a minute or so to add everyone into the room so please sit tight and we'll get started in just a few moments. Thank you. Thank you everyone for joining us. Takes home just a few moments to add everybody into the room so please get started and we'll get we'll begin very shortly. Thank you. Okay, hopefully assume has had an opportunity to add everyone into the room. We will go ahead and kick this thing off. Thank you everyone for joining us. Welcome to the latest media briefing on the COVID-19 pandemic. I'm Gregory Phillips would do communications. The new school year is getting underway with a lot of uncertainty for students, parents, teachers and administrators. We have four Duke experts with us today to discuss how best to make the school year are happy, healthy and safe. One for all concerned with us. Today is dr Danny Benjamin. He is a professor of pediatrics in the Duke School of Medicine and chair of the National Institute of Child Health and Human developments pediatric Trials Network. Also joining us is Dr Kenneth Zimmerman. She is an associate professor of pediatrics in the division of critical care Medicine at Duke University Medical Center. Dr Zimmerman and Benjamin are leaders in the abc science collaborative, Which studied in school transmission of COVID-19 to produce a blueprint for safe in person instruction. Also with us is Robin Girl, which she is a professor in psychiatry and behavioral sciences at the Duke University School of Medicine and director of parent child interaction therapy at the Centre for Child and Family Health and we have Harris cooper. He is professor emeritus of Psychology and neuroscience and researches the value of homework, various school programs and the impact of school calendar variations. Thanks very much all of our panelists for joining us and we will jump right in. Dr Benjamin. School districts across the country are voting right now on whether to require masking in schools. What is your advice to them? Thanks Greg. So clearly from a medical and medical safety perspective, The optimal choice here is universal masking K through 12. Regardless of what policy decisions might get made or where those policy decisions are made. From a medicine perspective, masking clearly works. It prevents transmission in schools. And fundamentally. The challenge for schools right now is that the majority of the people in their community are do not have access to a vaccine. So the community for Wake County public schools, for example, is not the vaccination rate for adults in the United States, it's not the vaccination rate for adults from Vermont, it is the vaccination rate for people who are on school property in Wake County. And so for each district, okay, Pre K through six. They don't have access to a vaccine. They can't be vaccinated. And for grades nine, excuse me, grades seven through 12. Uh, the vaccination rate and the vast, vast majority of counties as well, well below 50%. So clearly that's not a viable solution. Therefore, the prevention of transmission. All centers around masking uh, universally across the district. From a medical perspective. Absolutely. Thank you. Dr Zimmerman, you guys in the abc collaborative also studied distancing. What did you find about the need for distancing and how that relates to masking in schools? All right. Thank you. Greg. Through over the spring we collected data from 100 districts throughout north Carolina. Some of them are doing less than three ft of distance. Some we're doing 3 to 6 ft and some were doing six ft or more. Some were having busing. That allowed one person to a seat, two people to a seat three people to a seat. We saw no difference between the less than three ft, 3 to six ft or greater than six ft or the busing situation with regard to secondary transmission. This is in the setting, however, of strict adherence to masking. So in this setting we know that masking is one of the most important things, particularly if you want to get all of the kids back into school. Absolutely. Thank you. We've had lots of questions about masking and safety in schools regarding Covid and we'll get to those later. But for now I'd like to move on to you, Professor Girl, which, so the situation we have here is countless Children are returning to in person schooling for the first time in more than a year. And even those who did attend in person classes last year had to deal with a lot of uncertainty through that. What are some of the things that teachers and caregivers should be understanding right now about how, how these things might have affected the child students mindset coming back into school? Yeah, I think to borrow from the grateful dead. What a long, strange journey this has been. Um, I think as as we get ready for school, there's certainly some anxieties and worries in both Children and adults as well as some excitement and looking forward to being with friends again. I think we have to um, reframe the question of what about all that's lost and think about where we are and where we're moving to. So one of the most important things is we move into the next school year is talking to our Children and planning and discussing what's going to happen. This is the plan. This, it may change. I will keep you updated. What are you looking forward to about school? What are you worried about and having that conversation and listening to them? I think for teachers, we have to recognize that for teachers, they are also expressing some anxiety about the reopenings. And so, um, as teachers get ready to think about what's the routine, what's the plan that we're going to be putting in place and making sure there's