August 6, 2020

Preparing for Back to School During a Pandemic

Show Notes

On this episode, Chuck Gaidica is joined by Dr. Jann Caison-Sorey, senior medical director, Senior Health Services, Emergent Holdings. Together, they discuss how we can prepare for the upcoming school year.

In this episode of A Healthier Michigan Podcast, we explore:

  • Preparing kids for the school year and navigating the uncertainty of what school looks like this fall.
  • Adjusting to the new norm the new school year will bring.
  • Using the proper precautions to safely reenter school
  • The challenges parents, students and teachers will face this year.
  • Navigating mental health stressors
  • Understanding what schools are doing to prepare the start of school.

Transcript

Chuck Gaidica:  This is A Healthier Michigan Podcast, episode 60. Coming up, we discuss ways we can reduce stress, heading into the new school year.

Chuck Gaidica:  Welcome to A Healthier Michigan Podcast. It’s a podcast dedicated to navigating how we can all improve our health and well-being through small, healthy habits and we can start implementing them right now. I’m your host, Chuck Gaidica, every other week, we sit down with a certified health expert from Blue Cross Blue Shield of Michigan, and we dive into topics covering mental health, well-being, and much more. On this episode, we’re talking about back to school and how for some, that might be a stressful time as we’re navigating during a pandemic.

Chuck Gaidica:  With me today, Medical Director of Blue Cross Blue Shield of Michigan, Dr. Jann Caison-Sorey. She’s a board certified physician in pediatrics and a fellow of the American Academy of Pediatrics and the Detroit Medical Academy. And she’s also a Medical Director of Clinical Quality and Network Management in Senior Health Services for Blue Cross Blue Shield of Michigan. And she’s responsible for focusing on chronic conditions like diabetes and chronic lung conditions, asthma, and a whole lot more. Dr. Caison-Sorey, it’s good to have you back on the podcast.

Dr. Caison-Sorey: It is very good to be here. Thank you for inviting me.

Chuck Gaidica:  So we’re all experiencing major disruptions in our daily lives due to this coronavirus outbreak, and a lot of question marks rolling through minds of parents, single moms, single dads, even two earners, what are we going to do about the kids, as they are faced with this choice, do we send them back to school, if that’s even a choice, or do we keep them home? I mean, so much is swirling right now, huh?

Dr. Caison-Sorey: There is, there is. That’s an excellent question. And that’s a question that we really need to try and help people navigate. First of all, there’s a lot out there that really has not been, I think, decided upon, what is school going to look like? Is it going to be in person for some schools, online for other schools, a hybrid mix of the two for still other schools? And that said, it really impacts the family because you’ve got parents that work and the bottom line is what do you do when you’re obligated to go to work, you literally have to bring food home to feed the family, but you also have an obligation if school is a hybrid or online, to be home to supervise. So I think probably because of the difficulty of COVID-19 and the fact that we have so many, what I would call new norms, it has literally changed the landscape of America, from the home, to schools, to work, everything.

Dr. Caison-Sorey: So we’ve got a lot of new lessons that we need to teach children and one of the places where we start as parents, is stay close to the school, find out what it is that your school district has planned. If they’ve got sessions or something of that nature that you can attend, or at least to on call or online that you can dial into, that is a great starting point so that you don’t start school not knowing what is the plan. What is it going to look like? How do I prepare my students for it? Because this is a conversation that you have to have with your kids.

Chuck Gaidica:  And we tend to think of a lot of the obvious questions, which that number one on the hit parade is going to be, do you send your child to a school building where they could be exposed to coronavirus? Obviously that’s top of mind, but I hear my sister then say to me, in the school system she’s in, the buildings don’t have air conditioning and of course in Michigan, we’re blessed that we have something we could maybe call Indian summer where temperatures warm up October, November. She said, “How in the world can kids even focus if the room which is now shut down because they don’t want to put fans in the windows, gets up to 85 degrees or better.” Kids are wearing a mask, even if they could go back to school, focusing could be a whole different issue for them. I mean, it’s this myriad of questions that one follows the other.

