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Scott Webb (Vyverman) (Host):   A hot button issue right now is whether schools should open or start the new school year with distance learning during the COVID-19 pandemic. Of course parents are concerned, teachers are concerned, and there's so much that we still don’t know about COVID-19. Joining me today to help us understand how kids and teachers can transition back to school safely is Dr. Christine McCuistion. She’s a pediatrician at SVMH and across the street at Pacific Coast Pediatrics. This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. So doctor, thanks so much for joining me today. Here in California Governor Gavin Newsom recently announced that the schools in 32 counties in the state’s monitoring list will begin the school year with distance learning until further notice. Counties not on the monitoring list can move forward with the return to the classroom. Let’s just start with a broad question here. What do we know about COVID-19 and how it effects children?

Christine McCuistion, MD (Guest):   So in general the symptoms that children have are generally the same but milder. Overall, the children tend to be less effected than the adults are. Fewer are having hospitalizations and very few are requiring ICU like we hear a lot of adults are. Actually in California, at this point there has been zero deaths of children less than 17 years old thankfully. There is something called multisystem inflammatory syndrome that is associated with COVID-19 that many people have heard about in the news. However, this has been rare. There's been only six cases in California at this point.

Host:  So do we know if children are able to transmit the virus like adults?

Dr. McCuistion:   So the transmission dynamics of COVID-19 are not completely understood at this point. However, we believe at this point that infected children less than 10 that their transmission is uncommon or on the lower side compared to older children and adults. There was a study that just came out as of yesterday out of South Korea that those over 10 can transmit possibly as much as adults. So there's going to be more studies that come out in the weeks ahead.

Host:   Yeah. We’ve learned so much about COVID-19 so far, but yet it just feels like there’s just so much we don’t know and everyday there’s something new in the news or something to take note of. During this pandemic, some European countries closed and then reopened soon after we safety measures in place and some kept their schools open. There’ve not really been any contagions to the extent of what we’re seeing in bars, restaurants, and other workplaces in terms of the schools. So in California when students return to school, children from third grade on and staff must wear facial coverings and face shields. There will probably be other precautions in place presumably. So how does a parent discuss going back to school to young children, specifically about social distancing and wearing a mask while in school. Because I know I have a 13 year old and keeping her—You know it’s like you tell them to keep their distance. They start out distance and they're like magnets. They just keep getting closer and closer and closer. So how do we deal with that doctor?

Dr. McCuistion:   So what we’ve seen in our office with the many children who have come into our office for well visits this summer is that they have been keeping their masks on. By this point, sort of four months into this, it seems many teenagers, many children have been out at some point and have seen people wearing masks. They're starting to understand more of why we need to do this at this point. So there are some great videos out there for children depending on their age and their understanding that can help children to understand more of why we’re doing what we’re doing.

Host:   Yeah. I think we’ve already addressed this, but do children have some kind of natural protection against coronaviruses?

Dr. McCuistion:   It’s very interesting. No one knows for certain why. Many people are looking at this intensely right now trying to figure it out. Some believe it has something to do with the t-cell response with children compared to adults. Some people are looking at angiotensin converting enzymes, the door that allows the virus to enter somebody’s respiratory system. Some believe that children’s immune systems interact with the virus differently than adults. A lot of adults are getting sick because their immune systems tend to overreact to the virus, but this is not happening as much in children. So there is many studies going on. It will be very interesting when we finally know why that is.

Host:   Here in the central coast and more so in Monterey County, we continue to see a rise of infections. Those being infected and hospitalized generally are adults. So is it safe for children to return to school in other communities during the pandemic? Can kids go back to school safely?

Dr. McCuistion:   First of all, as the governor outlined last week, an area should have a lower rate of positivity. So here in Monterey County right now with mid-8.6 I saw this morning. Generally to get off the watch list, you need to be under 8%. That would need to be for two weeks. So it’s not recommended to have the in-person type learning until that happens. When that happens and when we have a lower positivity rate, then it looks like because of the European examples that we have that it will be safe with the safety measures in place. The CDC has put out some extensive guidelines of how to make that happen with the schools.  