an understanding across the board about what this will be like. Absolutely, thank you very much, Professor Cooper moving on to you beyond. Obviously, the safety aspects of the psychological aspect, there's a big educational change here that's going on last year was very, very disrupted. So, from an educational standpoint, what are some of the challenges that students and teachers are facing right now with everything that's happened over the last 18 months? There have been some recent reports that suggest that kids have lost a considerable amount of learning while they were out of school. This isn't surprising. Their research on summer learning loss, and what we've discovered with the pandemic is identical to what happens over summer, except more extreme kids lose math, they lose reading, Children from poorer homes lose more than kids from homes that are better off. Uh This is going to create challenges for teachers. Uh The first big challenge they're going to have is with regard to assessing where students are, then they're going to find that there's a much greater variation and where they are, and they're going to have to pick up from that point, um and figure out how to potentially individualized instruction, in particular ways that will help kids catch up. Absolutely, thank you tremendous amount to dig into here. Um and we're gonna open it up to questions now, thank you to everyone who submitted questions in advance and we'll tackle those first. But while this is going on you can also pose questions via the Q. And a window at any time. Um Dr Benjamin. I'd like to come back to you. We've had a number of questions regarding the delta variant. Obviously the research of the abc collaborative did was earlier this year, before the variant had really taken hold. So would any of your recommendations change as a result of this delta variant? How does that affect your findings or your recommendations from asking if at all? So the delta variant is several fold more transmissible than the original variant or the alpha bury aunt as such. It will make secondary attack rates in the unmasked setting much higher. It will result in much more quarantine and it will result in faster school closures as a result of multiple clusters. So it makes masking more important fundamentally, the virus is not more transmissible as it relates to evading masking. If that were the case, we would be getting much more transmission in the health care settings and we would be seeing much more transmission in districts such as Los Angeles where we recently worked with the Los Angeles folks and they have been successfully in summer school despite the delta variant and the pandemic. So we know that masking will work. The key item for schools that are doing masking is to make sure that the fidelity around masking is extremely high over nose, mouth and chin for schools that elect not to mask best. Best of luck with that. Absolutely. There's no more stark realization of how this thing looks than that. Dr Zimmerman, I'd like to come on to you obviously um masking is as we know that the headline here, that's what schools need to do. But I know that the abc collaborative came up with a series of recommendations for schools for two conducting personal instruction safely. Could you run through some of the other recommendations for us quickly? Sure, as you mentioned, Greg, most of this surrounds masking. We should be thinking very carefully about how we do that and how we do that with integrity and fidelity. So schools that are successful in doing this um are are monitoring their masking rates are watching people kind of come through our reporting that and being very transparent about what's happening in their schools with regard to um with regard to masking as well as with regard to secondary transmission, having transparency, having reporting data, having a third party analyzed these data are really also very important. Um, other things that are really important with masking in place. We now have something that is uh, we have an opportunity to keep kids in school now that we know that the secondary transmission rate is a secondary attack rate is actually quite low. Um, we are able, if you are a mask on mask to actually keep people in school. So quarantine doesn't have to happen in the setting of of mask on mask. Those are some of the things that we have seen throughout our our investigations and would recommend moving forward. If I if I might please, let's come back to the Delta very in for a second. A practical way for school districts to think about this is that last year we recommended the school districts, you really want your target To be above 90%. But we know from some of our studies with some of the school districts involved in abc that they were getting slippage of their mask compliance from monitoring that they did Down into the 80s. And they were still successful with the original variant with the delta variant beam as contagious as chickenpox With our not a 5-10. This means that school districts are more likely to have clusters if they have a mask policy but don't have enforcement and safety plants around that. And at the A. B. CS, we've included that service now around intervention plans for school districts that have mass policies in place and are having the occasional clusters and would like to improve. And the simplest way to think about it is a mass policy is only as good as the enforcement and the adherence. You can come to the office and I can give you amoxicillin for strep throat and it will do you no good if you never fill this prescription, it will do you no good if the molecule or the