Duke pediatricians discuss COVID-19 impact on children and families
Duke scholars, including two pediatricians and an economist, discuss COVID-19 and the impact it has had on children and parents.
Okay, I think we will go ahead and begin. Thank you everyone for joining us. Welcome to the latest Duke media briefing on the covert 19 pandemic and its effects on society. I'm Gregory Phillips with do Communications, and I'll be moderating this event. School systems nationwide trying to form reopening plans amid an ongoing increasing cases of covert 19 On unanswered questions about how schools will cook. We have three Duke scholars with us today to discuss the reopening of schools and the effects of the pandemic on Children. I'll introduce our speakers and get the discussion started them. Will it open it up to questions? We are recording this briefing, and that recording will be sent to everyone who registered, thanks to those reporters already ST Questions during this discussion, those of you joining us on Zoom can submit questions by the Q and A window at any time. They will also be an opportunity to ask questions in person in a few minutes. We'll probably have a lot of questions today, and we will do our best to get to everyone. You can also follow us. Follow up with us by email afterward. If we don't manage to get to your question. Thanks also to everyone watching this on YouTube. So now, throughout participants with today's doctor, Charlene Wong, she is an assistant professor of pediatrics at the Duke School of Medicine on a primary care pediatrician specializing in adolescent and young adult care. She is also a core faculty member at the Duke Margolis Scent of a Health Policy Doctor one. Good morning, Good morning. Also with us is Dr A Broken Back and boyo, who is an assistant professor of pediatrics in the division of pediatric infectious diseases at the Dog School of Medicine. And it's also a medical director of pediatric infection prevention at the University Medical Center. Good Morning to You Morning, and we have Lisa Geneti. And she is an applied economist who studies childhood poverty and how it shapes personal development. She is an associate professor of early learning Policy studies in Duke's Sanford School of Public Policy on a faculty affiliate in the center of a child and family policy. Good morning to you. Good morning. Okay, we'll go ahead and get started. Doctor, one would like to start with you. You have expressed concern that reopening schools will result in unpredictable needs for quarantining that could cause even more chaos for schools and parents than that we saw in the lock down this past spring. Can you tell us how you expect that to unfold? Yeah, Thanks for the question. This is Dr Wong. Schools reopen. With its many benefits for Children and families, we do know that more Children will get exposed to the virus because there will be Children, teachers or staff who unknowingly come infected with Cove in 19 to school. So what does that mean for a family whose child is in a classroom with another child who's been diagnosed with Cove in 19? Right now, the recommendation is that all Children who are within close contact of that child who's been infected quarantine for 14 days and Children in the same classroom, particularly younger Children, will almost certainly need the criteria for close contact, meaning that they've been within six feet for at least 15 minutes with the infected child. Importantly, right now, a negative covert test cannot clear your child to end their quarantine. Early in our clinical practices, we've been relating these quarantine recommendations to families who are already experiencing the scenario for example, and some of the day cares where we are seeing Children infected with Cove in 19 As they've reopened over the spring and summer, we hear the understandable stress, as parents ask themselves, you know, especially those who are working parents. Can I take off the next two weeks from work? Toe watch, My child is there, quarantine it, quarantining at home. And if not, can I find a caregiver, baby sitter or nanny? A grand parent who'd be willing toe watch my cove in 19 exposed child. In many ways, these unpredictable two week quarantines for individual Children or classrooms because of exposure to Cove in 19 at school can sometimes cause more chaos for families than what we saw with the blanket school closures back in the spring, where all of us who are working parents were mostly in the same boat as we trial to try to juggle our personal and professional obligations. What people can do now, including families, schools and important employed and importantly employers, is to prepare for these inevitable disruptions that we know we're coming from. Kobe. 19 exposures at schools preparation now will help ensure that families will be able to follow these quarantine guidelines so that we slow the spread of the virus and that schools can remain open for in person, learning that it's so important for Children and families. Excellent, thank you very much. Lost to dig into their for a moment. Dr Hacken. Boy, I would like to move on to you. What do you see is the most important questions for school administrators to address as they put together reopening plans and which of those questions have answers so far. Thanks, Greg, I think priorities. You're addressing all of that. It's important you just lay out the context by which I think I will purchase questions today. As a community, we should have the shared goal off acting in the best interests of Children. And I think right now that will take a lot of time money and certainly decreased. Kobe 19 prevalence. So, in the context of all that, what are the three questions that school administrators just surely very least keep in mind as they started to plan? A reopening in the 1st 1 is where will kids learn? And we may have answers to that. We do need to have probably more specific answers to that. And what I mean by that is would be at home or in school when, if it's at home, what virtual concept is free, accessible and equitable across old lending platforms for kids to use? I think the second question is who critically needs to be in person and who can remain virtual. And what I mean by that is this is not. This does not just impact students suddenly affect staff, teachers and all of those people that may be perfectly related to schools. Who needs who would need to be on campus or on the sea in a school setting and who can be made removed. I don't think we have answers to those yet I think that's going to be evolving. And he may change depending on what the plan that's picked or what plan is rolled out and what community community prevalence looks like. As we go forward. I think the third and very important question of lose a little bit to what Dr Wong mentioned, which is where can schools get help when and if they have to manage an infection cluster? For now, we have some early answers. The most obvious being the local whole department, certainly local pediatric infectious disease doctors or just clinicians of patricians, public health officials, nurses. We have multiple layers of help, but we may need to reach further into our community, said in People Donate. PPE have to volunteer in different pass it. He's to ensure that if schools open and when they open, we can create a set up that he could manage infections and decrease for the transmission in local communities. Absolutely thank you. Once again, lots of dig into their but presser Geneti and I'd like toe