As schools, businesses and public places re-open this summer as the global Covid-19 pandemic continues to evolve, parents will continue to look for guidance from their medical providers on how to responsibly protect their kids and their families. Today’s eWeekly provides guidelines and resources to help primary care providers begin to assist parents in addressing the risk/benefit concerns of decreasing stay-at-home measures. There is no one size fits all solution and the unique circumstances of each child and family and each local community will help define reasonable answers to the complicated question of how to proceed.
Just as there has been a balancing act between health safety and economic security over the past several months, we, as health professionals, now must be prepared to support families as they seek to balance their children’s needs for normative social and educational engagement with ongoing concerns for their family’s and their community’s health risks. Optimizing our children’s educational, social and developmental opportunities will inevitably entail increased risk to individuals and to the overall public health. Sadly, maintaining the highest level of health security, using ongoing maximal isolation, risks long term harm– what has been described as a “Covid slide” of decreased learning and educational progress that may linger on for years, increased non-Covid health risk (think nutrition for kids fed at school, lower immunization compliance, and inattention to other health concerns), and increased risk of long-term mental and psychosocial impairment in consequence to the stresses of the new ‘norms’.
All of us, and especially all parents, need to know that it is impossible to reduce risk to zero, but we and they should be aware of the modifiable factors that help children stay physically and mentally well.
Here is a review of some of the modifiable factors that will need consideration:
- Location Matters: Time spent in enclosed space, versus outdoor space will present more risk.
- Social Distancing: 6 feet of space with all wearing facial masks will increase safety, but kids will be kids, and a focus on achievable measures to reduce transmission risk should be encouraged— hand-washing, sanitizing efforts, and the like can be stressed.
- Social Pods: Limiting a child’s social contacts to stable smaller group of peers and adults, while difficult to achieve, will reduce risk.
- Length of Time: The longer a child spends in an enclosed space with other, the higher the risk. Good ventilation can help.
- Type of Activity: Interactive contact sports and physical play will be more risky than activities allowing 6 foot separation from peers and supervising adults.
- Personal Risks for Family Members: The risk factors of family members in the household (or a family member that the children will visit), such as chronic medical illness and age, are important for families to consider.
- Risks to Children from Family Members: Transmission of illness to a child from an adult with high exposure at work or from other activities is of potential concern.
- Families need to be advised to keep their children out when the child or a member of the immediate family are ill and all program staff should stay home if they have illness or symptoms of potential infection with Covid-19.
- Anxiety and Child-Led Guidance: We all will have anxieties about stepping back in the swing of things. If a child expresses concern about a specific activity, replacing it with a less anxiety provoking activity may help lower anxiety without reinforcing the fear.
- Parents should:
- Have a checklist of signs and symptoms of potential infection
- Confirm that all organized activities and schools (when they begin to open) are screening all entrants (students, teachers, staff) for symptoms of active illness
- Seek support in obtaining and using technology, if and when possible, to optimize social interaction and enhancing formal and informal educational activities
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- Upcoming Community Events:
- Thursday June 18th, 2:00 – 2:30pm: Dr. Hilary Bowers, Pediatrician and Director of Mental Health for Children’s Primary Care Medical Group, will be presenting a Facebook Live Stream to address some common questions parents may be asking about, review the modifiable factors, and encourage families to consider appropriate strategies. https://www.facebook.com/events/301231174380724
- Friday July 17th, 8:30 – 9:30am “The Impact of Covid-19: It is a Changed World—Let’s Manage it for the Good”. Panel discussion about the impact of the pandemic on local health systems in San Diego— with Nick Yphantides, MD, MPH, Chief Medical Officer, County of San Diego HHSA; Wendy Pavlovich, MD, Primary Care Pediatrician, Family Health Centers of San Diego; and Luke Bergmann, PhD, Director, Behavioral Health Services, County of San Diego HHSA as part of the CICAMH live stream webinar (see attached flyer)
- Wednesday July 22nd, 6:30 – 8:00pm: AAP CA-3 Chapter Town Hall #4 “Adolescent Mental Health during the Covid Pandemic” with Drs. Maya Kumar, Huong Diep, Mark Chenven will explore impacts and health care interventions to support teenagers and their families.
References:
- Sharfstein, J. M., Bloomberg, H., Christopher, C., & Bloomberg, H. (2020). The Urgency and Challenge of Opening K-12 Schools in the Fall of 2020, 6–7. https://doi.org/10.1001/jama.2020.10175
- Sharfstein, J., and Morphew, C. (200) The Urgency and Challenges of Opening K-12 Schools in September https://jamanetwork.com/journals/jama/fullarticle/2766822
- YouTube: JAMA Conversations with Dr. Baucher: Covid 19 Q&A https://www.bing.com/search?q=ou%20Tube%3A%20%20JAMA%20Conversations%20with%20Dr.%20Baucher%3A%20%20%20Covid%2019%20Q%26A%20%20%20%20%20Opening%20School%20in%20the%20Fall&qs=ds&form=QBRE