medicine never goes into the child's mouth and it will do you no good if you pour it into the child's mouth and the child promptly spits it out. I prescribed amoxicillin but it's not going to solve your problem. And the same thing is I think what we're gonna see if school districts struggle a little bit with some increased clusters and some secondary transmission. They need to uh they'd be well advised to reach out for some intervention safety plans. And we've helped school districts in the past year to do. Sure. Absolutely go ahead. I was just going to add as we think about it as dr cooper so eloquently put it, our Children are falling behind, they're struggling. And when we think about all of these policies, when we think about what's being done as Children come back to recognize if we don't have a plan in place that we actually follow and we see changes that are going to be happening. What is the impact of this continued stress on learning? We know it infects their attention, their concentration, their ability to learn new information, their ability for flexible thinking and problem solving challenges with information. So we're setting up if we if we don't have something in place that we can follow, that provides a sense of consistency, just gonna be setting Children up for continuing that stress and worry and potentially becoming further and further behind. Absolutely, thank you fresco. Which for that, we've actually had a question related to that that Professor Cooper I'd like to ask you about and then asked what kind of long term, longer term academic impacts could Children have if the school year is disrupted once again. And I guess another way of looking at that is, are these are these, um, disruptions that could work like kinks that could be worked out over the course of an entire school career? Or are we talking about disruptions that could fundamentally impact the long term outcome of a student once they get out of high school, there's, it's unquestionably the case, we have to make adjustments to, um, uh, compensate for what students have lost. Um, there are, uh, innovative possibilities that I think school districts might consider one of the most interesting and important ones would be the potential for extending the school year. Um, it would take multiple extensions for us to make up the five or six months, on average that students have lost, But it's also the case that, uh, in many industrialized nations, kids go to school for more days a year than they do in the United States. So on average, we go about 180 days. Um, it's not unusual for it to be 200 or 210. So school districts have to begin to think creatively and outside the box for how to make up for what students have lost. Sure, Thank you very much. Um, professor, which I'd like to come back to you. Um, you know, we've been talking about masking and the medical needs to have it in place to prove to preserve safety for students and teachers in schools. I know that there is a lot of talk about the psychological damage that masks might wreak on students. Um, could you just address that a little bit and tell us whether there's any evidence that masking can be harmful to students in any way? Sure. I think I want to take a step back in that question because what we find is how parents um model how parents discuss this issue with their Children can have the biggest impact on their teens on their kids if parents are saying um, um this is why we're doing it, this is for our safety and then Children are much more comfortable with it when parents are getting um, oh, this is horrible. If you have to wear a mask, it's going to create breathing problems, you're not gonna be able to learn, then that's where Children's messages are going to be. So how are we as adults monitoring and um discussing masking? I think it's also really important as we consider masking, that we also recognize that there are Children with neurodevelopmental disabilities that we also have to address in terms of masking. What is this like for them? Can they truly be able to take in all of the queues? So whether it is um masking that allows for us to see faces to address those issues are going to be equally important, but and and there may be I have not seen studies that say, gosh, if you wear a mask, you're going to develop ptsD, I have not seen that. I have seen absolutely that Children are more worried and anxious. But if parents can talk to them and model for them how to address masks, why we wear masks and what is their role, giving them some sense of control over this so that they feel like not only are they keeping themselves safe but their friends, their family, their teachers, um and other people in their environment, they do better when I feel like I'm helping somebody else as well. Sure. Thank you very much. Doctor Benjamin. I'd like to come back to you. We've had a number of questions. We know that high school sports in particular are important to a lot of communities and we have some questions about what your findings were pertaining to safely having athletics in school this fall. Sure. Safely doing extracurricular activities, be it sports or the arts is certainly feasible and should be done this year. So those should be offered. It's also clear that in north Carolina, when we offered those, we offered those primarily with masking. It's also from the north Carolina. Data been shown that there's more transmission in the extracurricular activities than there is in the classroom setting. Over half of the within school transmission. In high schools are in high school athletics. So student athletes are at the highest risk of transmission. This