go to you for a moment. The rate child poverty in the US is higher than for the rest of the population, and it's higher than in otherwise similar countries. How wise the pandemic about to make that problem of childhood poverty even worse. Thank you. I really appreciate this question, and it's really a wonderful follow up to Dr Wrong and Dr Combos opening comments. So prior to the pandemic, poverty was already really high in the U. S. Relative to pure nations affecting one in five Children. That number is expected to soar. Our best estimates suggested only going up toe almost up to five million Children, and part of that is it's for two reasons. One is that Children who were previously not for are going to become for um, and the Children who are poor are going to be experiencing even further deprivation from poverty. Children of color will be particularly hit hard. I think this is a really important question and issue locally in cities like Durham, where we have a vastly ethnically diverse community and really different types of resource is available to different individuals. So why might this be happening or escalating during a time of pandemic? There are a number of reasons that many of us know. I'm gonna pivot a little bit back to what's happening in the home environment, which I think intersex very closely to this question about school closings and what will happen in school environment. Parents were losing jobs. Food is hard to come by. Evictions are expected to increase. Um, as in a rental forgiveness laws are meeting their deadlines this month. The U. S. Labor market is not designed well to absorb formal care, whether it's child care for early Children or even monitoring and supervision of older Children and this intersex super close like it's closely with the question of school closings I'm in. The US lacks a strong safety net system for reaching vulnerable people. Um, and again, schools have played an important role in filling that gap. And I look forward Teoh talking more about each of those talks. Excellent. Thank you. All three of our Panelists for those openings. We have lots of big into a lot to get through. So we're gonna jump right into questions. I would remind those of you joining us on. Assume that if you'd like to ask a question, you can type it into the Q and a window where, if you'd like it to ask in person, you can press the raise your handle zone on if you're joining us by cell phone would like to ask a question. You hit star nine that will raise your hand of zoom call, and we can undo you and ask. You can ask a question that way. No. One question that we have that's come through via email tracking boy are come to you first on this, And the question says that, uh, is it possible the virus? Couldn't you take in subsequent waves to start to affect Children, a higher illness and transmission rates. Is there any precedent? You know, the other Corona viruses have done that on Def is the case. Then obviously, could the impact on Children and schools be even worse? So address the question in two parts. I think the first bodies have other verses, mutated and affected or infected different populations that will be different from what we have seen in the past. And I think the shortness is yes. We don't know enough about Courage Summer School V two to explain exactly what a future mutation would look like. And we're still trying to understand the path of physiology or the mechanics to explain why it does. Similarly, it seems that Children are have milder presentations of an infection and seem seem to also not transmit this as effectively as adults do. So without having those key those key important items, I think it may be hard to explain what a future mutation with me, but it's possible. I don't think in the last six months we've seen that happen on, and some people already started to describe mutations, and so I would not expect that in the short term this would impact the transmission within schools. I think the second part. And to make sure you address that completely, please correct me if I'm misinterpreting the question. But I think the second part was how this would impact just kind of school reopens in terms of transmission. And again, at the risk of repeating myself here, I think it's going to be hard to know. But we do have epidemiology data from the last few months that suggests what happens in the United States, and that's what we should use to inform the next steps. Not yet, thank you very much. We also have a raised hand among the attendees. So if we can go ahead and on you, uhm on, go ahead, please ask a question. Hello, this is Laura Leslie from WRL. Thank you for taking my question. A couple questions, actually, First, do you? And I guess this is Dr AC and Boil or for for any of the Panelists. But do we see a significant difference in risk between elementary age students and teenage students in high school? On Secondly, there's been some talk about allowing this to be a county level decision. What if we you know, Does that sound like a good idea to you, or would that be fundamentally inequitable? Um, you know, how would you respond to that? Thank you. Thank you for that question. The question is regarded in. Do we? So the most for someone was how do we address this in terms of just levels of making plans and transmission? And then I was seeing a difference in transmission between younger kids. I'm going to say elementary kids and older kids, probably high school kids, for the initial question that you mentioned. Yes, we are seeing a difference in the way in which the infection presents itself. It seems to be milder in younger kids and knowing that your kids have no been in larger congregate sentence, particularly school schools. We have not seen a lot of transmission in that age group, but I will say, particularly in our area. We've had child care settings that have been open all through the pandemic, and they have kids from about infancy old way to about 3 to 5 years of age and onto recently we have not seen rapid clusters, a rapid spread in childcare settings. As our community prevalence has gone up, we have started to see some clusters, some infections among staffers and among Children. And that's not unexpected. When commuted prevalence goes up. On your second question, I think we have to decide how we define local. But I'm in full support off making decisions based on local data that maybe at the state level, it may be at the county level. But if we are going to do that, we have to ensure that resources are available across the board. And so counties that historically may not have had adequate access to resources can get them. Even if they make, they have to make decisions based on the county data. Yeah, this is, Dr Wong wrote. I allowed Tell the next doctor. Wangle out out what Dr Aachen Boyo just mentioned. I think when thinking about the risk for, for example, elementary versus high school students, we need to think both about the risk of infection but also the potential benefits and what's developmentally appropriate for an elementary school student versus a high school student. Developmentally, we think that maybe middle schoolers and high schoolers will be able to wear masks that is probably not going to be developmentally appropriate or feasible for our younger Children. And so some of the we call mitigation strategies are strategies to reduce the spread of the virus in schools are gonna look different in elementary versus middle and high schools. Also thinking about the importance of education and