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Monday, August 16, 2021

Back to School 2021

Episode 63


Announcer (00:00):
Coming to you from Beaumont, this is your house call.
Dr. Nick Gilpin (00:16):
As we lean into the back half of summer, it's time to start thinking about kids, adolescents, and educators heading back to school this fall. The push is on to get students back to in-person schooling, but with so many children yet to be vaccinated and the rise of more transmissible variants, questions about COVID prevention strategies and the safety of school aged kids once again dominate our landscape. Keep it here. We've got your answers on the back to school COVID 2021 edition of the HouseCall Podcast.
Dr. Nick Gilpin (00:52):
Hello and welcome to the Beaumont HouseCall Podcast. I'm Dr. Nick Gilpin. This is our late summer back to school COVID podcast, the 2021 edition. We did a similar podcast almost exactly a year ago that addressed some issues around preventing COVID in schools. Of course, at that time, we didn't have vaccines and our collective understanding of COVID was considerably less than it is right now.
Dr. Nick Gilpin (01:15):
This time, we're taking another shot at it, pun intended, and we have Dr. Bishara Freij to join us on the podcast. Dr. Freij is a HouseCall Podcast veteran. He joined ASHA a couple months ago for the children and COVID vaccines episode. Dr. Freij is the head of pediatric infectious diseases at Beaumont Children's Hospital in Royal Oak, Michigan.
Dr. Nick Gilpin (01:35):
We're going to discuss a handful of key topics around the safe return to school this fall, including vaccination for school-aged children as a key prevention strategy. We'll talk about masking and physical distancing in schools regardless of vaccination status, and why this is important despite being somewhat controversial. We're going to talk about other preventative strategies such as staying home when sick, testing, contact tracing, hand hygiene, and so on. After my conversation with Dr. Freij, stay tuned for another podcast guest, Sarah Rauner, who will talk with me about the important psychosocial and mental health benefits of getting students back to in-person learning this fall.
Dr. Nick Gilpin (02:13):
All right, let's get to it. Thank you for joining me, Bishara.
Dr. Bishara Freij (02:15):
You're welcome, Nick.
Dr. Nick Gilpin (02:17):
Bishara, before we get started, I want to set the stage here. I like to do this on these podcasts because some of this information is maybe a little time sensitive, so this is a way for me to timestamp the information. We're currently at approximately five to six percent COVID test positivity in our community. The CDC considers this moderate community transmission. The Delta variant is the dominant strain nationwide at about 93% of all COVID cases. Young, unvaccinated individuals average age around 40 is making up the largest proportion of those new cases and hospitalizations. About 71,000 new cases of COVID diagnosed among children in the US in just the last week alone, which is approximately one in five of all new COVID cases, and about 54% of Michigan residents over age 12 are fully vaccinated right now. With all of that in mind, let's talk, you and me, about what a safe return to school looks like in our community. I'm going to let you just take it away.
Dr. Bishara Freij (03:21):
As you lay down the background here, there's still a lot of disease transmission going on, even some breakthrough infections among the people who were previously vaccinated. It's a small chunk of people, but nevertheless, they exist. We still have a long way to go in terms of trying to get to the finish line. But in order to achieve that, we have to all work together to do that. Also, in the meantime, try to protect the kids from all the consequences of the pandemic that are not just health related, but psychological issues and mental health issues as you will be addressing with your next guest.
Dr. Bishara Freij (04:03):
In order to achieve that as successfully as we can, as more and more people get vaccinated and more and more people get naturally infected, and we encourage everybody around these children who cannot yet receive the vaccine to go ahead and vaccinate themselves. They owe it to themselves, they owe it to their families, they owe it to their children, their neighbors, their parents, to do what they can to minimize transmission.
Dr. Bishara Freij (04:35):
Once it's like the concept of cocooning a child by having everybody around them as protected as possible, so that includes teachers, obviously, and personnel at schools and everybody 12 years of age and older, then every other step, all the other layers of social distancing and masking and hand hygiene and all these other items, they all help. None of them is a solution in and of itself, but each one of them on its own contributes towards the ultimate goal of limiting replication of the virus, making people sick, and allowing it to generate new variants that are perhaps more difficult for people when they get infected. We need to do everything we can to achieve the final goal. We're all in this together and we need to do it in a manner that we all can get to the end of this pandemic and move on with our lives.