is why CDC guidance is very clear that testing should be conducted routinely as a condition of participating in athletics, especially when rates are as they are in north Carolina today. So we had two options that worked in the last school year. The first was implemented in north Carolina, which was masking, that worked out great. The second was testing that was in Utah. That also worked very well. Fortunately with the vaccine available two Students of Sports Participation Age. This is an area where, from the medical perspective athletes could be safe if they simply vaccinated so that a safe option for families is frequent testing a couple times a week is outlined by the CDC. Another safe option, masking is done by north Carolina last year. And another safe option for the participants is documentation of vaccine. And if families voluntarily provide documentation of the vaccine, a school district could reasonably say, okay, you don't have to mask, you don't have to test. You're able to participate in sports via vaccination and school districts in north Carolina have already started to take this very thoughtful, thoughtful approach initially done by Orange County schools where they have an outstanding policy in place and is a good example and publicly available. Absolutely, Thank you. Um, Dr Zimmerman, a question we've had here, come in, asked about at the moment, of course, across the state and the country, we've got a mishmash of rules. Different school districts taking different approaches. Is that reasonable given that there are kind of outbreaks that are worse in some places than others? Or would you advocate for more of a uniform policy and the recommendations that you have regarding masks in schools should really be adopted universally? Do you think? Sure. So, one thing we know across the entire country that vaccines are not available for most Children in K through eight, That's whether rates are high Or by the rates are low, vaccines are not available for K through eight. So for that particular population it would be wise to have a universal policy of masking which has been advocated by the CDC has been advocated by the Ap and the N. C. DHHS. Strong schools toolkit also supports this. Uh there are nuances as you get into the older greats in particular because there are there is access to vaccines. But as we've seen across the country, there are variable rates of vaccination, there are variable rates of community uh infections. It would be straightforward and very simple if we had consistency across the entire country knowing that this has changed multiple times. I don't know if dr Benjamin has additional things to add to that. Yeah, I think, hey, you know, as Dr Zimmerman said, the The consideration in K through eight is really pretty simple. If you want to prevent covid, one does so by masking at the older age rates. We are not yet at a point where there is sufficient vaccination to have a safe work or learning environment as it relates to covid in the vast vast majority of counties throughout the United States. I think it's eminently achievable to get there by a vaccination, but we haven't done so yet, as evidenced by um what we're seeing nationally, as far as increased transmission in the adult population and adults are vaccinated at a higher frequency than 12 to 17 year olds and virtually every county in which there we have comparison data. I was sorry, no, go ahead. I thought you were done. My my apologies. My apologies. So while I think that vaccination is ultimately the answer here for the K through the pre K through 12 environment. As an intermediate answer. Until we get vaccination up to a sufficiently high rate. If you want to prevent covid transmission in your community, If you want to prevent covid transmission at your schools, then it's masking until we have sufficiently high vaccination. The although the mortality rate in Children is low Somewhere between two and 500,000 infected. When you consider a state of 1.5 million Children, two per 100,000 starts to add up to some deaths. That's going to be eventually noticeable. Absolutely, thank you very much. Let's go. Which I would like to come back to you. Obviously, we've talked a great deal about keeping students safe in schools, but we also know that this has placed a big burden on teachers as well who have a tough enough job as it is. Could you talk a little bit about what teachers are facing right now and what if anything, parents or students or administrators can do to help support them best? Sure, thank you for that question. I think we do have to recognize the role that teachers play. We certainly, I think last year, year, last school year, everybody in this country would have said give teachers raises. It is very hard to repeat third grade. Um, so, um, as we look forward, we have to think about social emotional learning, not only for students, but what is the self care policy for our educators? We're seeing many educators leave the field, so we're having problems there. Um, the disparities are so evident, so some school districts are having more challenges than others. Um, so as we think about supporting teachers, are there, are there things in place in the schools for teachers that may be struggling with their own stress that may be struggling with anxiety and worry about their own families. Are their systems set up? It's not just, we need to get them back in the classroom and establish a routine that is necessary, but it is absolutely not sufficient. So are there the are there ways that we can give teachers some skills? How can you um move forward in teaching, reading and writing and