Back to School - What You Need To Know

Dr. Clenton Coleman and Dr. Suraj Saggar discuss what happens when school is back in session this fall. How should we prepare for school? What do we need to do to keep our children safe?

Transcript:

very humid uh high heat index but you know what uh we realized is even with all this heat covered 19 is not going away right so as you may remember since we're doing the back to school cobin 19 special um there was some thought back in the spring that maybe with the higher heat the humidity uh transmission may not be as robust and clearly uh with about uh you know in florida just under 9000 cases every day um we have hot spots literally and figuratively going on so it that that hypothesis seems to have been disproven so so why don't we get into that let's talk about schools and covet 19 and since you are our resident infectious disease and baby daddy extraordinaire of how many how many you got going that you know about uh you know this is a breakpoint confirmed confirmed as one only so i'm not you know wasn't as busy as we might have thought so um our lovely friend uh donald trump said uh we we must return back to school if not he'll cut funding um and to me that sounds so eerily familiar like the economy and opening up restaurants and bars and stuff like that and now we see what happens with that right so we've got record-breaking cases in florida california we've outlawed we've outlawed indoor dining so what makes us all so sure that we'll be able to go back to school so what's your take what's your hot take well you know it's not a sound bite right it's a whole discussion that's why we're doing a whole podcast today uh to discuss back to school issues uh pros cons and everything in between because everything in life there's never uh black and whites a lot of great right so we started broadly is that we can't just like we politicize wearing a mast we politicize uh you know opening up the economy we cannot politicize uh our children's health and going back to school we really you know i've said from the get-go we suffered gekko let's just believe science let's look what the sciences showed us right so well let's let's start off saying we all agree going back to school is important absolutely so look no one is going to say that i think we should do another year of zoom calls and skype and what happened right so it's been very uneven in terms of how different kids respond right a second grader has a difficult time paying attention my fifth grader this past year you know we do work better than the second grader but still it's not natural for a couple months maybe they make it work we fill in the gaps but there's a whole host of issues going forward socially social issues with kids assuming that they're always going to be a parent at home right they can take care of the kid you know what you take a step back you assume that everyone's got a high-speed internet and a chromebook or a laptop for the kid to use you know that's kind of a large assumption i mean there have been studies showing that in inner cities let's say paterson camden newark something like 60 of the kids don't have access at home high-speed internet uh a laptop a chromebook a desktop what have you so that's a big assumption and what about parents that have to go to work what do they do for daycare right so this conversation is wrought with all kinds of issues right but i think today we should just focus on strictly the science so we're going to we're going to take a step back from the socioeconomic kind of issues what is the science telling us about going back to school so so let's let me ask you what are the risks are going back to school for the so it's not only the kids right it's the the teachers the parents the grandparents so um there was some evidence that children below a certain age have low transmit uh transmission rates or transmissibility admissibility right so that's not necessarily the case we know this virus in general soros kobe 2 is a very efficient uh agent in transmitting from person to person right dr fauci said it only down the line uh all the way down the line so and this is proven it's fact and we were very wrong in the beginning to assume that those are asymptomatic less likely to to transmit and it must be those who are actually symptomatic that would be much more likely to transmit right we now know that across the board pre-symptomatic before he gets sick and asymptomatic are very efficient viral shutters and when they shed the virus either they have those symptoms they can still infect other people right and so i can tell you personally we've seen cases already uh in our own practice in our own area of adults being infected and by contact trace and going back to asymptomatic child so this is a very real issue that people are already keenly worried about they're aware about they're worried about et cetera but you know this is something that is is not unfounded it is very much founded in our data that we've seen so far so that that's first and foremost but we also want our kids to go back to school we want them to learn we don't want to fall behind we also know that this this whole cold experience has been very uneven with hot spots new jersey new york connecticut tri-state was a hot spot now we're one of the few states in new jersey that continues to go down in in case rates hospitalizations et cetera so you know it's hard to make a one fit approach for the entire country so i think really each other wait wait wait what on that point like i think the problem is that with all these hot spots there's just a lack of uniformity right there's no guidance you know if you listen to betsy devos and donald trump um even the cdc's recommendations on going back to school it's so generic and broad that i don't think it leaves it up to the discretion of the school boards and the principles and stuff like that so i think it may be safe for one particular school but there may be outbreaks in other schools i i don't think it's a way to do it it has to be some kind of uniform policy well listen i mean these policies this is this has been the experience from the get-go and you know we're not we're not towing the line of any politics right we're talking science but even in the beginning back in march there was you know it was really individual areas even including our own hospital medical center holy name microsoft you know we had to develop our own strategies our own protocols there was a lack of central leadership certainly from the get-go and then and you know that has now somewhat been fine-tuned but it's still very area dependent upon what plans and protocols go into place so i think there's a lot of moving parts that you know people have to look at as well as local uh uh policymakers educators et cetera but so what are they looking at they're looking at what is the daily case counts right so new cases the percentage of cases going positive and then hospitalizations death rates a lot of different statistics people have to look at the problem is what's happening now in july wednesday july 24th 27th it's hard to predict what's going to happen and what the situation will be uh let's say right around labor day in september what about so as of today