Dr. Nick Gilpin (05:38):
Let's talk about vaccines because I think you mentioned, you alluded to it, and I agree, this is a keystone of our strategy. Question. A question I get, a question I'm sure you get. When it comes to vaccinating our students, school-aged children, is one vaccine, in your opinion, better or safer than another?
Dr. Bishara Freij (05:58):
Right now, the only vaccine that has received the emergency use authorization really is the Pfizer vaccine. I think the Moderna vaccine is pretty comparable, but they are a little behind the Pfizer group in terms of getting the regulatory clearances to use the vaccine. I think, once it becomes available, I don't really see one being superior to the other, even though they have not been necessarily compared head to head.
Dr. Nick Gilpin (06:26):
Do you have an expectation or a best guess as to when we might expect vaccines to be available for the under 12 age group?
Dr. Bishara Freij (06:34):
For the, I guess, 6 to 11, the Pfizer expects to have the data finished by the end of September, and they'll submit it to the FDA in October, and the expectation is it'll move quickly through committee, barring any surprises or problems. Then it'll be granted the emergency use authorization like the adult vaccines. Theoretically, October, maybe November.
Dr. Bishara Freij (07:04):
The only problem I foresee with this is the vaccine for these younger kids is not the same vaccine we use in adults. It's the same product, but the dosing is much lower. If they're 6 to 11 year olds are going to get about a third of the dose the older kids and adults are getting. That's where required new packaging and formulation and delivery of product. I think these things will add to the timeline, assuming everything else is in line. Then, for the younger kids, the ones that are six months of age and older, the expectation is maybe by the end of 2020 that their data will be finished and be ready to perhaps roll it out. This is my understanding.
Dr. Nick Gilpin (07:48):
Perhaps by the latter half of this school year after the [crosstalk 00:07:52].
Dr. Bishara Freij (07:52):
Yes. If everything goes well, I think, for the winter term, we may have what we need to finish the job in terms of protecting the younger ones.
Dr. Nick Gilpin (08:04):
I like that approach. I think that you could certainly make a case. Whether you or I agree with it, I think they probably want to avoid any perception of rushing, because I think that's been one of the biggest complaints that I've heard about this entire process, is it's been a rush. Again, whether you or I agree with that, in concept, I get the feeling that both the vaccine manufacturers, those that are conducting the clinical trials, and the FDA want to really avoid that perception.
Dr. Bishara Freij (08:34):
Early on, before the vaccine was given authorization, I had that concern myself. Is this being rushed to market? But realistically, even though the vaccine was rolled out back in December, we are eight months out now from the time the vaccine was rolled out. This is actually a lot of additional followup in terms of how effective it is, hidden adverse effects that nobody suspected, the number of people who have gotten it. As you stated, there's over 50% of the eligible population. Now, granted they were all vaccinated at different points in time, but you have a huge cohort that exceeds any study that would have ever been done, and the data are still very, very good. There's no real hidden longterm problems from the vaccine. The protection, there is a debate on how long it lasts. But overall, you can see that from the data in the states where there is a lot of disease, that the ones who are getting hospitalized are the unvaccinated. The ones who are getting in ICUs are they unvaccinated. The ones who are vaccinated tend to have milder disease if they get it, and they are not the ones getting in massive trouble with the infection the way it was a year ago for everybody.
Dr. Nick Gilpin (09:55):
Absolutely. You mentioned layers. I want to go through some of those layers as we talk about this idea of a safe return to school. One of the things that you mentioned was the ma...
PART 1 OF 4 ENDS [00:10:04]
Dr. Nick Gilpin (10:03):
... idea of a safe return to school. And one of the things that you mentioned was the masking and physical distancing, which has become a contentious issue, unfortunately. Let's talk about that and why that's important, even for those vaccinated students right now. Given what's going on in our communities with rising rates of COVID, why is it important that even the vaccinated students should be wearing masks?
Dr. Bishara Freij (10:22):
Yes. So you ought to fully vaccinate the individual, whether you are an adolescent or an adult, the vaccine provides you... The protection from infection is about 80%. So you're 80% less likely to get infected if exposed. And among those who do get infected, they tend to have milder disease.
Dr. Bishara Freij (10:44):
The problem with the milder disease, or the asymptomatic infection, is the virus is allowed to replicate. And the driver of all these variants and variant formation with all these Greek letters, whether it's Delta and Lambda and whatever is coming down the pike, these things will not emerge if the virus is not multiplying and allowed to come up with new versions of itself. So it is important to stop it in its track everywhere possible. If there is no replication, there is no variant formation. That really, to me, should be the driver of everything.