Dr. Caison-Sorey: That’s another excellent question. And what she’s experienced is our new reality. It’s not going to be easy in any way, no one was prepared for COVID-19. COVID-19 came out of nowhere, it just literally came out of nowhere. And the mere fact that it has had so many implications, social distancing is critical, wearing a mask is critical. And when I say critical, I mean to actually protecting yourself from getting the disease. So now you take those new needs and apply them on top of structures that really were not created to be flexible and adjust to something like COVID-19, a new normal like that. And you’ve got complexities, your sister’s absolutely right. You’ve got classrooms that are not made for social distancing six feet apart, you have kids who’ve never worn something over their mouths before, they’re used to socializing and now they can’t really socialize in a classic way.

Dr. Caison-Sorey: This is very disruptive. Not only that, I mean, the heat in the school is one thing, not air conditioned, but what about the restrooms? What about places where kids go and they touch and all that? So sanitizing is going to be quite another issue and when I say sanitizing, one time a day is not going to cut it. It has to be several times a day, the classrooms have got to be wiped down and sprayed down each night and maybe wiped down and sprayed down a couple of times a day. So going back in class, that’s where that conversation for parents has to be with the school. What are you doing? What are the measures that you’re going to be taking? How can I be guaranteed or even think that I’m guaranteed, that my child will be safe? To be honest with you, Chuck, a lot of parents are actually questioning.

Dr. Caison-Sorey: I mean, they may not have the wherewithal to stay home and do homeschooling, but they are parents, they’re protecting their children and that is what the role of a parent is. So they want to know, as I’m doing my part to protect my child, what are you guys going to do? What is the plan? And to be honest with you, a plan that’s not well thought out at this time, is not acceptable. You’ve got to have strict guidelines. Are we going to have masks covering our mouths? And that should be part of it. Are we going to have our students six feet apart? That should be part of it. Are there going to be hand sanitizers all over the school so that kids can keep their hands clean? How do you then guarantee instruction is going to be equal for those students who may have an opportunity to go back to school and then those students that are online? Then you have a whole other circumstance, do you have internet to even have online?

Chuck Gaidica:  I want to double back on the mental health aspects of this for parents, we can’t leave teachers out, obviously the kids, but I want to dive into something relative to the children first off, because of your expertise. We hear all kinds of interesting data, that’s coming from foreign countries as well, kids can go back, it would be safe. Let’s not make any assumptions, but even if children are not more susceptible, which I’ve heard some vocalize, they could still have COVID-19 and spread it back to a parent when they come home or a teacher could get something. In other words, I guess my direct question to you is, are kids less susceptible because they’re kids or is that a misnomer?

Dr. Caison-Sorey: I’m going to just say this because the CDC has put out quite a volume of information on this. COVID-19 does not respect your age, it does not respect anything about the individual. You can be older, you can be younger, you can live in an urban environment, you can live in a suburban environment, you can live in a rural environment, it does not matter, you are susceptible. Now the infectious patterns have shown us that initially when we encountered COVID some months back, it appeared to affect those people that were older and those people who tended to have comorbids and by comorbids, I mean, maybe you had heart disease or you had lung disease or combination of the two, or you had diabetes, something that we considered an existing, a preexisting health condition, hypertension, people with hypertension seem to be significantly affected by that.

Dr. Caison-Sorey: So, if you caught COVID and remember COVID is person blind, it’s not looking at, “Oh let’s find those people that are a little older and have comorbids.” It’s person blind in the sense that they’re more susceptible because they have a little bit of maybe a dip in their immune systems because of these coexisting conditions. That said, initially we did not think the young people, just based on the data, Chuck, we didn’t think the young people were as susceptible. But what we’re finding is the young people have a higher risk of being carriers, so even though they clinically may not appear to have any symptoms associated with COVID, i.e. the fever, the cough, the fatigue, and all of the things that go along with COVID, even getting to a point where you need to be hospitalized and be put on a ventilator, they are carriers. So you can have a perfectly healthy person in your home and this is a huge risk, anywhere, going to work and back, school and back, wherever, daycare.