the Kobe slide that we've already seen from the last Miss semester high schoolers are going to be more able to remote learn than elementary school students isn't an ideal way for them to learn, probably not for most high school students, but they are at least better equipped developmentally to do that than a kindergartner, for example. So when thinking about which schools to reopen elementary middle high school students for in person learning, it's important to think about all the different risks and benefits to Children at different developmental stages. In regards to the second question for should this decision be made locally? I do agree with Dr A Convoy Oh, that I am also in favor of these decisions being made more locally, both because we know that the rate of community spread is very different in different localities across North Carolina across the country and also because we, as Dr Convoy of said, we're still not sure what the best way to open the different schools are. Elementary, middle high school. Is it one week on two weeks off, two days in person, you know, with cohorts, Um, this is going to be an opportunity for us to learn and to course, correct as we go, because we're probably not going to get it all right out of the gate, because it's the first time we have ever tried to do something like this, this scale across the country. And so it'll be really important for us to monitor what's happening and then to improve how we're doing to make sure that we're protecting the health and well being of Children, families and, importantly, the staff and teachers at the schools. So this is Dr Gianetti. Anyone echo and support. All the comments were made so far with my pure colleagues at Duke, you know, developmentally. The other thing to think, I think it's super important to think about developmental stages. We know this from examining poverty and its impacts on how it's greater at early stages of childhood, versus later and how it's important to continue addressing poverty, for example, as Children age. Um, and it's certainly true that as adults at lessons might be more likely to, um, behave and be able to follow these rules. They're also more independent. And so I think the more that we can think about respecting their social development as well they're learning, the more likely we will have success in thinking about school openings and supporting their development with the second point, I just want I think it's important. Teoh recognize this distinction between, um, local having some authority at the local level, understanding and appreciating what's happening locally with local data on local contacts, but also the value of having state and federal guidance and collaboration and coordination. I think it would be an error if every county of every city acted on its own. One of the beautiful aspects of the United States is, um, this concept of trade and mobility across communities across counties across states, and I think we've seen some success in the Northeast because of some collaboration that's happening not only between let's say in New York City and New York State, but also across the states, and that really made some headway against the pandemic. So I think some decision making and guidance from above, um, in collaboration with what's happening locally is is probably ways to point in the right direction. This pandemic. Excellent. Thank you. All three of you, Laura. I hope that answers your question. We have another raised hand, Brian Dunlevy, so we can go and had an undo Brian on. And you should be able to go ahead and ask a question. Thank you so much for taking my question. I appreciate it. Um, I'm just wondering sort of what the status of the data is on. How, uh, Children transmit over 19. How effective they are transmitting Cove in 19. And given the fact that we seem to learn something new about this virus almost daily, um, is it is it really may be premature. Teoh even talk about, uh, widespread opening of schools, given the fact that we could find out something more about transmission among Children on down the line. Thank you. So this is Dr King Boy will take on initial stab. And of course, I look to the rest of a paddle to address this as they deem fit. I think for the initial question, we have some specific data, both internationally and then also locally, and I'll try and be a little bit more specific in my response here. So one recent study came out of Chicago and was just looking at the early days of the pandemic track in infection rates and how household transmission was occurring. You can question some nuances of statistics and how we analyze data. But essentially, they found out that when they look at households, most often, the adult in the household was the one that was initially infected. And if it was the child that was infected, they seemed to have been less than a 15% risk or a chance that the child will then transmit across the household on We don't know why, but in the covenant to that is when a child is exposed to an infected adult, seemingly were also picking up lower rates of them getting infected. You could argue about our testing strategies. If they don't have symptoms, can we actually find the virus and all of that we're going to then about as we move forward thinks of the pandemic is unprecedented times and were forced to use data as we get it. We've had about a six monthly way, and we're learning every day, and we're going to continue to learn. So I don't think it's premature to have the conversation. But I certainly don't think we can rush into any decisions because a lot of data still fruit preliminary. And they have been obtained in the context of most of our nation's school aged Children being in a household set in an outside of congregate sevens. So we should certainly start having the conversations. We should be cautious as we approach final decisions and be very flexible to adjust in. Even when we get new data. And this is Dr Wong, I'll add to that. I think also again when thinking about the different age groups of Children and what we're seeing as we've mentioned before. Both, it seems that the virus behaves a little bit differently in younger Children, for example, even those in day care compared to those who are in high school, but also what families were able to do in regards to separating high school student more from their family. Compared to a younger child who is still very dependent on their family members to do things like feed them and bathe them. Eso again, thinking about the developmental stages of Children and how there is a lot of difference thinking about our younger Children versus our older Children. I will say that we just want to make sure we again highlight. There's a really strong case for trying to reopen schools because there are so many benefits both for Children, not only their academic benefits, but also their health and well being and social emotional health, particularly benefits for Children and also for families, many of whom were really trying to get back to work to restart the economy. However, I agree with Dr a Convoy. I think we really need to proceed with caution and care and avoid broad sweeping mandates about requiring schools to open, because we are certainly very early and learning about the experience of Children and their experiences, particularly in schools and other congregate settings in the United States. While you are correct and that we've seen an explosion of cove in 19 research and we're learning something new every day, a relatively small