Dr. Bishara Freij (11:21):
So even if the masks are controversial, they're uncomfortable, they're not perfect, they have their own problems. They do help. There's a lot of studies that show decreased transmission, especially in the days before we had even the vaccine to work with. They are by no means ironclad wall, but they do reduce transmission. And every case we can prevent is one less chance of having a variant emerge that is potentially detrimental, maybe even worse than the Delta variants we're dealing with right now.
Dr. Nick Gilpin (11:55):
As we go through the CDC's playbook that I have here of their approach to safe back to school, one of the things that they talk about is screening tests, particularly for those students and staff who are unvaccinated. Talk a little bit about that. What is your thought about utilizing screening tests in students and staff? And contrast a little bit the difference between a screening test versus a targeted test for someone who may have been exposed or may be symptomatic.
Dr. Bishara Freij (12:25):
Well, screening tests would mean you just sample people, whether they're symptomatic or not. And that, personally, that's my personal opinion. I don't speak for the CDC or anybody except myself. Implementing screening for all these children and staff on a regular basis is not going to-
Dr. Nick Gilpin (12:48):
It's tricky.
Dr. Bishara Freij (12:49):
... go very well. I think it's going to be a dead end pretty fast. It's uncomfortable to get those swabs. It is costly. You have to pay for it out of your pocket or insurance, and if you have to do it on a regular basis, it adds up. It adds up quite a bit. That's different than an exposure and maybe you're trying to make sure you didn't get infected. If there was a problem in the class where you're trying to do basically contact tracing and making sure everybody who got infected quarantines so they don't spread it to others, that's mitigation. You're trying to mitigate the effect of what happened. But in terms of just general screening, I don't find that all that useful. Prevention through masking and vaccination and hand washing and distancing as much as possible is a much more effective approach, a more practical approach.
Dr. Nick Gilpin (13:48):
I like that answer, Bishara, and I agree with you. I think when we look at these recommendations, academically, it may make sense to screen regularly, to have an understanding of what your prevalence is at a given time. But I think you're absolutely right. It's practically very difficult. It's operationally very difficult. It's costly. Schools may not have access to those resources. One place where I have seen screening testing used a little bit more wholesale, and fairly effectively I might add, is in sports and extracurricular activities.
Dr. Bishara Freij (14:20):
Yes. That, I agree with you. But that's targeted screening because you don't want to mess up somebody's season. You don't want to... In fact, if you're playing football, you're coming face to face with people, you're yelling and screaming and tackling people. That makes a little more sense. But just random people, couch potatoes like me, people like that, it doesn't make sense.
Dr. Nick Gilpin (14:46):
No. Fair point. So I'm going to keep moving through some of these other things that I'm sure you're very familiar with and support. The CDC talks about good hand hygiene. I think no controversy there. They also talk about using well ventilated spaces and outdoor spaces, if possible, which some places may have the luxury of doing if they have better weather than we do in Michigan. And then another one that I want to key in on is this idea of staying home if you're sick, and obviously getting tested if you do have symptoms. I think this is something historically, Bishara, that we as a society have done a pretty lousy job of. Staying home if you're sick and really setting that example of not being afraid to stay home. I think we're a play through the pain society, if I'm being honest with you. What are your thoughts?
Dr. Bishara Freij (15:38):
I completely agree with you, even though I think the people's philosophy is beginning to maybe shift, they're beginning to see that this is not a good approach. This idea of staying home and not exposing your classmates or colleagues applies to influenza and RSV, and a whole slew of respiratory viruses which also cause problems for a lot of people in any given year. They're massive problems every year for the population. So I think in terms of doing that, it's always a good idea. The culture here has always been, like you said, play through the pain. But I really feel that people are beginning to see that this is not a wise way to conduct life.
Dr. Bishara Freij (16:27):
Now, we do have different venues now. In the past, there was no virtual classes. You couldn't do online learning. So if you didn't go to school, you lost out a lot. If you didn't show up to work, there's plenty of workers, they'll get rid of you, things like that. But I think this is all... The change has been forced on people. And I think in one way, this is one of the better things that have come out of living through this pandemic, which is to start wondering whether we're being smart about things.