Dr. Caison-Sorey: The bottom line is that person can be a carrier, be healthy, come home and the grandmother that’s in the home, or even the infant that’s in the home, can contract that. Now the question becomes, who becomes super sick and who doesn’t? The younger people tend not to be, although we’re starting to see a little bit of a blip in the data that we’re seeing from the CDC, in that the younger people are starting to have more symptomatology. Not sure why they’re having that symptomatology, some have suggested, “Well, some of the kids vape and maybe they’ve got some preexisting lung issues because of the vaping.” I don’t think that that’s been proven, but the bottom line is, we’re starting to see a change in how people are exhibiting it. But for the most part, the younger people have a higher risk of being carriers, so they bring that into the home.

Dr. Caison-Sorey: So that’s one of the things that we have to be mindful of when they go back to school. Wearing a mask and when I say wearing a mask, I just need to clarify this, I’m sure everybody knows it, but the mask must cover your nose and your mouth, I’ve seen so many people walking around with a mask over their mouth. Remember COVID is a virus, once you cough, sneeze, those droplets get out in the air, they can literally travel on the air to the next person, up to six feet and in some instances, the data will say that they can travel farther than that, but six feet is the measured distance that we consider safe. But if you don’t have that mask covering your nose and your mouth, you are at risk. If you have COVID, maybe you’re asymptomatic, but you can transmit it to somebody else. The other thing is good hand washing is critical. Six feet away. Those are critical elements to at least ensuring some measure of safety.

Chuck Gaidica:  Well, you mentioned this topic of comorbidity or underlying conditions, and we saw that so distinctly in the city of Detroit, and we saw this overwhelming affect in people of color. Well, there seems to be an assumption that we all know that we’ve got diabetes or that we’ve got hardening of the arteries. Not everybody walking around has been going to their local hospital and knows their blood panel by heart and knows what’s going on right now from the inside out. And so when we hear about that, it tends to imply as if, well, we all know who’s at risk, you should just stay away. We don’t even know if our child has … we have a son who has got an autoimmune disease, autoimmune hepatitis, he’s lived with it for half of his life, he’s fine, but he would be at risk, but he happens to know that he has this, not all people know.

Dr. Caison-Sorey: Right, exactly. And I’m really pleased that you brought that up about the numbers in Detroit. Some people thought, “Well, for the people in Detroit, why was it so significant in a city like Detroit?” So you realize a lot of people in Detroit, there’s a lot of crowding in the communities, so the idea of being able to social distance is not as easy when you’re a frontline worker. So you have a lot of people, not saying that people in Detroit have frontline jobs, but you might see that there may be more people, younger people or people that are older, that have these frontline jobs where you’re coming in direct contact with public.

Dr. Caison-Sorey: So you’re over the counter, in other words, I’m communicating with you and you’re within three, four feet of me and you are a carrier or maybe I’m a carrier, but the risk of exchange is so much higher in a city like Detroit, but also in all urban areas that have that crowding, where people, not only do you maybe work a frontline job in a public service setting, you’re a frontline person, but you also live in a place where there’s other people.

Dr. Caison-Sorey: In other words, I can’t social distance when there’s 10 people in an elevator. Do you know what I’m saying? So there’s a lot of factors in urban settings that will always for a virus like COVID, that is COVID heaven in the sense that it can move from one person to another, because this is not the flu. So Chuck, it’s very important that people understand, this is not the flu. Now the flu in and of itself is infectious, the flu in and of itself can unfortunately cause mortality or kill a large number of people. However, COVID, when you look at the two side by side, is far, far more easily transmitted. It’s far more easily transmitted from one person to the next and it doesn’t necessarily make you sick right away, it can sit for, that’s one of the reasons why they said you’ve got to quarantine for 14 days.