so they have to take the data from today so my point is even though we're a relative safe zone if you look at a map a heat map or a green area not a yellow not a red right that variable may change by september so i think when we talk broadly if we talk specifically any parent anyone listening out there has to understand that whatever we're saying today could be outdated by september and any plan that may be put in place now will most likely have to be revisited and refined going forward and we have to be willing to always put the brakes and even hit reverse right with any plan that goes into play but as of right now the idea is that we know that transmissibility is related to density so how close the kids are together right and it's related to other factors like not wearing a mask or wearing a mask obviously it's much more transmissible and efficacious to transmit indoors and outdoors we live in new jersey so we can't have outdoor schools so they're trying to decrease the density if you look at the equation what can they control they can control the density and they control mass squaring at least in theory right that's where it gets hazy you can maybe control kids wearing masks in fifth and sixth grade onward i would be hard-pressed to find any parent that really believes their kindergarten their first grader their second grader will be compliant with wearing a mask at all times right so this is where it gets hazy and i think the really the biggest part of this is decreasing the density and that that's what it comes down to decreasing or so every other day am pm these are conversations that you know and and pros and cons with everything which we can discuss and in the end of the day there is no definitive answer because this is really uncharted territory but if you decrease it becomes more natural for kids to have less interaction more natural to have that uh six foot uh barrier but let's be honest as humans we're used to getting together it's hard to tell a kid stay six foot away from your other friend because it's human nature get together so the easiest way to at least facilitate that is decrease the density and that you know is what most schools are looking at am pm odd and even you know decreas to putting kids in different categories and trying to limit the density now of course that's right with all kinds of problems because right public schools a lot of public schools are working with limited funds right so how do you do that what do you do with the kids every other day is it live learning or is it just login on the computer and you know check a box i did this i did this i did this what about parents who have to work what do you do about daycare so the kids that go to daycare they're now with other kids does that defeat the purpose so they come back the next day to school so you can see a lot of issues here so i think and i guess another issue is what happens if you know someone gets sick do you quarantine the whole school is there is there enough testing to do contact tracing right so the kid who's sick in the class does the whole class get tested does the teacher get tested the parents get tested all that stuff has to be worked out as we stand now as far as getting tested right we're pretty limited and try to do that before we need faster turnaround time so you have these answers very quickly right so we know that kids can be uh anyone can be can transmit the virus and they're pre-symptomatic or asymptomatic but just because the fact you don't have a temperature does not mean that a child cannot potentially transmit to somebody else of course now short of testing everyone every day or the virus which is not reasonable and not practical we have to ensure then decrease population density compliance with mass and compliance with hand hygiene with the understanding the end of the day this is not a perfect scenario uh they're still gonna be i think guaranteed uh a transmission during school right it's already happening with sports right i mean there's been outbreaks in the mlb there's been outbreaks and rutgers have been outbreaks in ridgewood uh all linked to contact sports okay you mentioned sports i think what would work in this ideal situation is what the nba is doing with the bubble right so you send your kids off to school for you know two months you don't get to see them they get tested every day they don't leave and they get their education and you could face it that's right i mean i'm gonna propose that they work for the nba that's not gonna work for school obviously it's a good thing junior it's not a good thought i think what is it the uh the yankees game against the phillies has now been cancelled because the phillies played the marlins the marlins have several positive cases so that's just a heartburner i think of what can happen at the at the high school and and middle school and elementary level right so school sports are important too are we can't tell those two let me let me preface it by saying i understand when parents say sports is important you know after school activities is important they're all important it it's true so then we have to understand what is the risk we're willing to take because it is true if we take a step back then most kids will be asymptomatic or have very models these and be fine fine at least in the short setting in the short term do we know the long term ramifications of having cobia 19 no we don't right the short term yes they're going to be okay the vast or wrong majority or if they come home they give it to their parents parents are okay parents go visit the grandparents are we okay with that right you know are we assuming that every you know we don't know teachers have all different age groups you know elementary schools oftentimes teachers may be younger you have every the whole age gamut right of teachers certainly by just uh