Dr. Bishara Freij (17:01):
So I think right now, if you're a student, even if you're doing in-person classes, they're keeping the online portions of the teaching because they also need that for some kids who cannot come or people who get sick. So you can keep up with your homework, with your demands, without necessarily having to show up in person. And then you can keep going, not fall behind very quickly. And it will be just a temporary period of time until you recover from whatever you're going through, and then you can go back to joining your classmates or teammates or whoever you wish to join.
Dr. Nick Gilpin (17:42):
Sure. Another one of the strategies that the CDC talks about, and other organizations talk about, is cleaning and disinfection, which is something we've come full circle on throughout the COVID experience and the importance, or relative lack of importance, of what cleaning and disinfection might actually mean. What is your opinion on how often cleaning should be done in schools? And what exactly should these schools be focusing on during their cleaning and disinfection process?
Dr. Bishara Freij (18:16):
Well, the cleaning and disinfection will work to get rid of what exists on the surfaces, and 10 minutes later, you could be back to where you were before the cleaning. So I think keeping things clean, in principle, is always a plus. Being obsessive-compulsive about it is neither practical nor logical. And even all of these cleaners, if you use too much of it, there are some environmental impacts on those. You can smell the cleaners, they can irritate people. Again, I'm all for it. I just don't think it does much. It doesn't do nearly as much as masking, for example. Masking will be way more effective in reducing transmission.
Dr. Nick Gilpin (19:10):
And hand washing, of course.
Dr. Bishara Freij (19:12):
Hand washing, absolutely. It's a good idea, period, not just for COVID, but for pretty much anything you want. So I think it's always a good thing to do. But cleaning the surfaces, I think, is not going to put a big dent in anything.
Dr. Nick Gilpin (19:32):
Curious to get your thoughts on this, since you mentioned masking again. I think that's one of the areas where I'm getting the most questions, certainly around masking. So I'm sure you've had this one before. A parent says, "Dr. Freij, my kid's school is not requiring masking, but I really want my kid to wear a mask." Talk me through that. Walk me through your approach to this. And what should I be telling my student and how should we be having that conversation?
Dr. Bishara Freij (20:01):
Well, I think-
PART 2 OF 4 ENDS [00:20:04]
Dr. Nick Gilpin (20:02):
How should we be having that conversation?
Dr. Bishara Freij (20:02):
Well, I think we lead by example and I think parents who believe in the importance of masking should educate their kids about its importance. They should model the behavior so that they do it themselves. And I think the onus is on the teachers to make sure that kids who choose to mask don't get bullied or harassed or messed with by others who may be coming from households that are maybe more negative about this thing. I mean, once you send your kid to school, it's out of your hands what happens, but kids will do it. I mean, at the beginning of this pandemic with all the masking and all this stuff, I really was not sure how the younger kids will handle it, but in my office, I'll tell you, they are very good about it, the kids. They will keep the mask on.
Dr. Bishara Freij (21:03):
And even when you want to examine their throat, they use it to shield themselves from you because now it's covered, like leave me alone kind of thing. But they keep it and they don't... So even kids, I mean, I take care of a lot of kids who have developmental problems, cerebral palsy, down syndrome, autism, and they keep the masks on. They do. So I don't think it's as difficult as I thought it would be a year ago or a year and a half ago. I'm very pleasantly surprised and very glad I was mistaken in my thinking that they would not do well with it. But I think you should teach your kids to do that until we're done. And it protects them, not just from COVID, but it'll protect them from other respiratory viruses as well. Not perfectly, but it will be positive nevertheless.
Dr. Nick Gilpin (22:03):
Good answer. So [Bashara 00:22:05], with all these strategies in play to get back to safe in-person learning, one question is, is there still a role for closing schools and what might that look like if things get weird again, as I like to say?
Dr. Bishara Freij (22:20):
I don't see ourselves as getting back to last year, but I do see you might have to shut down some class for a little while or things like that. That probably will happen here and there, but I just do not see... Even now with the increase in activity of the virus in our area as an example, we are nowhere near the last year's numbers. That's a reflection of we have a virus that spreads more easily and yet the numbers are not as dramatic as a year ago. A lot of it is, there's a good chunk of people who are immune now to this and they will interrupt transmission, but we are not done. And if we don't control it, we may lose all the gains we've made and that's what we have to try to avoid.