Dr. Caison-Sorey: You can be fine for day one through 10 or 11 or 12 and then all of a sudden bang, you’ve got it. And some people have gotten it outside of that window, but the data tells us that one through 14 is the determined amount of time that seems to be okay. But the bottom line is we have to realize this is not something we’ve ever seen before. It’s new to physicians. It’s new to scientists. We are learning about COVID-19 every day. And I read about it every day, simply because questions that you’re asking me are questions that people need to talk to their doctors about, simply because if you have a comorbid, if you have an underlying, it really will increase your risk, but also if you’re young, keep in mind, you can be a carrier.

Chuck Gaidica:  And you’re talking about children, as a dad and a grandfather, I always get tickled, I will sit there and smile and I’m sure you do too, when you just observe children. There is a vast difference between a four and a five year old child and a 10 or 12 year old child. I mean 10 and 12 year olds, we can talk about masks and social distancing. And when I’m talking about getting tickled by something, I’ll watch my granddaughter who’s five years old, she doesn’t care if it’s a boy or a girl, what color a person, all of a sudden their arms around each other, they’ve got a new best friend that they didn’t have two seconds ago. And trying to get the little ones to understand what’s happening because it’s just in their DNA to go have fun, “I want to have a new friend.” And that’s another issue, it’s a delightful issue to have to worry about.

Dr. Caison-Sorey: It’s one of the hardest issues that we’re going to have to deal with.

Chuck Gaidica:  Oh my gosh, yeah. The burden that is on the shoulders of parents making the decision, God forbid that you make a decision where you say, “We think it’s right, the kid should go back to school.” And then somebody gets sick in the family. I mean, there are so many things running through our mind. What are you seeing from your end of the funnel, the inputs about the mental health aspect of this and how it’s affecting families with children?

Dr. Caison-Sorey: That’s a wonderful question. First of all, let me just begin that by saying kids are naturally social, you can see it from the time they’re toddlers, till the time that they’re teenagers. What do they do? They group together, that’s who they are. Now, that is absolutely as normal as normal can be, they’re social, it’s a compliment to their academia. So kids that have that social capability can mix and have friends and engage and all that, that’s all part of learning as well. So once they return to school, you’re going to see that again. But unfortunately COVID-19 is not a friend of socialization. So even for the toddlers, all the way up to the teenagers, socialization, that’s all going to change and that’s going to affect how young people think. So the bottom line is now, the only way you can really engage socially with your friend, is on the laptop and you can see them, you’re on Zoom or you’re on Skype or whatever you’re on.

Dr. Caison-Sorey: That’s not the same as sitting in the room and talking with your friend or sitting in some other space, the gym of the school and talking to all your friends. So that’s where the behavioral health concerns come in. So parents, this is going to be really key for you to keep a very close eye on your young person. You know that individual better than anybody, better than the pediatrician, better than whoever, the caregiver, you know your child. So the bottom line is you want to look for clues as to, is there something different about what’s going on with them? Is there something that you really need to take a closer look at? One of the things we look at is, is there a little bit more complaints about body aches and pain, is the child becoming more withdrawn, difficulty sleeping, excessively tired, not able to go to sleep or sleeping all day.

Dr. Caison-Sorey: So those are clues and it doesn’t mean that those are the only clues, but what you’ll also see maybe is self-withdrawal behavior. And in some instances you may need, if they’re adolescents, you may need to ask the question about substance abuse. Is there something going on? Because I mean, unfortunately kids do things that we’re not always aware of, so there could be marijuana use or sharing or that sort of thing. But look for things that seem to be lowering their self-esteem, self-harm behavior, unfortunately we have cutting, kids who cut, so you have to be astute. You have to be able to look at your child every day. One of the little secrets that physicians do, sometimes we get, back before COVID I must say Chuck, but we would get close enough, particularly our adolescent patients so that we could A, take a look at your eyes and see if your eyes, were glossy and you’re able to focus.