just percentage chance you're gonna have teacher underlying conditions that may make them more susceptible to serious complications of covid right what happens to them you know so these are all kinds of issues that i think i that i i think i certainly understand and i feel for so when we say we must get our kids back at all costs i mean that is a foolish statement without understanding the whole ramifications and understanding the limitations even with decreasing density even with with testing and testing for temperature there inevitably is going to be uh transmission from childhood that's just the reality right so we you mentioned transmission from childhood child but we we don't focus on those instances where kids actually got sick the kawasaki like syndrome and to me as a parent that's pretty scary can you tell us more about that do you have any insight about it is a multi-system so i mean it affects the whole body inflammatory disease they actually have their own separate entity now for coping is it very common no people should understand that you know you always want to um separate fat from fiction it's something people should be aware of this is not something that every child out there is getting even majority even a minority it's a very small percentage if you look at kawasaki's disease and then the incidents associate kobe 19 there's a slight significant increase it's still very very low now this disease has been around for six months so do do do we as as scientists as physicians know the long-term ramifications especially in kids who are still developing whose brains whose central nervous systems are developing no so there are still some unknowns so for those out there that say well my kid will get it no big deal i mean i cannot tell you as a physician you cannot tell no one can say the physician there is no long-term sequelae in terms of brain development in terms of other issues that may come down down the road so i think people shouldn't be so cavalier just say let my kid get it they'll be fine they'll be immune going forward right um we know that cobia 19 has a special affliction a special predilection i should say for the brain the cns so there's always been at least a theoretical concern in children whose brains are still developing up to age of 18. how does that affect the brain development are there long-term uh ramifications sequelae long-term effects and that is still an unknown so people should be aware of that certainly so to me and i want to get your opinion it sounds like there's too many loose ends and too many variables and too many questions out there i would vote as a parent and as a physician to home home school until we have a better idea of what you know we were going to avoid the socio-economic issues but you know that is assuming making a lot of assumptions you know that we have to understand remember especially in city settings a lot of kids depend upon uh schools for free lunch right they depend up you know working parents may not afford daycare they assume that hey my kid will be at school from nine to three nine to two and i work during that time just saying homes i think we should have options so what do you all right so give me your ideal situation listen my ideal situation may be different than yours maybe different everyone else i think you know someone very very much more astute and and elegant than me had said that mike you're pretty astute you're a prettiest dude i'm not bad you're very less less eloquent but more astute if you were if you were to um be an advisor to our president of the united states what would you recommend as far as school opening right but never mind never mind your local board of education look i think we need to have multiple options available options that are flexible that can evolve as the data evolves we should let all the plans be not uh ruled by economics not ruled by politics but by data and data that is data especially in cover 19 this pandemic is evolving in real time so as things change we have to be able to adjust and change you have to see hard interventions if by opening schools you see the the new cases remaining relatively flat you see the positivity rate not increasing right so we're following signs here not what's happening in the politics in october november etc uh then we say okay we'll hold the course you know if we see if we see by using hard data that know the positivity rates increasing daily hospitalizations is increasing so there must be secondary transmission from child to child and child to an adult and someone who may more likely have severe disease we need to say hey we may need to put the bricks in this we need to reverse we started some contact sports we may need to say no this is not the right thing so we need to have constant visual surveillance and testing but my challenging question to you is how do we do that how do we get data if we can't collect data and get data in a reasonable time i i agree with you if we were able to if we were to have data and reliable testing in an appropriate amount of time then that would all make sense but if it takes a week to get results back you can't contract it's hard to contact trace someone who's been exposed a week later to other people the health of human secretary alex azar who by the way is from my hometown and whose father was my ophthalmologist a good friend of my father huh west side salisbury maryland that's it right there so he's a son of salisbury as i say he was uh very vocal in the news this morning and yesterday saying we need more rapid testing with 24-hour turnaround that's true because when you have that quick turnaround you can make which which is accurate and sensitive and specific we can be much more uh proactive about making decisions is someone positive someone they okay if they're positive very quickly access who do they come in contact with not wait several days right the more days that go on the more hours that go on the more time someone has contact with someone else or some kind of someone else and we can talk about contact twisting all day but it's not easy it's not easy you know new york city for instance has a contact tracing core but i'll tell you perfect example i i saw someone last week a a a patient you know a mother and a son who came back to the tri-state area from florida a hot zone both positive well they stopped at two or three rest stops and two restaurants between here in florida yeah over a three day period now up now 95 how i mean how feasible is it that you're going to contact every single one