arithmetic while also helping Children with social emotional learning without reducing your school? They are adding more to the pipe and there are many programs available, but teachers have to be given those skills. Teachers have to be given the skills um of what to do when there are deaths. I mean, there were two returning back to schools. There will be students that have lost, um, caregivers and relatives. There will be teachers that are no longer there. We need to make sure that teachers have some supports on how to address um, grief and loss, whether it is through death or whether it's through loss through economic insecurities, housing, insecurities, food insecurities. It is unfair to ask teachers to go back to usual teaching without giving them skills to help with the normal for now situation. So if I might, I think that's an outstanding and my doctor, which if I might just jump in a bit around the virology and efficacy of the vaccine. And uh, touch on maybe your question just a bit. So, one of the compelling work safety arguments for school staff. And it's more than just teachers, right? Because students don't teleport to school, they ride a bus. Um, the tooth fairy does not provide lunch, their cafeteria workers there. Um, and, and as my mother would say growing up, you know, I'm, I'm not at school, you need to clean up after yourself, Right? So for school staff, the argument for a safe work environment is as follows as it relates to masking. Look, If I'm a custodian in the 10th grade, I can protect myself by a vaccination. But let's say that I'm married to somebody who's had a solid organ transplant. Let's say that I have two or 3 kids who are too young to get the vaccine at home. Maybe I even have a newborn infant. Is that non trivial risk? And I go to school where there's no masking requirement and of course I'm protected from severe disease because I've received the vaccine, but I can still get the infection because it's delta. I can still take that infection home to my family to buy spouse who has not yet made sufficient neutralizing antibodies because they've had a solid organ transplant and I can kill her. I then also transmitted to my Children who are too young for disease and maybe give one of them a mild course of infection and perhaps the other one is unfortunate enough to be hospitalist. And then I then go on to give it to my newborn child when school boards vote to not have masking in place with the delta variant here. This is what they are going to be asking of their staff every day every day as it relates to a work and learning environment. Absolutely right. And I would say that the mental health stress of having to make those risk benefit every single day is um, is very high and very, very problematic. Um There are many um families that don't have the luxury of work from home. They are essential workers. I can't work from home if I'm janitorial staff or a school bus driver. And so having to make that risk benefit, that I know that I need to do my job so that I could have the money to pay my bills. But at the same time, what if something happens and I bring it home to my wife, to my new born, to my Children, to my aging parents that live with us. So these and when we have an answer like vaccines and masking, it reduces that that stress and worry that is going to be there every single day for families. So um I mean, again, we can make better choices, put better guidelines in place to help reduce some of those levels of stress and worry. So Greg maybe to put a finer point on this. People whose job it is to keep you alive, encourage masking people who are running for reelection. Have very mixed opinions about whether or not there should be masking. Absolutely. I hope people are hearing what you are saying. Um Professor Cooper, I'd like to come back to you a few minutes ago, I asked uh Professor Girl, which about the burden on teachers and everything they're having to cope with. And you've mentioned about how, because of the resources gap at home, there will be students who have different amounts of learning loss just purely from an academic standpoint, there's so much extra that's on teachers right now. Are there particular things that you think or particular resources that schools or districts can make available to their teachers to kind of help highlight these issues that they should be looking for this year, that are out of the norm or ways to kind of ease that burden on them while still giving students what they need in this particular moment. one important thing is school psychologists um, as dr Kerr, which said there are going to be kids showing up who have lost grandparents, parents, there are gonna be kids showing up who have no or very limited resources for learning at home and especially for the youngest Children, being in a social context for those many hours is going to be uh something very new and unusual to them. They're going to have to go through a important period of adjustment, not being at home anymore, not having their parents, their, if their parents could be there. Um, all of those things uh, teachers can get assistance from, through school psychologists and social workers. Class size is an issue also, we can think about again with teachers leaving the profession, not sure that there are lots of opportunities for reducing class size, but that that would be another way to get to go about it. And so I think the most important resource, especially at the beginning of this school year will be to have sufficient psychological assistance for teachers, both for them and for their students. Yeah, absolutely. Thank you very much. I