Dr. Caison-Sorey: When people speak, you can smell their breath. You can see if there’s something on their breath. Can’t tell you how many times that I’ve picked up the scent of alcohol, marijuana, that’s all something that you can do. Now in the era of COVID, you have to be careful here. Super, super, super careful here because you can’t do what you did before COVID. All I’m saying is this, pay attention to risky behaviors, something that they’re doing that’s new, that they never did before. Self-harm, “I don’t think I want to live anymore. It’s not worth it and nobody cares about me.” That’s critical, that’s stuff that you need to pay attention to. Most times, if you sit down and engage, remember young people are very interested in talking to you if you’re interested in hearing, but in this world where everybody’s got 15 different things to do, sometimes we don’t sit down and talk and hear.

Dr. Caison-Sorey: So, for behavioral health conditions, because of the social isolation that we’re in right now, it behooves the parent to be very close to their young person. Remember this, we’re not talking about just high school kids, this can be something that you can see in middle school and in some instances you can see it in elementary school. Behavior is critical here and listen to what your young person is sharing with you, “Nobody likes me. It’s not worth it for me to live anymore. I’m tired. If I went away, nobody would care.” Those are your signals. All right. Now, if you don’t feel that you can solve this on your own, maybe you want to get a specialist involved, psychiatry, psychologist, behavioral health social worker, or if there’s a suicidal issue, you may need to reach out to the National Suicide Hotline or go further, call 911 if you’re concerned.

Chuck Gaidica:  Let me turn this around for a minute, because I think we have, as parents and grandparents, because let’s face it, we may be stepping up to help the kids with their kids in this time of them going back to work. But I remember back to, I’m going to date myself, I don’t know that it was the 60s, maybe it was the 70s when the anti-smoking campaigns started on television. And I remember a commercial like it was yesterday, where a dad was washing his car. He had a cigarette in his mouth and the whole point of the commercial, they zoomed in on the little kid helping wash the tires and all the little kid kept doing was looking at his dad and he was learning behavior by observation. He’s going to mimic what dad does. And so the moral to that commercial was, well, be careful what you’re doing in front of your kid, because they’ll pick up your bad habit as well.

Chuck Gaidica:  And I think about that often in this situation, because we, as parents, can also be going through some of the similar behavioral or mental health stressors. And if we’re verbalizing that too much, not like we shouldn’t, we don’t want to hold it in, but our little kids, the little kids around us are going to pick up on those cues. And even for a 10 year old, who wasn’t filled with anxiety, well, if mom and dad are both anxious and they’re showing it and that’s all they’re doing is talking about it, that’s all they’re doing is watching the news about it, well, it’s bound that some of that’s going to rub off.

Dr. Caison-Sorey: That’s absolutely true. And what you said is key, parents are modeling behavior every day that they have contact with their children, which is 24/7 365. They’re watching you, they’re picking up your cues, they’re learning from you. You think that you’re only teaching at the time that you are intent upon teaching, you’re teaching when you’re not teaching. So the bottom line is now that people are struggling, we have a significant number of parents and families that have lost their jobs, they’re struggling and kids feel that. So you’re modeling it and even though you try to say, “Well, no everything is going to be okay.” That anxiety that you’re exhibiting, maybe crying or being distraught about things, that translates over to your child. Children are wonderful in the sense that they are sponges, they will pick up anything you put out there.

Dr. Caison-Sorey: It’s amazing, they will pick up anything you put out there. So the job loss, the struggling, the need for money, and maybe even some loss of a home or a car, things like that, that translates over to the child. For children, the best way to deal with things is to talk about it. You want to do age appropriate conversations, but children need to feel secure. So even though you may not have everything you want, your child needs to still feel secure and feel loved, that those are critical, even though you’re struggling, they have to feel secure.