proportion of that research has been on Children. I am happy to see that because of the questions of school reopening, we are going to see more of that research emerge that is focused on Children because the well being of Children is going to be a really critical component of us being able to manage and overcome this pandemic together. So I wanted to add more to the considerations here since we started this kind of notion of trade off thinking, which I think is ultimately what each of us is seeking to on the public health food as well as, um, you know, economic support for these Children and families and says we think about school openings and closings. You know, we should really think also hard about the function of schools more broadly in these communities. They're not just environments for learning, of course, their their primary objective. But they also offer a number of things. We've already mentioned a little bit of the childcare function, but they served for families lacking any other kind of market to support child care in care of older Children. They also serve is accessible places for distribution of services. In some cases, actually recently has been food kind of stepping up as the most cohesive system in our country right now. To distribute food in addition to food banks and other in faith based communities. Access to psychological support, even access to families to think about work in other services, teachers and professional staff is part of schools are important gatekeepers to detect neglect and to help support Children with services outside of the school environment. Schools also offer some stability in the context of disruption. I'm going back to the what? What likely is going to be happening without more support evictions? I'm further unemployment and food insecurity. So I think part of the trade offs of the public health concerns should also be balanced with what's happening or eat with the economic environment, Um, for Children in all these local communities, and not to forget that schools serve multiple functions. Excellent. Thank you all three for that. All right, everybody, you can submit questions about the Q and a window. Several of you have done something that's great. You can keep them coming and you can raise your hand. And for their hands that are getting raised, we will get to you, but I'm gonna move on to a couple questions we had come through via the Q and a window on day one. Asks, uh, from Carolina Journal. Um, have there been any examples of covert 19 outbreaks or clusters in schools anywhere in the world that you're aware of it? Is there anything we can learn from most again? I guess I could start off. This is Doc. Tracking boy on the question was regarding school based clusters around the world in the most people would know. Yes, they have been a number of examples, I think one of the ones that have been reported fairly consistently on where occurred in Israel. Andan other have been a few within European countries as well. But I will say they've also been a number of countries, particularly in Europe, that have open schools safely and have done so in the context of little community prevalence of Kobe 19. We can learn a lot, and one of the main things weaken Line is the only way to reopen school safely will be to have a comprehensive approach to reduce in moving 19 transmission in our community, and that requires everyone every single person that exist in the community has to play a part in reducing transmission so that when schools open, at the very least, we don't we do not create a community bleed where transmission within the community is also happening within the schools. Think that's gonna be the key step and then also looking at how countries have developmentally tried Teoh create strategies to reduce infections and kids. So for some people, they focused on masking for older kids and focus on creating bubbles, the court effect for younger kids and ensuring that they can still see a smile. And it can still make eye contact and things like that. Just we kids learn differently and ensuring that what should strategies we implement and not going to do it disturbs store kids as they and this is Dr Wangle add. I agree with everything that the doctor can, Boyo said. You know another consideration, and we're not there yet. Though other countries have been piloting and testing different strategies for using testing upon entering schools, you know, right now, mostly you're using the test for a Q tip gets stuck up a child's nose, which is certainly uncomfortable. I am really again excited to see the innovation in the progress that's been made in developing more of the oral swab tests. Because once we have tests like that available, even test that are being that are able to be done at home, that really opens the doors to a new strategy for safely opening and having Children return to school. If we're able to do more regular testing, we call that surveillance testing of Children, staff teachers who are attending school again. We're not there yet, but we should be looking to other countries that have started doing some of those strategies. For example, in Germany, in their high schools, they had students testing themselves upon entry at a regular interval on those types of strategies should also help to slow the spread of Kobe, 19 in schools. So I will respond very briefly to that, and I will continue to encourage different opinions on this. But I was slightly different from that, because I've I struggled with seeing testing as the entry criteria or re entry criteria, particularly because of the test in efficacy and kids, and so if we have Children with milder symptoms, who may still be able to transmit but negative. And we use that as a decision making process. We may do ourselves a disservice, however, there isn't no perfect answer, and there is not going to be a one test fit. So until I would encourage more discussion around the use of testing. But I do fully support Dr Ones Common that we all need to ensure there's access to test in, particularly for kids, as they return to school if they need them. I will think this is Dr Jenny and I want to contribute to the good points raised so far. And for me, it's very tricky thinking about what we can learn from other nations for a couple of reasons. One, We don't have a safety net in the way that other nations do, so it's just simply better everywhere else, except for the United States. It's something we don't have it. We just have a very different one, much more fragmented, um, a bit more inequitable, designed to minimize fraud, not designed to protect Children. And so that is one sort of context difference that may affect how the school re openings can play out. On the second is we just have a much more head originating diversity in our population. And as we witness in the future last few months, um, you know, a lot of distress over that hurt head originate e and how economic resource is have been historically allocated. Um, and that kind of strife is not as present in many of our pure nations. And so we have to consider that also, during the school re openings and how we're going toe make these comparisons and then the third is we don't have a history of I'm gonna go back to my, um, you know, this is a question for myself and for others is how we think about the role of leadership, um, and leadership going beyond local communities and establishing sort social norms that our public health, um, favorable eso This goes all the way through to social distancing and