Dr. Bishara Freij (23:11):
And people have to understand everybody's tired of talking about the disease, the infection, the masking, the social distancing. So if people are as tired of hearing about it and dealing with it as healthcare workers and a lot of the population, then do something about it. Help us get through the finish line by trying to prevent the virus from multiplying. Get vaccinated, use the mask, wash your hands, distance as much as possible. And we can see the finish line then at some point.
Dr. Nick Gilpin (23:52):
Well said, Dr. [Freiz 00:23:54]. I'll leave it there. I really appreciate your time. Thank you.
Dr. Bishara Freij (23:56):
Take care. Bye bye.
Dr. Nick Gilpin (23:56):
All right, thanks.
Dr. Nick Gilpin (23:59):
And now we're going to pivot to part two of our podcast. This part of the podcast will explore the psychosocial and behavioral aspects of why it's important to get students back to in-person learning. And our guest for this segment is Sarah Rauner. Sarah is a pediatric nurse practitioner at Beaumont. She's contributed extensively on this topic, including through local television and media outlets. Thank you for taking time to join me today, Sarah.
Sarah Rauner (24:22):
Thanks for having me.
Dr. Nick Gilpin (24:24):
So Sarah, my last guest and I just discussed the latest recommendations for what a safe return to in-person school this fall might look like. We talked about vaccinations and other preventative strategies. These recommendations from the CDC, the WHO, and the American Academy of Pediatrics are very tightly linked to the concept of child and adolescent development and wellbeing, which is something I know that you've spoken quite a bit about. So talk for just a moment on why this push for in-person learning is so important for students.
Sarah Rauner (24:56):
That's a really great question and one we've been getting a lot lately in pediatrics. And it's the question of, are we going to go back or are we not? And I think there's three major pointers that needs to be brought forward to talk about. We have academic development, social development, and then the physical health and nutrition. So when we dial down a little bit to that, the academic development, studies have shown us that math and reading scores suffer for students doing virtual versus in-person learning. And I think two of the big reasons for that is it's a question and answer session in learning when you're a child. You got to be able to ask the question and get an answer. And a lot of kids just simply won't do that in virtual learning. When you're learning, you're also learning dynamically. So things change, you learn off of what the person next to you is asking, what the person next to you is learning and I think you lose that with this virtual learning session.
Sarah Rauner (25:49):
So not only is it academic development and pushing them forward to the next level, but it's the social development too. So the importance of having a routine and I've spoken on this many, many, many times. I think our first thing as parents was to let kids just be themselves and live with the pandemic. And now we have to get it back and we have to get them back on a routine for so many reasons. But it's social development, so it's routine, it's having social interactions with other students and other teachers, which are adults that aren't their parents, which is a huge one and emotional intelligence. So it's problem solving. It's creating social bonds that aren't there when you're on a classroom. Having ninth graders walk into high school and not walking in a door, but walking into their bedroom or their office or wherever they're taking virtual learning and not knowing a soul in any one of the classes and looking at these screens full of either names or faces that they don't recognize. It makes them feel alone, isolated.
Sarah Rauner (26:51):
And then simply the physical education and health. A lot of these kids in so many communities rely on just simply food from school. You get breakfast, you get lunch, and you get a snack. Whereas other kids just don't get that or they get very unhealthy foods. And then the physical education piece, it's moving from class to class. It's not just the physical education of having gym, but it's getting up out of your room, out of your house, walking to the bus, walking in as you're being dropped off and then simply walking from class to class. We lost all of that in virtual learning.
Dr. Nick Gilpin (27:25):
Absolutely. I think we could certainly agree that there might be circumstances or situations where a school would have to shut down for a period of time if there's an extensive outbreak in the school or in the community, but I think these over long shutdowns have really been detrimental. And one of the things that I've seen and read about extensively is this idea of a pulling apart of this social vulnerability. You've got, frankly, the haves and the have nots and you're seeing more and more distance between these populations. So if you could, talk for a minute about how this is particularly important for systemically neglected populations and how the absence of in-person schooling is contributing to some of those gaps.
Sarah Rauner (28:09):
Sure. The Economic Policy Institute found that the pandemic widened the gap that put the low income students at a disadvantage relative to their better off peers, which basically means a lot of kids just simply don't have devices. They don't have internet access, or if they do, it's very limited or very slow. They don't have the specialized instruction that comes with it as well, like tutors and teachers that you can go to on your off hours or after school or before school. And with slower online learning and less availability of devices, you lose all that online learning modules that the teachers are able to put together. So they can put together a wonderful learning platform for these kids, but if they're out of school for extended periods of time, they're not building on that academic development, which is what's so important for them.
