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COVID-19 Update: March 31, 2020, Discussion with Knowledgeable JRC Doctors

04/02/2020 12:12:17 PM


March 31, 2020:

Here's the interview with Kim and Rob for reference:

JRC is working to help our members stay connected during the COVID-19 pandemic and its ever-changing implications for our community.  Our working group of staff and lay leaders continues talking on a daily basis with health professionals.  JRC's board president Elliot Frolichstein-Appel recently had an opportunity to chat with Jennifer Weiser, a local pediatrician and parent in our religious school.  An edited transcript of that conversation is below.


Elliot: Thank you for sharing your experience with JRC parents.  How is COVID-19 affecting your everyday work?


Jennifer:  I'm a pediatrician at Erie Family Health Center in Evanston.  As of this week, Erie's 12 sites are, like many other health care centers, moving to a new model for delivering health care.  Our patient-facing staff will work in rotations, spending some time working in urgent care, where we see patients with pressing health concerns, some time working in our tele-health platform where we interact with patients remotely, and some time working in low-risk care, for example performing well child visits and vaccines.  Like many hospitals and clinics, we are designating each of our sites as either a “clean” site or a “sick” site, and establishing protocols so health care workers minimally cross over between sites.  If any of our workers get sick, they will need to stay home until they recover and are considered no longer contagious.


Elliot:  I keep hearing changing stories about the extent to which children are at risk of COVID-19?  Can you help set the record straight?


Jennifer:  Data from China indicates that kids do get the COVID-19 virus, and sometimes have symptoms, but they tend to be mild.  Sometimes they are infected but have no symptoms.  China did a study of 2,100 kids, two thirds of whom were suspected COVID-19 cases, and one third of whom were cases confirmed through positive tests.  90% of all of the kids were either fully asymptomatic or had very mild symptoms like a runny nose.  Only one of the 2,100 kids in the study died, and a handful of others had severe disease.  While these studies are not conclusive, they do indicate that kids can catch the virus like adults, but its ability to replicate in a child vs. in an adult is unknown, and we don't really know yet why it may affect people differently based on age.  Some professionals have conjectured this may have to do with children's immature immune systems, but we really don't know.


Elliot:  All of us who are parents worry about our kids and want to do what is best for them.  Should we keep up with regular exams and shots, or should we wait until things calm down?


Jennifer:  The American Academy of Pediatrics recommends continuing to vaccinate children up until 2 years of age on schedule just as before the pandemic.  The process of dividing clinics into well sites and sick sites is under way, and clinics around the country are working to resume well care and vaccinations, even if they’ve had to delay this for the last few weeks.  If we postpone vaccines too long, our country could have other epidemics on our hands which we don't want for the kids or for our health care system already stressed by COVID-19.  I'm reminding all the parents I interact with to call their pediatric clinic to schedule any young child’s appointment in order to monitor growth and development and obtain required vaccines. You may end up seeing a colleague rather than your own pediatrician.  Your pediatrician or a colleague might call you for an interview, then do a "light touch" clinical visit, where your child is weighed and measured and receives scheduled shots.  For annual checkups, also call your pediatrician's office.  The decision of whether to go ahead and schedule or postpone if there are no shots due may depend on whether the doctor is monitoring a chronic condition.  It is likely your pediatrician can do a lot by tele-health.  Particularly for children older than two years old, the doctor may do a tele-health Q&A with parents and child, then have you bring the child in later when the epidemic subsides for a clinical exam if there are no concerns.  We want to protect kids and families from accidental exposure while still providing necessary pediatric care.


Elliot:  What about if my kid is sick?  Should I go to morning walk-in hours as usual?


Jennifer:  It is likely that walk-in hours are canceled in many clinics.  Even if they are not, the best practice if your child is sick is to call first rather than walking in.  We can do a lot on the phone, and that helps keep kids away from infections and in turn lowers the burden on the whole system.  We may do regular phone monitoring for kids who are running a temperature or showing other symptoms.  We will still hospitalize children if they need it, and we'll ask you to bring them into our office for an exam if needed, but it will depend on symptoms, severity and the age of your child.  Certainly, if your child is having difficulty breathing (grunting or panting or similar), call 911.  Otherwise call the pediatrics office first, even if your child is coughing a lot or has a fever.


Elliot:  I know a lot of families are stressed out with parents working at home and kids trying to do school work but bouncing off the walls and interrupting parents.  What are the risks and frankly, good coping mechanisms for being cooped up?  Can we just send them outside to burn off some energy? 


Jennifer:  First and most important, please stay home!  It reduces the risk of all family members getting infected and of spreading the infection between families.  What does staying home really mean? You can certainly make essential trips to the supermarket and drugstore alone.  But it is better not to bring kids to the grocery with you if you have another adult who can stay home with them.  Arrange for grocery pickup / delivery if possible.  