wearing math and how that can then have ripple effects throughout communities and allow us to least prevent, you know, be spread even before it starts. That is a much more challenging thing, I think in the US, um, I suspect than are pure nations. Oh, yeah. Not talking. Boy, I completely agree with you. I think there's certainly so much still to be learned about testing and particularly how the different types of tests perform and Children compared to adults. So again, I think, Dr Jason, to your point, I think this also again calls for leadership and coordination so that as we're doing the really important research to fill these critical knowledge gaps, we make sure to include Children in these research response agenda so that we can learn more and determine whether or not testing upon entry to schools is going to be useful in Children because of the testing characteristics that we have. Yeah, if you're so much with comprehensive answer there, we have another couple of hands raised s so we could go ahead and a mute Beth mole who has been patiently waiting to ask a question about Please go ahead and tell us who you're with and what's your question? Hi. Thank you so much for taking my question. And I'm holding this this session. I'm with Ars Technica Science publication. I wanted to ask a question. I think for all three of you, if you could talk a little bit about long term effects obviously, last semester, Um, the spring was disrupted with quarantines and hybrid models. And, you know, maybe people taking our school systems using, you know, maybe a few days a week kind of schedules. Things were maybe gonna be crushed, disrupted for a long time. So could you talk about, you know, Ken, kids catch up. You know, in different age groups in different income groups, what should we be? You know, how is this going to affect them for future? I'm happy to kick off and answer. This is Dr Geneti, and thank you for asking that question. Long term effects were so focused on what what to do. Now, I think it's hard to have a vision of what the future will look like after the theme of economic resource is being constrained and let me add to bat. But we have something else going on now, which is uncertainty and adding a lot of stress to families. So the combination of economic uncertainty, along with um, overall distress does not fare very well for Children. It'll especially, um, affect Children. During their early years of development in their brain development, my colleagues can speak to that. A little bit more. It will affect older Children to in a particularly interesting way. And we have Children graduating from high school with a real milestone ahead of them going to college. We have Children, young adults graduating from college with the real milestone of entering the workforce. And what we've learned from prior economic recessions is that it's very, very, very hard for them to catch up, because what happens is the pandemic will subside on. I hope my colleagues will agree with that. You can end with a note of optimism. This will pass on, the economy, will rebound, Um, and at those points, Children will also rebound. But there are going to be generation generations of Children who will have some negative effects, potentially for a very long time. It's very hard to be coop earnings, for example, for the current generations of Children who are ready to enter the workforce. Yeah, this is Dr Wong. I can add to that cause. I completely agree. I have been asked by reporters Will this pandemic be an adverse childhood experience for Children? And I think for many Children, particular most vulnerable Children, this will be an adverse childhood experience. I'm in adolescent medicine pediatrician. So I mostly work with teens and particularly teens who have mental health conditions and issues. We have seen such a spike this, you know, in our own practices. This has been borne out across the country across the world. Children who didn't previously have a behavioral health diagnosis or condition of depression or anxiety having new diagnoses of depression, anxiety, those who already had these diagnoses having exacerbations. I've had patients describe them to me as being stuck in an anxiety attack and having a really hard time getting out of that because, particularly for our older use, their very aware of the economic stress that their parents are in their families are experiencing. Um, I think for other what very vulnerable Children were also seeing cases go up or child abuse and neglect again. As Dr Jason said, schools are a place and physician's offices are places that that abuse and neglect are often picked up and with school closures. And also we had a dramatic decline in families coming in to our pediatric offices, attending well, child checks. Even as we've made those available virtually, we're seeing still a slow uptake and some family still not feeling comfortable. I'm coming into the office is so some of these safety net locations where we pick up abuse and neglect and are very vulnerable. Children are not there for these Children and families. And so certainly for those Children who experience abuse neglect during the Kobe 19 pandemic, this will be an adverse childhood experience which will have lifelong consequences for Children and their well being. Why my colleagues instead of this far better than I I come and so I agree. We boat Dr Wang, and after definition, I will say we're all worried about long term effects. And I think the only thing I'll add here is the fact that we also need to prioritize child centred metrics both in how we're reviewing the pandemic and how we're monitoring the effect of the pandemic. It may seem like an afterthought crying Lee, but Children are our future when we can do better a monitor and how this is impacting them currently. And in the future. Excellent. Thank you. All three of you. We have another hand raised in the chat so we could go ahead on, um, you were ready to Take your question, please let us know who you are and who you're with. Hello. This is a Durie, a chumba with wfm wine used to in Greensboro again, thanks to the Panelists for this session, my question is this Now, so far on, based on the conversation, you have said that ensuring safety of the kids in school depends on various conditions. Ah, that include the suppressants strategies like testing, expanded social distancing and masking. But we've seen a lot of jurisdiction sort of struggled in this area, and, you know, they had challenges and difficulties. But just keeping these basic what many of you have set up the basic suppression strategies now, in light of that, Andi again without putting any assumption on your own personal cases. But putting yourselves in the shoes of many parents who are waiting for these decisions that would you then under these circumstances, send your own kids to school? At this time, I'm happy to volunteer us first on and then Well, that's why this is Doctor Jin alien eso Thank you for that question. And yes, this Is that the risk of revealing, um, sort of how we think of ourselves as professionals, but some of us were also working parents. So I have three older Children when in high school, in two in college. And I've been, I have to say, impressed with how hard, Um, local schools, universities district's are working, um, to think creatively about how to bring Children to school, how to sustain their learning in a safe way. Um and so, you know, there is recognition it's not gonna be anything like it was before. Um, but I am very grateful