Season 2 | Episode 5
>> Dr. Catherine Soprano: In general, the fewer number of people that you're going to be in contact with and the fewer number of people that they are in contact with, the more safe you're going to be. So, trying to decide within your family what the acceptable risk is in seeing other people and interacting with other people.
>> Joe: Hello! And welcome to the Merck Manuals Medical Myths Podcast, where we set the record straight on today's most talked about medical topics and questions. I'm your host Joe McIntyre and on this episode we welcome Dr Catherine Soprano. Dr. Soprano is a clinical assistant professor of Pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University. She is also an attending physician at Nemours Alfred I. DuPont Hospital for Children in Delaware. Dr. Soprano, thanks for coming on the show.
>> Dr. Soprano: You're welcome. It’s nice to be here.
>> Joe: Now, most of the time when we welcome doctors onto the Medical Myths podcast, it is to talk about some myths that quite frankly have been around for a while. But we're very fortunate to have Doctor Soprano here to talk about something that's on everyone's mind, COVID-19. And specifically, COVID-19 and children. At this point, many of us adults have adjusted to the "new normal” we face. But for children that adjustment and how they react to the virus can be a bit different. So now let's start off with a question we've seen very often when it comes to kids and COVID-19. Doctor Soprano are children immune to COVID-19?
>> Dr. Soprano: So, no. Children absolutely can be infected with the COVID-19 virus and can get very ill. But if you look at the statistics that are coming out from all over the world, children seem to be less affected unless severely ill when they do get infected. And I don't know that we understand the reason for that at this point yet.
>> Joe: So, when it comes to children and masks, let's say. I know most of US adults are told we need to wear masks when we're indoors, especially when we're at the grocery store for example. At what age do children need to wear a mask? What age should they wear mask? And what are the rules there?
>> Dr. Soprano: Masks are usually required at all areas when you're going out at this point. Kids less than two should not be wearing a mask. It is possible that they could be suffocating. That they could have their airway cutoff related to the mask. So, if kids are less than two then they should not be wearing a mask. Kids that are greater than two, who are out in the community, just like with their parents, they should be wearing a mask at the same time.
>> Joe: Now we know that some states are starting to open up, I think some quicker than others, obviously at this point for different reasons. Is it OK at this point for parents to allow their children to see friends and family again, depending on where they live?
>> Dr. Soprano: What I've been saying to a lot of families is it definitely depends on where you are. So, every state and even, I think some different counties are changing their restrictions in terms of what places are able to be open. You need to stay up with the local news and local recommendations from your area. But I think where I am in Delaware, things are opening up pretty well now and we're seeing fewer cases. And there's always this question of when can I let the kids see other kids. And that's a difficult question to answer because it needs to be really specialized for your family. So, I think discussing that within your family, discussing it, even with your pediatrician or with other health care providers, because if they do have medical problems, we might suggest holding off on that. In general, the fewer number of people that you're going to be in contact with and, the fewer number of people that they are in contact with the more safe you're going to be. So, trying to decide within your family what the acceptable risk is in seeing other people and interacting with other people.
>> Joe: So, going off of that answer a little bit, you mentioned the fewer people that children see, probably the better. I know a lot of schools are coming to a close as we get into the beginning and end of June. What about summer camp and day camp? Is that out of the question for many children and families, or is there a safe way to go to summer or day camp?
>> Dr. Soprano: I myself have been trying to ask and answer these questions for my own family. And obviously for my patients. I think when it comes to summer camp, first the question is; what are the risk, what things have that summer camp put into place? What guidelines, what requirements they have put in place for their students when they're coming? There's a really nice document on the CDC website. It's called “Considerations for youth and summer camps,” and there's a really nice “Guiding Principles” section that talks about different risks of different types of situations.
The lowest risk is going to be if the campers are in small groups and they stay together all day, every day. So, they're interacting with the same people every single day, and it's a small group. And that those campers are able to social distance, so stay 6 feet apart from each other and that they're not sharing objects like balls or whatever else they're playing with. Most of the activities are outdoor and that they're in the same kind of local geographic area, so that you're not traveling hours or a long period of time away out of their community. So that would be the lowest risk.
The second risk category they call it more risk and these are when campers are mixing between groups, but they're still staying socially distant. So, 6 feet apart. They're not sharing objects; they're doing mostly outdoor activities and they're staying within their local geographic area.