appreciate everybody submit questions by the Q. And A. And beforehand we are going to try and get to as many of them as we can. And unsurprisingly, a great deal of them deal with covid and safety. So we're gonna buzz through as many of these. We can uh dr Benjamin, I will come back to you here for this one. We've got. There are a lot of universities and health systems that are requiring students to present proof of vaccination before returning to campus. The question is, is it a mistake for public K. Through 12 schools? High schools? Obviously in middle schools with students who are old enough to get vaccinated not to be doing the same. So there's two areas there that are that are different for um the college environment one is that in K through 12 or pre K through 12, we have a solution that we've replicated many many times that is easily enforced, which is masking when one goes off to college, you are in a dorm room. Oftentimes with a roommate is not going to be masking their um. You and your friends might go down too the downtown area and drink a bottle of frontal lobe inhibition, also known as going to a bar and then engage in all sorts of behaviors that reduce mask compliance. So the compulsory aspect of this for colleges and universities is very different as far as the risk and the ability to contain covid In a college campus compared to pre-K through 12 where we know conclusively, we can do so with a mask policy at the local level, whatever that might be. Now, the second difference for the Kind of mandate approach in the pre-k through 12 is that we don't actually even know the correct dose yet For over half of the student population, that is pre-k through age 11. So to start having differential policies that gets into territory that is beyond my expertise and goes into legal concerns as far as mandates are in place. Yeah. Now options such as we've outlined for athletics, options of test or vaccinate, that's a very reasonable approach that a thoughtful school district could employ. Sure, absolutely. Thank you. Dr Zimmerman, another question for you, The American Association of Pediatrics has reported a substantial increase nationally in the number of cases among Children in the past week. And north Carolina case is consistent with that trend. Obviously, kids make up a substantial portion of the unvaccinated population right now. So these numbers just more evidence of the need for vaccines. Or are there any other conclusions we can draw from that increase? I think that there are evidence of the need for vaccines. I think they're evidence of the need for continued masking and most most circumstances. Um, definitely in all indoor circumstances. I think this means that we have to be more vigilant about moving forward. We can do this, but we have to be more vigilant moving forward. Sure, absolutely. Thank you. Um and another covid related question and Dr Benjamin. I'll bounce back to you for this. Um, we've seen beyond covid, the number of unvaccinated kindergartners has increased slightly over the past several years. Are there any signs or are you concerned that this reticence towards getting the Covid vaccine could increase vaccine? Hesitancy more broadly over the coming years? Well, clearly, whenever a new vaccine comes into the pediatric population, we have to be thoughtful in our approach because the concern is that while support for vaccines for all Children, it's quite high, the potential for very disruptive and quite frankly irresponsible behavior as it relates two vaccines, uh, increases. So if it were up to the anti vaccine crowd, we would go back to the days of thousands of Children Hospitalist and in an iron lung, we would go back to the days Children routinely getting meningitis from organisms that melt brain tissue. If it were up to the anti vaccine crowd, thousands upon thousands of Children would suffer and die needlessly every year. And we're seeing that group effectively kill several 100 americans every day today with Colbert. So the anti vaccine crowd is a leading cause of death in America. Thank you very much. Doctor Benjamin dr Zimmerman. I'm gonna bounce back to you with another covid question before we move on here, we know that there are lots of public figures claiming masks don't protect people from the virus. Um, I don't know that we have any sense of whether information is coming from clearly is not back with science, but beyond reiterating the findings of your research. Do you have any sense of our best we can counter that information? Or is it just a simply a case of reporting that this is the evidence and the evidence is that masking works. Greg. The evidence is that masking works? We have it from that example, from multiple situations in life. We know that places that have implemented masking mandates saw their cases plateau, we saw it in hospitals when we implemented a masking mandate within Duke hospital, the cases that were hospital acquired flattened out. We have seen it and the low transmission within schools, The science is the science and it will continue to lead us hopefully forward. I I think, you know, if I could build on that for a second, um okay, I think we have to take a step back and we know masking works, we have to we have to do a couple of things. I think one, we have to acknowledge that yeah, everybody would love to not have to wear masks anymore. People are tired, but that doesn't. And I think both dr Benjamin and Dr Zimmerman underscored it. If we would just commit to this we could get that plateau. We could go back to a day where we may be able to take those mass off. We are absolutely not there yet. But we also