Sarah Rauner (28:59):
So the underserved are becoming more dramatic... They're becoming dramatically separated from those that are more served. They have the better computers. They have the quicker wifi, they have all of those types of things. And in general, the big gap used just to be in, a lot of times, just in nutrition. Now we're finding it more and more in the actual academic learning and retention that there's a big gap.
Sarah Rauner (29:26):
Speaking of nutrition for just a second too, you have these kids that a lot of times are in underserved populations where the parents may not have the financial means to provide them with three balanced meals a day, where a lot of times they were getting fast food or convenience food because it's cheaper and it fills them up. Going to school, they get a breakfast, lunch, and most of the time a snack, backpacks sent home with kids full of cereal and bars and things that they can eat that are more healthy. We lost the ability to have that when we started with this virtual learning. So not only are they not getting the educational...
PART 3 OF 4 ENDS [00:30:04]
Sarah Rauner (30:03):
Not only are they not getting the educational platform, they're now not getting the nutrition that they need to feed their bodies, their brains, their development, to push them forward in this educational gap.
Dr. Nick Gilpin (30:14):
Yeah. And what I'm seeing as I read some of these recommendations from the CDC and other organizations is that keyword, equity, keeps getting used over and over again. It's about equity and we have the tools to provide safe in-person learning, and it's not only important for the students emotionally, it's important for this concept of equity. Follow up question, Sarah, I know you work in a pediatrics clinic, have you seen examples of where students have directly suffered as a result of not having in-person schooling? And what does that look like?
Sarah Rauner (30:47):
So I think I can give you three particular examples in general. One of them is the lack of physical education that we've talked about. We've seen a dramatic increase in children's body mass index or BMI number, which then in turn puts them at risk for stroke, heart attack, things later on in life, these things are reversible. If we can get a handle on these and create a better routine and get them to be where they were before, we can absolutely put these kids in a healthier situation moving forward as an adult. So I think BMI is one of them.
Sarah Rauner (31:19):
Parents child relationships, I do think is another thing that... Not in all circumstances, but in some circumstances. I took care of a kid who I talked to the parents and the kids together, and I like to talk to the kids separately if the parents allow it. And I could just tell that there was a lot of anger in this room. You could just feel it the way the conversation was going. And the second I got the parents out of the room, the child just broke down in tears, and this is a teenager. And I'm just like, "Okay, let's get it out. Let's cry it out. What's going on? But, you're not telling me something." And the poor child looks at me and says, "I just absolutely think my parents think I'm a failure. I don't have the energy to get up. I don't want to get up. I'm so anxious that I'm going to get COVID, but yet I'm so sad that I don't want to clean my room, and I don't want to help my parents that I just feel like a complete and utter failure."
Sarah Rauner (32:11):
So I'm watching in front of me the unfolding of this poor 17 year old, who is just lost in all of this. And the parents are upset because they're not picking up their room. And she can't pick up her room because she's flat out clinically depressed. So those types of things, when you put people in a situation where they're together 24/ 7, it changes your expectations of each other and I think it changes your relationship. So I think people need to be very aware of what's going on in the home at that time. Thankfully, I was able to get some followup on her, and in counseling and with some medication, and they're doing a lot better now. But it's a long road ahead of them and one of their biggest fears was, "What if this happens again?" And my statement to them was, "Well, you know what? We know what we're dealing with. Let's see if we can stop it before it starts again." And then the third one is, kids I hear over and over they feel like they're lost in the computers if they are there. They feel like they're in a screen of people, that they're not getting that social connection. And with that social connection, you don't have the, "I want to do better than he did." Or hearing so much about their grades or, "Well, all I got to do is pass, right? That's all I'm worried about. I have to do just good enough to get by this semester." So I think those are three of the biggest reasons. One thing that I don't think we've talked enough about as well is lack of access for things like ABA therapy and our autistic population. Speech therapy on our kids, the thought of doing speech therapy with masks, in-person is very hard. And to get some of these kids who have educational challenges or emotional challenges to watch you on a Zoom and try to learn is hard. So all of those therapies that kids need that are in-person, those are the ones that my heart goes out to those families because they strive on that routine of being able to go to school, being able to learn, and that routine of doing it over and over and over again.