for the creativity being put to the table and, um, in in the case, in my case to our universities, there will be each be going back to school in a hybrid fashion. And, um, in some cases, in a fashion in which they will be deliberately sir, clustering with small groups of peers with sort of an agreement that this is gonna be their social circle. And as the economist, I think that sounds pretty good, but I will let my colleagues speak to the promise of that kind of a bridge. Yes. So I also I have two Children, one who is an elementary school and one who is in day care. Um we in our family, like so many families, are making a very individual decision weighing a lot of different trade offs regarding what's the risk of infection. How important is it that our Children, who are younger, have the social emotional development at there ages? It is really quite inappropriate, in my opinion, to try to distance, learn, for example, it kindergarten, Um, and so we are planning to send our child who's an elementary school back to school in person, if that's an available option. We're also weighing that with the needs toe have child care and coverage, given the different schedules that are being released. For example, with only two days per week or different weeks that are going to be in person learning on day, we're working really creatively with our community. In our neighborhood. We've been all all of us who are parents of working. Parents have been talking with each other about how we can support each other. How we might like Dr Donation said, create clusters where we have caregivers and parents who share the responsibilities on different days for caring for the Children, making our own little pod on so that were both able to parent help support remote learning On days that that's happening as well as fulfill our professional obligations, I wouldn't be Presumptions to tell any apparent what to do, particularly with also many of the certainties and because I don't have to make the decision of all schools. Currently I This is not something I can weigh in that personally. But I think it's I would agree what everyone has said, which is that the pandemic is not going away any time soon. And so really eight, relying on our communities to see how we can support each other to create an environment where learning can occur and parents can function. Which function also means having some sort of a stable income working if you need Teoh being home with kids if you need Teoh, it's probably all I have to say on this, Okay, great. And I had one thing. You know, I think another consideration that we're certainly hearing we have a lot of families who are asking us in our primary care pediatrics practice. This very question should I be sending my child to school when we think about the different considerations that each individual family needs to think about. It's also about who else is in the household. Do you have a child who has risk factors, conditions that may make them at higher risk if they were to get an infection? And then, more commonly, who are the adults who are living in the household? We know that there's a much longer list of conditions that put people at higher risk particular. We've got a lot of nontraditional families, particularly in some of our vulnerable lower income families, where they have nontraditional households where there are grandparent's and anti sore, all living within the same household. You know, thinking about again, What's your what's the risk tolerance of each family for sending their kids to school? Knowing that there is an increased risk of exposure to Kobe, 19 in schools were never gonna be able to bring that down to zero. But thinking again about each individual family situation. This is Dr Jenny. I just want to add to that that, um, school's and district's move forward, and families consider their individual context. Um, that to the extent that we end up in a model of hybrid learning, it not to be presumptuous. Also about what Children have access to outside of school environments. So Internet access ipads laptops. Um, a safe, quiet place to sit and learn. These are all I think should be unequal ground. Right? In considering public school openings, it seems unlikely the public schools and schools are gonna be open every day in their usual schedules. And, um, I don't think I've heard a lot about what's gonna be John resource wise to support Children's learning outside of the school environment along those lines. Splendid. Thank you. All three of our Panelists for that very comprehensive answer. So one question that we've had is under current North Carolina lost. All students would be required to attend the first week, 1st 5 days of instruction in person on Yeah, we're seeing a lot of this across the country as there are there. Some pushes for, um, complete in person instruction where schools are obviously trying to prepare for reduced numbers of Children school. Any one time laws like the one in North Carolina. If it were to follow through, how much of a difference would it make the school's toe have to be at capacity for the first week? Could that cause a spike in spreads in those schools. I'll go first on that. This is Dr Wong. Certainly that could cause a spike and spread in addition again because this should be allowed to be an individual decision for each family, considering the risks that they have it within their household. It's my opinion that there shouldn't be such a broad sweeping Mandy to say that every child must attend in person at any point during the semester, and certainly not during the first week, where everyone's gonna be trying to work out the kinks of the new systems that have been put together over the summer time. It would be my opinion that there should never be a mandate, particularly this point in the pandemic that Children must attend in person. There should always be a remote learning option. This is after a Kim bio addressing the question on the mandate for in person learning, and I would completely agree with Dr Long. I think what is setting were in a stage where we're rethinking everything we think and how we eat, how we buy groceries, how we go to restaurants, James. How we take probably transfer transit now more than ever, we need to rethink how we go to school and how kids go to school. So I'm not sure that mandate an in person appearance for every kid allows each administrator each group it. It's each parents and staff there trying to figure out the best thing for a child to be flexible in those options. So going back, Teoh approaching this in the best interests of Children, I think we need to allow for some flexibility. And we can't have legal mandates that completely knocked those out of the hands off the local administrators that are working on this. Excellent. Thank you both for that. And Dr Woman follow up question for you. You mentioned your remarks earlier about the need to your parents and employers to be able to plan for these 14 day quarantines. But I'm gonna happen. What are some things that parents can do right now to prepare for that? What are some things that employers ought to be thinking about in order to be flexible? Yeah, I'll start with this is Dr Wrong. I'll start with employers because I really think employers need to take the lead here. We know that there are gonna be some of these unexpected disruptions for working parents. And so if employers could take the lead by doing things that, for example, our health care systems did when we saw the surge early on. Developing