have to think about the messaging. Um So clearly for many communities for many different groups who the messenger is makes a difference. So we need to think about who do you want to hear from that may help move that needle. Um And it maybe for some it may be um the doctor Fauci from the maybe individuals from the C. D. C. For other groups that may be the spike lee commercials on. Um Take this is our time to take our shot. So we have to think about what are the different ways to get the messaging out there? That different populate that different groups that different um uh cultures that different religions may hear a little bit differently, all leading to the exact same message. Get your vaccine when you can and wear a mask. But we need to think about that. The messages may need to be delivered in different ways to get to that point. Absolutely. Thank you both for that first cooper. I'd like to come back to you. Um even, you know, amidst all this, talk about safety and keeping people safe from disease, it almost seems trivial to come back to the notion of homework. But for students over the next year, and in every year, homework is such a huge part of their lives. This is something you study. Do you think that given the learning loss over the last year, are we at a point where we should think about homework differently in the sense that there should be more of it or less of it or the nature of it should change. Um The more or less is really not a an issue, there shouldn't be, it shouldn't be more or less because at a particular point too much homework doesn't accomplish what it's supposed to. All students should be doing homework. But the amount and type they're doing should be a function of their developmental level. Doing homework is actually what students have been doing for the last year. Um And to the extent that they have become more facile with home study and with the use of technology, getting technology out to students is incredibly important, especially Children who don't have access to it. Uh extending broadband into rural areas will assist in this way as well. Um So homework ought to continue to be part of kids. Uh are armed men sure for learning probably at the beginning of the school year, I would suggest to teachers that they be careful with the amount they assign because kids will be spending so much time in a learning environment away from home, but they ought to gradually build it back into the way they teach. Absolutely thank you professor, which I'd like to come back to you. You touched on this earlier um, in a sense of what parents can do and caregivers can do to help students. And you mentioned the importance of routine, Could you talk a little bit about how important that is and what difference it can make to the students who feel uncertain as they're going back to school? Sure. Um when we think about routine, again, it is incredibly necessary for best outcome is just not sufficient. But when we think about routine, think about now, um starting now, what is that routine going to be like as a school year begins? So thinking about mealtime, um, homework time, bedtime, family time, quiet time. Um, across the ages build it into the schedule that can get, that can help with a sense of security, that can help with a sense of safety. So routine can be incredibly important. I think it's it's also critical to give choices for kids when they come home. Do you want to have a snack now that you're home or do a little bit of homework first? Let them choose, but them have a voice. So routine is important. I think it's important in the classroom to the more teachers can be consistent about this is how our day flows. The better for the younger kids, having a schedule posted with visual aids can be extremely important. And for Children that learn differently having schedules that may not just have words that may have pictures that may have other ways to communicate, but the better our schedules can be, the more, the more um we can build in routine, the better across the board. Um we know that that helps reduce anxieties. That reduces worries. Absolutely. Thank you very much. I'll come back to our pediatrician's here and I do appreciate the two of you not turning blue in the face from having to make the same point over and over again, but maybe eventually everybody will get the message. Dr Zimmerman. Um we've had a question here, you both talked earlier about how masking can affect how we think about quarantine. So the question we've had here is how how wearing mask or requiring masks in schools, how would that affect how long somebody who comes in close contact with an infected person has to stay quarantined. Can you talk a little bit about the interplay between quarantine and masking? Absolutely. So over the last year we saw that in the mask on mask environment. So a mask person who was infected and a mask person who came into contact with that infected person. The risk in school for infection was less than 1% because that transmission risk is so incredibly low masking works. We, the C. D. C. N. C. DHHS have now changed their policy that allows people who are in the classroom in a mask on mask environment to stay in school even though they've come into close contact with an infected person. That's huge because last year thousands of kids missed thousands of school days. So if we can do masking, we can keep kids in school. The alternative in the setting of not having masking is that one Increased risk for transmission. But to if you are a close contact, you have to stay out of school for 10 days. Unless you get a test that you can get at 5-7 days and stars could