Elliot:  Just how safe is the great outdoors?


Jennifer:  We know the virus may live for up to 72 hours on some surfaces, so we don't want kids touching playground equipment in public parks.  The swing set in your backyard is awesome, because nobody outside the family is touching it.  Family walks or bike rides are good, playing in your own yard is great.  Stay six feet away from passersby, don't touch things.  Kids shouldn’t play ball with their friends because the virus can be transmitted on the ball or the frisbee and then subsequently to higher risk folks in the household.  You can talk to neighbor kids over the fence as long as everyone stays six feet apart, but don't throw things back and forth.  If grandparents don't live in the house, plan on no physical contact with them because they are more vulnerable to disease, and kids can still carry the virus without showing any symptoms.  Regular phone calls are great, Facetime or Skype or similar are awesome.


Elliot:  How about our kids' mental health?


Jennifer:  We know that routine is important for children. Our regular routine has been disrupted by the pandemic, but we can establish a new routine.  Keep the same wake up time, have breakfast, get dressed.  You can designate work time, play time, etc.  Children under ten may be able to sustain 20 minutes of sustained work, then ten minutes of play.  An older child may be able to work for a longer period.  Active play is still key.  Backyard games are great within your family.  Balls, jump ropes, buckets, making up their own games is fun.  Older kids can make up their own workout routine for fun.  As always, keep an eye on media time, aside from e-learning.  If your kids are playing video games, play with them, if they are watching movies, watch with them to ensure they are all age appropriate.  Parents may be anxious about their kids accomplishing all the goals of the regular school year, but teachers say the most important thing is that kids are doing a variety of tasks daily in reading, writing, math, social science, and the arts, and getting plenty of physical activity (at least one hour per day).  But don't sweat the regular school year goals that would be accomplished in a school setting.  One helpful article I read said “You’re not home-schooling, you’re crisis schooling.”  Most important is that kids are having quality time with their families.  Give them some challenges so they don't lose ground academically, but most important is to enjoy time together.  In Evanston, District 65 has a choice board with sample activities.


Also, for kids on the autism spectrum, or for children who have learning disabilities or behavioral challenges, routine is even more important to manage their stress and behavior.  You may want to use a visual schedule with pictures rather than words to help establish and maintain a predictable routine.


Elliot:  How do I know if my child is NOT doing well emotionally with this new reality?  I often don't even know how I'm doing with it, and our family dynamics are changing with everyone at home all the time. 


Jennifer:  There are a number of indications to look for in children.  Trouble sleeping, excessive worry, excessive complaints like stomach-ache or headache without other symptoms.  Changes in behavior, like starting to act younger than they are.  For teens, initiating alcohol, tobacco or drug use, or regular expression of sadness, depression, anxiety or fear.  If any of these are happening, parents should be in touch with the child’s doctor, who may have suggestions or provide a referral.  Most therapists are doing tele-health -- available for families and kids. Therapists are navigating this virtual world very well.


Elliot:  Children are curious.  How should parents talk to their kids about COVID-19?  We like to have answers for them but some of us feel particularly in the dark in this current situation.


Jennifer:  Don't let your young children watch the TV news where there is likely to be graphic imagery that's disturbing.  This can be a risk even for adults.  If kids have concerns, try to reassure them.  Remind them that scientists and doctors are working as hard as they can and as fast as they can to help.  Children can already do things to help -- wash hands, sneeze and cough into their arm, and avoid playgrounds.  Remind them that doing these things can help keep other people from getting sick, and it can help the health care workers take care of sick people.  Children need a feeling of control to help manage their anxiety, so these can help.  If they are anxious or cranky, keep reminding them that people are working on this, and it's okay to be worried.  Also model self-care like meditation in front of your kids or together with them.  Discuss the situation calmly and try to maintain composure, at least in front of your kids.  Children will mimic how their parents react and cope.  Monitor the family’s media use, and use teachers for recommendations for good resources to teach kids about what’s happening.  Use age-appropriate social media, and stay connected to friends and loved ones electronically.  Some kids may tend to talk more on a phone call than on a Facetime or Zoom call.  If kids are being goofy and making faces on a video call, connecting in ways different than adults might, that's fine – it may just be how they want to connect with their friends.  Remember, they're still connecting with their friends. 


Elliot:  This is great advice.  Any suggestions for parents of older teens whose kids are more tech-savvy than their parents in a time when we're all so tech dependent?


Jennifer:  Maybe you'll have to start paying them for tech support.


Elliot:  Thanks for all you do!  We hope to see you (virtually) around JRC, and we really appreciate your insight. 


Jennifer: My pleasure. See you soon!

Tue, January 19 2021 6 Shevat 5781