The third risk stratification is the even more risk, and these are when campers are mixing between groups and they are not necessarily remaining socially distanced. But again, the campers are local and they're not traveling outside of their local community. And then the most risk is going to be when campers mix between groups. They do not remain spaced apart and then they are traveling outside of their local geographic area. So, I think every camp is going to have a different guideline and I think you need to be discussing this with your camp, understanding what their guidelines are going to be. And what acceptable risk you feel that your kids should be taking. And also weigh, how much are they missing friends and how much are they missing playing with other kids? 'They've been home probably pretty socially isolated for couple months now. So those are all things to consider in deciding whether to send your child to a camp or sleepaway camp and how to determine those risks.
>> Joe: Now, what about things like pick up sports or even organized sports. Especially in the summer most of these are done outside. I assume that's a bit safer than doing sports or hanging out with friends inside. Are outdoor activities a little bit safer than indoor activities?
>> Dr. Soprano: es, so any outdoor activity is considered to be more safe just because of ventilation and air conditioning and movements of air within an enclosed space. So outdoor activity is definitely preferred. In terms of sports, I think probably by definition pick up sports are going to be with people that are closer in your community, people that are, you know, on your street or in your general community, and they're going to be a fewer number of people. So probably safer than organized sports, but I think again, just like the camps you need to kind of assess the risk of whatever sport it is that your child is going to be undertaking. So again, the CDC has a document on this and they talk about varying risks depending on what the sport is and what the type of competition is. So, they define like the lowest risk as skill building drills or conditioning at home. And that's kind of alone or only with family members. Then increasing risk is going to be if they have like just a team-based practice. More risk is going to be if there is kind of a within team competition because there's more likely to be trouble with social distancing. Even more risk would be a full competition between two different teams, but from the same local geographic area. And then the highest risk is going to be if there is a competition between teams from different geographical areas, So you know there's a lot of factors, sometimes even the age of the child, what sport it is. One of the things that me and my husband have really struggled with over this time is that my daughter, she's five, she does gymnastics and she loves it. And it's something that she did every week and so that's been closed since March and we got notification that they were going to be opening up for modified classes and we had to look at the guidelines that are gymnastics provider had given us and decide whether we felt that the risk of her going back outweighed or didn't outweigh her real desire to interact with other kids and to do gymnastics and have fun. And we had a discussion on it. We saw that they were not allowing anyone other than the children into the building. So, we have to drop her off at the curb essentially, with her teacher. That all the associates and the children have to wear masks during the time that they're there. They have to bring their own water bottle so they're not going to be allowed to use the water fountain that’s there. And then things like for specifically for gymnastics, but this could be the case for anything. How are they sanitizing the mats or whatever other equipment is needed? And we were told that they were sanitizing in between classes, which I thought was really great. And so, we decided that this was acceptable risk for us, for our child who is well and doesn't have any medical problems and who really, really wanted to go back and do gymnastics again. So that was something that we had to decide, and we're also sending our kids back to summer camp, so it's going to start in July. Again, because they really need social interaction and they really are looking forward to it. And the place that they're going is going to have mostly outdoor activities and in small groups, so we figured that the risk was actually not that high.
>> Joe: When it comes to children, just hanging out, spending time with their friends in the neighborhood, what questions should parents ask fellow parents about the precautions they are taking due to COVID-19?
>> Dr. Catherine Soprano: I think the biggest thing is, has this family been socially distancing and isolating during the time of COVID-19? And what are they doing if they’re not? Are they wearing masks? Are they going out in the community? How many people are they interacting with? Those are all questions. Because even if the child has been home 24 hours a day and not interacting with a lot of people, if the parents are going out and not being safe then the parents could be putting the child at risk which then put your child at risk. So, thinking about it in not just the people that are interacting directly with your job, but who are those people interacting with and why those people are being faced with the way that they're interacting with other people.
>> Joe: Don't go away. We'll be back with more right after this.
>> Joe: Whether you're a parent or a seasoned professional, a medical student or a caregiver, the Merck Manuals has the right medical information in the best format, and it's always free, easy to access and readily available for you.
In the same vein as day camp, summer camp, a lot of children see those pools in the backyard or their friend's backyard and want to jump in, especially as the temperatures rise. Is it safe to swim in a pool during the COVID-19 pandemic?
>> Dr. Soprano: COVID-19 is not spread via water. But the thing that's important to think about is being a socially distanced within the pool to allow for you to not be passing the covid in the air. That's something to talk about with your summer camp too. Because a lot of people go to summer camp because they want them to go to the pool. And to make sure that there's going to be hopefully fewer people in the pool so that they can make sure that those kids are able to be socially distanced within the pool as well.