be to test at 5-7 days. If it's negative, then you can come back on day eight. This change in policy if mask on mask is huge for keeping us in school, for preventing further learning loss and for helping us to really move forward. Thank you very much appreciate that. Okay, Dr Benjamin, I'd like to come back to you. Got another question here that asks whether districts that aren't requiring masks are flying blind and being irresponsible. Well, the responsibility question is beyond my area, but especially as it relates to this, um, I can tell you what's in the best interests of the people medically, but I'm not a policymaker. But I can tell you where schools start to cross the line as far as flying blind and have very questionable behavior. So we know that masking works. We did that because 100 school districts in north Carolina under leadership was bipartisan leadership. We require them to report their data as it relates to within school transmission. And they had to report it every week. And those school districts did an outstanding job and they showed that masking works. So we know that one pathway works and that's universal masking. Now, some school districts, I would like to go experiment and the experiment that they would like to conduct is in the setting of the delta variant. We don't want to have universal masking. So we are going to subject our students and our adults to experimentation. Unfortunately, they're not doing if they don't do systematic data collection and publicly report how much within school transmission they're having. At this point, they've crossed the line as it relates two having transparency around the results of the experiment that they are conducting on Children and families and staff members in their district. Sure. Thank you. And as a follow up to that. And because the work that you guys did as the abc collaborative is so important. And we had a report here say that he's seen some district citing the june report that you guys issued as evidence that transmission is low within schools. And he asked, are they missing the key underlying factor that of course those schools you studied were requiring masks. I think DR Zimmerman muted herself. Which 1st 1st signal to me that it's time for for me to yield the florida her. Yes. Yes. I mean all the data from the last year has suggested that transmission is low, but it is low because it's not magical. People worked their behinds off. They did a really good job. That school administrators, that's teachers, that's parents. People worked really, really hard to make this a safe environment to enforce, masking, to make sure that people felt comfortable coming into schools to have policies and procedures that people followed. They did a really good job, but they worked at doing it. So yes, they are missing the point that the work was put in. This did not happen by chance. We know That Children can spread disease. We know that Children can spread COVID-19 that has been proven over and over and over again. We know that adults can spread, we know that Children can spread to adults. Children can spread to Children. Adults can spread to Children. That is very well established. So this is not a magical thing that happened. It's not low transmission by way of just things happening. And Greg, I want to re emphasize this point about responsibility because we've got some of our district partners that have voted to go without masking but they've also voted to continue to be transparent around their data collection with respect two community acquired versus within school transmission. And I see that as a school board that has weighed the risk and benefits of masking, they decided for themselves that um they're gonna go with mask optional. But to their credit, they've taken the very responsible next step which is to allow their data to be evaluated By an independent 3rd party. Well that is uh you know, that is a reasonable as far as uh this question is concerned. You know, this is this is reasonable. Um This is I strongly disagree with. I respectfully disagree with, but I respect them for at least providing data transparency so their families and their staff can quickly see how much risk am I at? This is much different than school districts that say, okay, we're going to take this alternative approach. We're not going to have universal masking, but we're not going to blood folks know what are within school transmission is and what the risks are too are people at that point you're flying blind if you are sure. Thank you very much. And I think we will leave it there. I appreciate our panelists not getting too exasperated. And if people take anything from this, it should be the vaccines work and masking works. Thank you everyone for joining us. Thanks to our panelists can issue Zimmerman, Robin Gurwitch, Harris, cooper and Danny Benjamin for sharing your perspectives. Next week we'll be discussing treatment for mild to moderate cases of covid. If you'd like to receive the registration link for that event, please email Duke news at Duke dot E D U. Or if you're watching on Youtube, just like and subscribe. In the meantime, if you're on the fence about getting vaccinated, please talk to your doctor or a public health professional so you can get reliable answers to your questions. Um, and since, uh, Professor Girl, which brought us in with the grateful Dead, I will mention that animal collective who once sampled the grateful dead said we should all be out in the flowers and feeling better. And if we get vaccinated and where I'm asked, we can get there sooner. Thank you everybody and have a great day. Thank you. Thank you.