backup staffing plans cross training employees to perform the essential functions for their businesses so that if an employee finds out the night before that their child's classroom has been quarantined, that employees won't feel pressured to come to work the next day because there wasn't a backup staffing plan in place. Certainly this these next set of recommendations require more funding on, and we've seen some of the emergency funding come down. But other policies, like expanded and non punitive paid family leave flexible work schedules, which many of us have been practicing flexible locations that working parents are allowed to work and then also, in some cases, subsidized emergency childcare. If schools or daycares close unexpectedly, employers can really help fill that void four employees to make sure that they have a safe place to send their Children so they can still fulfill their responsibilities. This will, of course, be incredibly important for any essential working parents, but also any other parents who are required their income as's faras. What families can do it is, it's a tough situation to be, and certainly one is talking to their employers. Toe. Learn what plans are already in place. Help nudge employers toe. Get more prepared Now, as we enter the fall, when we know that schools, some schools will reopen and we'll see some of these exposures and then also for families to think about what support networks do they have in their communities neighbors, other family members who might be a bench basically for childcare when these unexpected disruptions happen. But again, I think it will be particularly tough if it is a disruption that is related to quarantining your child, because I think it will be very difficult for families. This is what we're seeing already, and some of the Children have been exposed. You know what childcare provider is going to agree to watch a known covert exposed child, which would potentially put themselves and whoever they live with, if anyone at risk, it's a really tough position for families to be. And so the more that we can prepare now officially, employers taking the lead so that employees feel supported when these events occur. Excellent. Thank you. And Professor Geneti. And I'm wondering if you want away in here because obviously when Children are out school, it's having this measurable effect on increasing poverty. How concerned that you, about the sudden quarantines and Children who may be in school, being taken out, them worsening Excuse me? Worsening personal situations across the country. Yeah, thank you for that. I was going to naturally chime in. Thank you, Dr Long for a sitting of that context. Uh, so I think we should be careful. Certainly, employers are part of the many actors and systems that should be interacting and coordinating with schools and public health and politics and everything else. But we should be really careful about the high burden that we might place on employers because their reactions and the way they react, depending on what kind of employers they are, might have inequitable effects. You know, we've seen on I'm thinking here about low skilled laborers which interacts very closely with child poverty. So the reality of child poverty is Most of those Children are living in families. Um, with a unemployed adult and their earnings were just very, very low or end or erratic. And that's why household income is so low. Those workers are incentivized to go to work. They need earnings, they need to pay for food on the table. And as we've seen that in many cases that they're burying that risk of Kobe 19 you know, lacking any other choice. Um and so it will be clearly in those cases, employers are not gonna be in the position potentially to close the door and also in conditions of high unemployment. Um, from the employers perspective, you know, there is a labour market in which they can pull from, so I think we employ certainly will have a rule. But I'm gonna go back to the point of government. The government also has a role here. Job guarantees extending unemployment benefits. Um, all the wonderful things that Dr Wong talked about that we hope and can develop is more systematic components of the labor market moving forward, including leave, um, and one of the other things that we haven't discussed so far That certainly would help with preventing soaring child poverty and help families is cash allowances. And so there was a stimulus check that was distributed in the spring and response to the pandemic. There's been some on again, off again conversation about whether there should be another check sent out to parents and families and individuals in America. Um, and that should come back out as a real part of this conversation for economic support. So literally having cash and bounce in the hands of families so they can continue A to stimulate the economy right by purchasing what they need to purchase, um, and continue to support environments for Children, irrespective of they end up learning in a hybrid environment or in the school. And we know something about this. We know about the role of cash allowances and cash gifts, and we're learning more. Um so I hope that will certainly be part of the overall conversation as removing forward through this pandemic landed. Thank you. Don't tracking boy. Got a couple of infection control related questions for you here. One is that obviously one of the terrible things about the situation right now is that U. S. Is trying to reopen schools even as cases of getting worse. Do you know is there any data from anywhere else in the world where schools were reopened when cases were still climbing. Um, Andi, is there anything that we can take from that? Is there any way to do that about it? Worse, the U. S. Is quite unique in this situation. I do not know data in which schools were reopened in the context of always seen in the U. S. And that's because of the rate of infections in the U. S you can see, compared to a lot of the other countries were far hired a lot of other countries, so we would be the first to reopen schools in that particular context. That being said, if we are address in Rio planes at a more local level, even on a statewide level and you're saying lower prevalence, we can look at comparative countries that have similar prevalence is and schools every open and reopen six weeks sort of around about. We have answered that question, but the U. S is in such a unique situation is hard to you have objective data. Teoh address that at this time? Sure, absolutely thank you. On another, we talked obviously a lot about Children. That's the focus of this briefing. But of course, the reopening of schools poses great risk to teachers, many of whom are in vulnerable populations themselves. What kind of risk does reopening pose to teachers? And then, obviously, that's the knock on effect of if things just get sick, the ability to even provide teachers to classrooms. How concerned are you about that? He hasn't even bring that up. Greg. I don't want to do understood the importance of teachers and all of this, and we're focusing a lot of kids, and we focus on that because we know historically kids go to school. Most parents would tell you my child gets a virus every month and we just deal with it, and I think that's why there's been a lot of conversation about what to do with kids coming back together and exchanging viruses essentially. But we also know that people that have to interact with kids consistently also become infections here. In the