>> Joe: Let's say my child has come down with an illness of some kind. Whether you may think it's COVID-19 or something else. I know a lot of people are recommending Tele-health as an option now. For parents who may not be familiar with Tele-Health, can you explain what the benefits of it are and when parents should consider Tele-Health versus coming into the office to see their physician?
>> Dr. Soprano: So Tele-Health is something that we were doing before Covid. It's gotten a lot more common since because it because of all the social distancing and trying to keep people home. But really, it's like a FaceTime chat with your physician. It's on a secured network and you have a video conference with your physician on the other line. You can even usually have more than one person on there, so like if Mom is at home with the kid, but Dad has to be at work, he can also be in there as well. And it's a lot about trying to assess risk. You know, because we can do some exam, we can look at a rash. We could have the patient walk. We could answer a lot of questions, but there are some limitations to it, right? I can't listen to your heart through a virtual screen. I can't look in your ear. You know I can't feel your belly. So, it's a little bit limited in that way. But I think a lot of primary doctors have been utilizing it to do a screening. So, if you're saying that you're sick and you have a cough and cold or a fever, trying to assess OK, how sick are you? And do we think that you need to come into the hospital? Do you think you need to come in to the office to have a more comprehensive evaluation and to try and decide what are the risks of coming into the hospital or to the office, and what are the risks of staying at home? Because I think the recommendations if a child is ill but not severely ill, so they have maybe like cold symptoms and a fever, maybe like a flu like symptom, is for them to stay home. And that they shouldn't necessarily come in to be seen because they're going to then if they do have COVID-19 be putting more people at risk. So, trying to keep them at home as much as possible. At Nemours, we've actually been doing these what we call them STAT clinics and they actually are outdoor clinics to decrease the risk of bringing these kids into the hospital or into the clinic. So, it's like in a tent. So, you drive up your car and the doctor will see them in the car and make decisions about you know, do they need Covid testing? Do they need to go to the emergency room? In that way, so that the fewest people are being put at risk by encountering the sick child.
>> Joe: What about when parents have very, very young children and they are in need of their vaccines that you get at certain stages of your life? Is there reason to delay them? Should parents still come in and bring their child to their physician to make sure they get these vaccines at the right ages or is it ok to wait? What’s your recommendation there?
>> Dr. Soprano: The American Academy of Pediatrics is kind of our governing body. They give us a lot of guidelines. Have been pretty adamant that we should not be delaying immunizations because of covid. And the biggest reason for that is because if we delay immunizations in a large section of patients, then we will have trouble with those diseases reemerging that we're trying to prevent, and then we could have even more problems. So, we have been pretty adamant about kids less than 18 months are getting their primary series of immunizations and they need to be given as close to on time as possible to protect them and to protect everyone else. So that's been pretty clear. And I think every primary doctor office is doing things a little bit differently. Some offices are only seeing well visits in the morning because they're going to see sick visits in the afternoon to just try and keep any sick kids away from the well kids. Some places are doing Tele-Health well visits so that they're doing the actual doctor part and the counseling and anticipatory guidance via Tele-Health and then the child comes in for a specific kind of nurse visit to get their immunizations separately. Again, to try and reduce the risk and decrease the number of people that are encountering the patient. So, you really have to talk to your primary doctor about or your primary doctor's office about how they're dealing with that, because immunizations are really, really important, and the last thing we need is another pandemic for one of these other diseases that we know how to treat.
>> Joe: I'm sure this is a question that many parents will ask come September, come the end of August. But when schools are starting to pick up again, when daycare is starting to pick up again, what questions should parents ask of either daycare providers or school administrators about the precautions that they're taking if students and if children are headed back to daycare and school this fall?
>> Dr. Soprano: There's a lot of unknowns about that so far. I think every school district every school is going to have different things. What's difficult is we don't really know what precautions are going to be helpful yet. There's been some talk of trying to keep your kids socially distant and so maybe having fewer kids in the class or something to that effect, but I think the biggest things are masks and social distancing. And then how are they screening kids? So, one of the things that's really nice about here in the hospital where I care for patients is that no one is allowed in our building without a screening questionnaire being completed and passing. And also, everybody's temperature is being taken. We all have to wear a mask, no matter who you are, whether you're a patient or associate and I think that's what makes things safest. Those are the things that I would expect. That they should be actively screening the kid every day and making sure that kids are not coming to school sick. And then knowing also, what are the contingency plans if a child does get sick? Is it everybody they’re in contact with are going to be sent home or just that child? Because you're going to need that information so that you can be available to pick them up. I think for daycare it's going to be similar again. How many people are they going to be in contact with? What precautions are going to be taken? Day care. A lot of those kids are less than two, so they're not going to be masks. But make sure that people who are caring for them, that teachers are masked to protect as many people as possible.