Host:   Yeah. It does seem like it’s quite a process and quite a burden just on the schools and the systems of keeping everything clean and constantly all day every day, but if we want our children and our kiddos to be safe going back to school that’s probably necessary right?

Dr. McCuistion:   Right, it is. I will say that you get used to it. You get used to the temporary norm of how things will be. We’ve gotten used to that in our office, how things have changed. Once you start proceeding and following these guidelines, it gets regular and not as burdensome.

Host:   Yeah. Let’s hope so. As you say, a lot of people throw that around, “the new normal”. Let’s maybe hope that a lot of this stuff is just the temporary normal, right?

Dr. McCuistion:   Right.

Host:   So teachers have complained that distance learning does not come easy for some children and we know that’s true. They fear that kids are falling behind and will continue to fall behind as we head into this full school year. Does it worry you and what’s your advice for teachers and parents?

Dr. McCuistion:   So it is definitely not an optimal situation for the distance learning. Particularly children with special needs or disabilities, children with autism, they're not going to be able to really learn by Zoom. It is concerning. So it is best to return to in-person learning because that’s where children learn the most.

Host:   Definitely. There is no substitute. I've talked to a lot of doctors about telehealth and telemedicine and it’s really amazing and I hope that sticks, but as doctors know sometimes there's just no substitute of that gold standard of really being in the same room with a patient. For a lot of children, even the best students, even those that thrive online, being there in the classroom together with that ready access to the teacher is definitely important to the learning process no doubt. There’s a lot of wealth and a lot of poverty in Monterey County. When schools closed, we saw the very stark reality that many children do not have access to the internet yet alone a computer at home. Some districts to busses with Wi-Fi to certain school parking lots. Kids could use the internet right then and there and do their homework. How concerned with you are about these children, the majority of whom at Latino, in terms of their learning and possibly falling behind?

Dr. McCuistion:   I'm very concerned about it. I appreciate the different measures that school districts have made to help with the internet access, but still the in-person is definitely the best way to learn. The governor did mention last week when we announced the new guidelines for California that there was more money being sent to districts to help people with special needs or needing extra services. So I would definitely have parents call their school districts if they're having trouble with the online process to see how they can get extra help.

Host:   So doctor, we know that children are children of course. That’s what we love about them. How can we ensure that they will wear their masks, keep socially or personally distant from other kids at school? Just generally what are your thoughts and advice about all of this COVID, kids, school, and all of the above?

Dr. McCuistion:  California has outlined that children third grade and older are required to wear a mask. In general, again, the children we’ve seen this summer, they're used to wearing a mask now. It doesn’t seem to be a problem. It’s the younger children who have a little trouble keeping their mask on. That is why they have also said that they could wear face shields, which I think is a great idea. They're a lot more comfortable, especially for these little ones. It would be a good idea if they wore those instead. I saw someone today actually who had decorated their own mask, a teenager, and was very proud of it. It reminded me that this is a great idea too. That teachers could have kids decorate their own masks. That might make them want to wear their mask even more.  

Host:   Yeah definitely. I think especially across the spectrum, the range of kids. You could see that being a great idea for kindergarten, first grade, but also teenagers. They all like to be individuals. They all like to stand out. So maybe there's something in there for everybody. Is there anything specifically parents need to know from school officials? Is there anything they should be asking if they have that opportunity?

Dr. McCuistion:  Well, first of all I've seen some plans for schools in terms of—especially when they return for in-person learning. I have been completely impressed with what they are doing to help prevent kids from getting sick. They are some over the top plans, and I'm very impressed by those. Of course, parents can ask a school what they are doing to keep the kids well, but a lot of schools have been doing a great job of keeping parents informed as to all of the changes they are making to ensure the kids stay safe.  

Host:   Yeah, it does seem the communication has been good whether it’s been through social media, that kind of thing. Of course, things just seem to be changing so quickly and opinions keep changing and the scientists and all of that. So it must be very difficult for everybody involved. Those on the school side of it, those of us who are parents, and many of those people, of course, are parents themselves. You just see what's happening with all of this and all of the uncertainty and questions. We get it, right? You get it.