end, we're actually more worried about what's occurring in adults right now because we're saying a lot of Children have milder infections, but when we see it in the young adults, older adults, people with co morbidity is and that list continues to increase. We're worried about long term effects, and so going back to the original question, I think where any plan we make has to consider the impact on teachers. Yet I'm also reassured that there a lot of protective measures that can be put in place if we can open in a community that has a decreasing a lower prevalence that can reduce the chance of the child that a child would transmits an infection to a teacher or vice versa and still provide an environment where safe teaching can occur with some flexibility to allow for newer teaching techniques that I can come up with people that skilled in first in this area can continue to come up with thank you very much. I'll give our other Panelists a chance Toe Wayne on that they've got anything to add. Yeah, I'll just add again. I think it's so important to consider the teachers and importantly, all the rest of the staff who work in the schools, the bus drivers, the folks who work in the cafeteria. The folks who help are going to be helping sanitize the school with greater frequency of during this time because we do know that they are at proportionally have ah high proportion of those workers who are at higher risk because of their underlying medical conditions all out through one other thought in here. I think this is more for daycare teachers, but there are a lot of daycare teachers that don't have health insurance and yet we're asking them to go in. And because they're interacting with younger Children, they are having close contact with these kids, even though they're trying to wear masks and gloves. But again, toe appropriately provide care to these younger Children. You need toe touch and pick up the babies and the toddlers on DSO just really pushing for thinking about how we're ensuring that we're protecting the health and safety of the staff who were asking to interact with our Children, ensuring that they have health insurance, ensuring that they have the appropriate protective equipment, ensuring that they have the time to make sure that those processes are in place. And everyone across the school the families were bringing their kids to school are aware of what those processes are. Those are all challenges because we are also trying to get school started in some cases early because we know that the fall typical runny nose fever, viral season, the doctor act that Dr Convoy a reference it's coming on. So the more learning that we're able to do in advance of that where we will see even if schools are open, Children who have symptoms, many of them won't be able to go to school. Or there'll be missing days here and there on DSO again, really making sure that we have the support system built up around the staff, the adults who are working with our Children in schools and in daycares is so important. Greg can I had one quick one minute comment here, please. Thats is not talking about again, and I think Professor Jin Nation may be better able to speak to some of this. But I think I don't also want to miss out on mentioning that this has disproportionately affected a black and Latino population and also to mention in the context of that, a lot of our staff teachers come from various backgrounds. And in North Carolina there's been an ongoing fight to ensure that teachers are no underfunded and their salaries that increase. So as we're approaching this, I think the whole point of a comprehensive approach and thinking of economics has to do with addressing some of the prior issues or inequities. I've already existed because that's the only way we can go forward and ensure that we have a robust teaching force staff and people that help provide child care that can continue to provide it consistently or recruit others to help to build up this workforce Well said, Well, this is Dr Janet, and just to build on that, um, that, you know, we shouldn't be naive. I think one thing that's coming through this entire panel is interconnectedness. So while we give people formal titles and roles like teachers, those teachers are also parents. They're also caregivers. They also have their own Children. Um, and so it's really hard to think about a siloed one policy decision that's very focused on something like mandating attendance to schools for five days. Uh, you know it will fail. It will have negative repercussions if we also don't consider the fact that parents have to work that Children are potentially situations where they're supporting families or their at risk at home. in ways that means that they cannot be at school. In addition to the fact we shouldn't be naive that any one of these policies will be equitably felt by all the families. And that's largely because of a new, inequitable, pre existing system prior to this pandemic. Excellent. Thank you to all three of you. We are almost a time here. So I've got one final question that I'd like all three of you to weigh in on here in North Carolina. The governor is supposed to make an announcement this afternoon about the reopening of schools. But more broadly across the country, what is one of the top things? The one or two things that you would really want governors and leaders to be putting in place for the reopening of schools? What do you want to hear from our leaders as it pertains right now to the reopening of stores in the I can jump in, I think locally we need to address the mandate. Having old Children in school for the 1st 5 days doesn't seem consistent with the approach to reduce transmission within schools a lawful flexibility and find child centred metrics that perfect that protect Children, teachers, staff and anyone that's peripherally associated with school. Okay, I will add to that having a companion strategy that will support Equitable High Brady learning, right? So that's having an infrastructure outside of school. That's equitable Internet access. Safe place to learn, quiet place to learn technology. And this is Dr Wong. I'll add that all policymakers have a developmental lens when they're thinking about the benefits, risks and needs of Children and different age groups. And with that in mind, I would really hope that all policy makers prioritize in person. Learning, particularly for our youngest Children, are most vulnerable Children who don't have a safe place during the day or who don't have adequate nutrition during the day to make sure that we match the limited resource is of in person learning to those who are high at most need. Excellent. Thank you, all three of you. For those those points, we will leave it there. I appreciate our Panelists trying to get their arms around the very timely and tough topic, thanks to all reports for joining us. Thank you to our Panelists Luke, Anakin, Boyo, Charlene Wong and Lisa Genet. Ian, for sharing their perspectives on next briefing will be at 10 a.m. Next Thursday, July 22nd when we will be discussing how to get people to follow public health advice about distancing and wearing masks. If you'd like to be included on the advisory, please email Duke news at duke dot eu If you have any questions we weren't able to get to today, please send an email to the email address on the advisor you got. We will try and get answers for those for you today. In the meantime, please stay well, thank you very much for joining us. Have a great day. I think. You, you girl.