>> Joe: On this podcast like I said, we typically deal with some longer standing myths that have been around for a while, but COVID-19 is obviously a relatively new phenomenon now with a lot of new myths and questions. What are some of the most common questions you're getting from parents right now regarding COVID-19 and coronavirus?
>> Dr. Soprano: The biggest question we kind of already talked about is how do I keep my child safe and what are the recommendations? And, again, masks social distancing are the biggest things. I also tell families like if you don't have to take your kids somewhere try to keep them home. I haven't been taking my kids to the grocery store. Either me or my husband or going on our own rather than in the past we would go with a family, just as an outing. So I think those kinds of decisions can really keep your child safe. And then again making sure that you understand what new guidelines or new precautions are being put in effect at all the different places that you're taking your child. That you understand that and that those are acceptable for you. So that's the biggest question. The other thing that has started to come up is the question about school, and I particularly take care of patients who are not well, so they have medical conditions, so trying to decide what we're going to accept and what things that we're going to need to ask for, for that child as well. So that's things that I'm hearing from families.
>> Joe: Now, this isn't necessarily a myth, but a question we have seen a lot. Obviously as adults we've all had difficulty accepting COVID-19 in the new normal, we face an being able to stay home and not being able to see friends. But for children, that's obviously a bit different, especially for younger children getting them to understand why this is happening. What a virus is has been difficult. What recommendations would you have or what advice would you have for parents in explaining COVID- 19 to their children and why social distancing is important?
>> Dr. Soprano: I have always been maybe a little bit too brutally honest with my family with my kids right now. My kids are nine and five. And they understand a lot about what's been going on. My son is really smart so he was asking a lot of questions. He you know, wanted to know about what a virus was and why is this one so bad and I think it's important to make them understand that this sickness it can spread and we can't see how it spreads. So even though we don't see that things are dirty they could be dirty and that's why we need to wash our hands really effectively and we need to wear a mask and we need to try and stay away from people that we don't live with and explain to them that it needs to be farther away than we think because I think a lot of kids don't not really know how far 6 feet is. You know, for my daughter, she's five and she is also very interested in this. And she has been having a little bit more trouble understanding that kind of space situation, and I think that's pretty developmentally appropriate for a 5-year-old that they have more difficulty with that. But she understands that it's to keep her well. And she understands that we have to do this to make sure that we not only keep ourselves well, but that we keep others well. So those are things that I like to talk about with him. I have always tried to be really honest with them because you end up making yourself crazy keeping things from them.
>> Joe: So obviously we're not going to be able to answer every question that a parent would have on a 25–30-minute podcast here. In your opinion, where should parents go if they have other questions? For more information about coronavirus or COVID-19 and protecting their children.
>> Dr. Catherine Soprano: So great question. So, the CDC website is amazing, there's search tools. There's a whole section on COVID-19 and specifically things related to children, so you can easily go there and find lots of detailed information about some of these things that we've talked about. The other place that's really helpful is your primary doctor. Give them a call. And then I think it can be helpful also to go to your state or your county if they have a website. Because they're going to be telling you about whatever way that they're stratifying their reopening. So, I know Pennsylvania, they have the different colors. In Delaware we have phases one and two that are happening. So, I think different states are probably doing it in a little bit of a different way, and it's all based on what their burden of disease has been, but I think that that can also be really helpful. So, the AEP, the American Academy of Pediatrics is also a really great resource. And they have released some guidelines some of them are for a physician, but there are also ones that families can read talking about again, specific pediatric issues related to COVID-19 and then also the Merck Manuals. I'm one of the editors of the Merck Manuals and we added a lot of different information about COVID-19 related to children and also adults.
>> Joe: Well Doctor Soprano thank you so much for joining us. I think it was a very enlightening episode but also a very important one. I know a lot of parents have tons of questions about how COVD-19 effects their children and what precautions they should take. And I think you answered so many questions today. So, thank you again for joining us. And as we say at the Merck Manuals.
>> Dr. Catherine Soprano: Medical knowledge is power. Pass it on.
>> Joe: Thanks so much.