Dr. McCuistion:   Yeah.

Host:   So eventually when counties are taken off the state’s monitoring list and they're able to open schools, parents will be feeling a lot of anxiety as we know. What’s your advice to parents, especially as we get towards a vaccine. What do you say to parents who don’t ordinarily vaccinate their children? This is going to be a thing. Do you think that COVID-19 vaccine should be mandatory? Is that a thing we can do? Could we make a vaccine mandatory? Should we?

Dr. McCuistion:    Well so far the progress with vaccines that I have found have been encouraging. I do hope that there will be a safe and effective vaccine out in the near future. If there is a safe and effective vaccine, of course we will be encouraging people to get that vaccine. I'm sure there will be people who don’t want to be vaccinated. Of course, here at our office we never force anyone to receive anything they don’t want. I'm not sure whether or not the state will make that required.

Host:   Yeah. It’s going to be interesting to see how this plays out. In addition to parents who don’t vaccinate their children for whatever their reasons are, I'm sure some parents are not going to want their kids wearing masks. I mean maybe there are legitimate reasons. I mean are there reasons why people can't wear masks or reasons why kids can't wear masks in school?

Dr. McCuistion:   I don’t think so. I think that wearing masks are legitimate and can cut down on any risk of spreading the virus as well as the shields. So it doesn’t sound like there's going to be any PE or any of those kind of activities. That’s usually the biggest challenge with wearing the masks. There wouldn’t be any lunches, at least at first, where they would have to deal with taking off the mask and putting the mask back on. So I'm optimistic there won't be a problem.

Host:   Yeah. I'm with you. I hope so. I hope it’s not going to be a problem because as we’re learning here, wearing masks protects really not only the person wearing them but everyone around them. There’s just every good reason to wear masks, especially if there are no health concerns, that kind of thing.

Dr. McCuistion:   Right.

Host:   Yeah. So during COVID-19, we’ve understandably and rightfully spent a lot of time talking about the healthcare workers on the frontline, the real heroes in the battle against COVID. Now that we’re talking about kids going back to schools, it occurs to me that we should start talking about the teachers and that they should have a very big say in this conversation because they are going to be on the frontlines. They're going to be in those classrooms with the kids trying to make the best of all of this, sense of all of this. So what would be your advice to the teachers as things ramp up and kids coming back to school soon?

Dr. McCuistion:   If a teacher is over the age of 65 and they do have an underlying medical condition that puts them at increased risk such as cancer, chronic kidney disease, COPD, a weakened immune system, a BMI greater than 30, serious heart conditions, sickle cell anemia, or type 2 diabetes, these teachers might want to consult with their physician. These teachers might want to consider still teaching by video. If you're not, with the teachers I would be encouraged by what we’ve seen in the schools that have opened in other European countries. Also just be encouraged by all the safety measures that are being put into place that should make you less anxious to get back to the classroom.

Host:   Yeah, I hope so. I hope you're right.  As we wrap up here today doctor, anything else? We’ve covered a lot of ground. As we know, there's a lot we know, a lot we don’t know. Anything else we should include today specifically for everybody? Parents, students, teachers, everybody involved in what should be an interesting and challenging and perhaps even somewhat exciting time to go back to school.

Dr. McCuistion:   What I would say is first off is for teachers. I am so thankful for teachers and for principals. They are such a valuable part in the lives of so many children and teenagers. I can't emphasize that enough. I just hope that once the COVID positivity rates come down, especially in our area, that every effort can be made to resume even partial in-person learning because the kids really need to see their teachers again and have that in-person instruction.

Host:   Yeah, I couldn’t agree more. My mom was a teacher and a principal. So obviously I have a special place in my heart for teachers. So hoping this goes well for everybody—parents, kids, teachers. As you say, as the positivity rates begin to come down, as we get closer to a vaccine, hopefully a real new normal will emerge and it’s one that we are all comfortable with and can live with. So doctor, thank you so much for your time today. You stay well. For more information on the coronavirus, please visit svmh.com/coronavirus. We hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well and we’ll talk again next time.