Dr. Nick Gilpin (34:11):
It's interesting because we are doing this real time, risk benefit analysis, always. And I want to stick with something that you just said a moment ago, and I want to talk a little bit about resiliency, because you're right, I don't think any of us knows with certainty what the next several months are going to look like. It could be a bumpy road. We could have shutdowns again. We could have schools closing down, like I alluded to earlier, because of outbreaks. And so how can parents help demonstrate this idea of rolling with the punches? There's a lot of uncertainty out there right now. Things might get weird again. Talk me through that a little bit.
Sarah Rauner (34:47):
One of the big things as parents that we have to do is, number one, we have to keep our children on a routine. I think the fact that if they go to bed at the same time at night, if they get up at the same time in the morning, they're eating breakfast, whether they're going to school or not. They can't have school, if it does get shut down from their bedroom. You have to get up, move out, go walk the dog in the morning, go walk anyone in the morning, just get out and move first. So if you can mimic that routine that they're doing at school at home, that will benefit them.
Sarah Rauner (35:18):
But I also think as parents, we sometimes have to take a step back and say, "I have to do that too. I need to take my mental break as well. I need to make sure that I'm going to bed at a good time, I'm eating well, I'm exercising, I'm moving my body everyday, and I'm being a good example for my children too." And then role play some of it. Say, "Okay, what are you most worried about going into day one of school? Let's talk about it." Let's say, "Okay, I'm worried about, am I going to make new friends?" And my biggest conversation is, we're all in this together.
Sarah Rauner (35:49):
So if something comes up, let's talk about some techniques that we can give you to work through these things. Things as simple counting backwards from three, or counting forwards to 10. One that I really liked, because we're trying to ignite other senses, is something that you can see, something you can smell, something you can touch. Start working on those other senses in the moment so that you can then reduce your anxiety and press forward with change. Because any kind of change, whether it's good change or bad change, allows those anxious feelings to come in.
Dr. Nick Gilpin (36:23):
I like that. So I think this is a good place to wrap things a little bit, and I want to finish this on a positive note. This has been a really good conversation. The pandemic has been for us all, you, me, for the students, for our patients, it's been a physically and emotionally draining experience, certainly for our healthcare community as well. But we have the tools now I think to make in-person learning a success. I think we're better situated today than we were a year ago. We have vaccines available. We have better treatment protocols, more safety protocols in place. The CDC, the WHO, other professional organizations have given us this nice roadmap, a science-based roadmap for helping to get our kids back to school safely. There's a lot of federal monies out there that have been devoted to making sure that in-person school can be a success, and to help close some of those opportunity gaps that we talked about earlier.
Dr. Nick Gilpin (37:21):
And we've learned a lot from our collective experience, from our successes and our failures in this space. And we know how high the stakes are to ensuring safe learning. So I'm really optimistic about the coming school year. Sarah, final thoughts, things you want to add?
Sarah Rauner (37:36):
I agree, I am optimistic as well. I think that we do have the tools. I think we just have to use them, right. And I think we also have to reserve judgment on people that are making their own choices. I've talked a lot to my kids about mask wearing, and social distancing, and trying to find a normal right now that works for us. Having a conversation on a daily basis and just having a touch point every day, "Hey, doing okay? Need anything? What can we talk about?" And I think as a group and as a society, we have the resources, we just need to use them the right way.
Dr. Nick Gilpin (38:10):
Well said. Let's leave it there. Big thanks to Sarah Rauner for joining me today. Thank you, Sarah.
Sarah Rauner (38:15):
Thank you. Thanks for having me.
Dr. Nick Gilpin (38:16):
And I also would like to thank Dr. Freij again for joining us on the podcast, and want to remind you to send along any questions or suggestions to And for more information on COVID-19, please go to And I'll leave you today with this healthy thought. Conducting school in person is tremendously beneficial for students and their families. And getting back to learning in-person is a high priority for our communities this fall. By getting as many students who are eligible vaccinated, paying attention to the community rates of transmission, and practicing other COVID prevention strategies like masking, physical distancing, and testing, we can help our communities a safe, healthy, and productive school year.
Speaker 1 (39:02):
Continue your journey to living a smarter, healthier life. Visit to access information and resources related to today's podcast.
PART 4 OF 4 ENDS [00:39:16]