person that stopped at those you know all those rest stops restaurants except it's not it's not feasible so yes we need to get the levels down in new cases where we can easily do contact racing when we're having cases exploding in florida arizona south carolina texas we're nowhere near you know the levels maybe here in new jersey for now but if that changes then we need to be able to again have those hard stops so when you talk about testing you're very much right it's really not just the amount of testing but they huh can say say that again you are right rarely you know you are right that's right you couldn't say you just you couldn't say you were right you're just throwing a rare i had you know what it comes naturally and i apologize but i always feel like i have to prepare it poop you down somehow and that's really not right so i apologize all right it's that it's that quick turnaround time is what we need you know we've come a long way from march and april where i wait a week ten days for a patient have to make some phone calls get approval by the state state has to get uh repeat the test down the cdc i mean that was that was our hands tied behind our back our hands are free now but we still need to move faster and faster for sure and then what happens you know there's so many questions i have what happens if we're in new jersey and then we go on vacation or can can we not go on vacation to a hot spot and come back to school it's like do we have to quaranti there's so many different questions like you know some employers require that their employees quarantine for a certain amount of time before coming back to work we know in the hospital we have to quarantine for i think almost a week before we actually go back to work does that apply to schools as well i mean i think in new jersey look there are the certain red states red zones hot zones we're going to call it that you're you're required to check in and quarantine right who's enforcing that right that becomes i mean you know that someone may say i came back from south carolina i came back from texas are they really reporting in you know are they telling anybody if they're just driving in if you're flying in fine for driving in is you know are they really using easy pass attract people that has been a question that's eluded me as well how how compliant have we been with with tracking and with and with enforcing these quarantine rules i think with schools it's going to be tough spring break comes along you know if someone chooses to send their kid to uh go take a challenge to florida and florida's a hot spot yeah you know and born ahead of time i think yes they should be obligated to quarantine for x amount of time or at least test within now we know that most people the most effective period the first 10 days either when they're asymptomatic but still positive or pre-symptomatic that the time is before they show symptoms so is there really two weeks it might be ten days we can use testing along that time if by ten days you haven't tested positive i would say the vast majority of people that can be considered clear right yeah i mean these are things we're gonna have to answer going forward so i think what i took from here is that it's a complicated issue right so kids are at risk they can transmit the disease so we have to have a you know a very secure plan that includes you know appropriate turnaround time for testing in order for me as a parent to feel safe i'm sure and you as well to feel safer to bring our kids back to school um you getting closing remarks right i i don't it's no mind is racing i know there's a lot going on but just i'll bring it back you know to because we're trying to also be cognizant of social and uh economic and racial and all those uh you know equalities within health care i mean i think a lot some people tell me hey i should just homeschool right i'll stay at home again it still shows you that that's a possibility for some people not for others so i think you know from the get-go this virus has exposed and exploited um differences in patients people's socioeconomic status that's not just united states that's around the world yeah and i think going back to school the same way there's some people who may say i've had friends tell me i'm gonna send my kid to private school you know why because private schools by definition have ten kids per class they'll be much they have more resources they might be a bigger campus you know than a private than a public school in inner city or suburban setting easier to um easier to uh social distance public schools are are governed by labor laws and labor unions including teachers unions private schools you know they might say well teachers can have to do whatever we tell them to do so i see a lot i think this is gonna be just another example of that disparity i'm hoping as as as policy makers that they will look at physicians and scientists and say you know let's just focus on the science and the data uh so we can make every single person across the board whatever choice they may choose private school public school magnet school at home part time at home home school whatever it might be that everyone has a chance to go to school everyone has a chance to learn to be educated and they can make at the end of the day it's going to be a lot of it's making the best decision that every family he has to make for themselves but we need to ensure those policies are in place that we can give them the best chance to make those decisions now how do you like that for a conclusion well said well said the real question is what would john rule do do you know about that

you know wasn't he big like when i was in med school late 90s this is not going to turn into a giant rule conversation that's just me i'm trying to think of that song i can hear the back of my head it's like uh holla holla that one right there all right never mind um he's got the real growly voice you know what you like to expose my lack of uh of hip-hop knowledge although i'm very knowledgeable like 80s 90s you know ghetto ghetto boys uh fat boys uh beat street you know all that i think you should stop while you know while you're a certain level of cool is maintained oh my goodness well anyway i'm metal next time and see what you know all right well stay tuned to further episodes regarding kovid19 and school and going back to school and all that stuff i think we're going to have multiple conversations about it i think we should please subscribe i think the link should be below and we'll see you next time