Chuck Gaidica:  And I think we’re in a time where the word grace needs to be used more, whether it’s tensions in society, you don’t want to get mad at a teacher because they’re navigating a space they’ve never navigated before. That may have been your favorite teacher for somebody last year and all of a sudden now, because they’re telling you they have to shift and go to a Zoom cast or something, it just seems like we have to be understanding of each other because we’re all navigating this space we’ve all never navigated before and we’re just trying to help out. So a mutual respect and a little grace, it’s not just about going wide on the sidewalk to step out of somebody’s way, it really is just being understanding, that we’re all trying to do the best we can, in most instances, I think.

Dr. Caison-Sorey: I think grace is a perfect word for it. These are people too, your favorite teacher, your principal, your school, they’re struggling too. You have to realize they have families as well, they’re going home to their families, just like you even heard some healthcare workers, just feeling the pressure of going in everyday, dealing with patients who had COVID and worrying, were they taking that home? The teachers are in the same position, as the parents are, as the kids are. I mean, parents worry about their kids contracting COVID at school, the teachers are worried about contracting COVID at school, so we do have to have grace around that. And that’s one of the reasons why I think it’s imperative for parents to find out from the school district. What’s the plan? How are you going to deal? How many teachers are coming back? How are you going to deal with the in-classroom, if that’s what you opted to do, how is it going to look?

Dr. Caison-Sorey: And even some of the schools, we have enough time, this is just the beginning of August, for a parent to put a mask on, put some gloves on and do a walkthrough. What is it looking like? Because by now COVID has been with us since the shutdown in March, so by now we ought to have some things in place that make it look like, “Here is our plan. This is what we’re doing.” We shouldn’t be thinking about it right now, if we’re thinking we’re going to go back into the classroom, there have got to be some measures already put in place. So this grace that we speak about in honoring people’s need to feel safe, walking the walk and talking the talk, that sort of thing, we’re putting measures in place where teachers that say, “I’m willing to come back, but I want to feel safe.” Make them feel safe, make sure that there’s personal protection, make sure there’s hand sanitizer.

Chuck Gaidica:  And make everybody feel respected.

Dr. Caison-Sorey: Yeah and the respect. It’s okay to have an opinion, it’s okay to decide. Maybe I have a young baby at home that maybe has some health problems, they can’t afford to bring that home, so they may opt to be an online teacher, that should happen and that should be okay and the grace to understand why. But it’s the parent’s role to make sure that they’re doing what they need to do, learning as much as they need to learn so that they are informed.

Chuck Gaidica:  Well, as we start to wrap things up, give us a few takeaways here as you’ve been so helpful today in so many different directions, but give us some takeaways as things we should be thinking about as we’re navigating into the beginning of a school year, that’s like no other we’ve ever had.

Dr. Caison-Sorey: First of all, I’m going to reiterate something that’s probably been a common theme of what I’ve said. Find out what your school district has put together for if they’re planning on bringing the students back into the classroom, what is the plan? What is it going to look like? How many teachers are going to be involved? How big is the class? Are you going to be able to social distance? Do the kids have to wear a mask, and do they need to take a couple of masks with them every day? Will the school supply the masks, which I doubt, I think the parents are going to need to do that. But are there going to be hand sanitizers? What happens when people go to the restroom? That’s number one. Number two, parents need to have a with their young people. This is not pre COVID, this is post COVID and everything has changed.

Dr. Caison-Sorey: So the more young people understand about their role, they have a hugely important role to play, that you need to wear a mask at all times, it needs to cover your nose and your mouth and needs to stay on when you’re talking with your friends. You need to be six feet apart. So educate your student is what I would say, critical. Find out what your work life balance is going to be if the school decides they’re going to have a hybrid or online, how are you going to be able to navigate work? What are you going to do to satisfy your ability to work, but also have the ability to take care of your student that’s at home? So there’s a lot of questions that need to be answered. Those need to be answered now, the day to do it is not the day that school starts, that planning process has to happen now.

Dr. Caison-Sorey: Get your supply of masks, get your supply of gloves, maybe the pump hand sanitizers need to be in their backpacks. So plan for it. If they’re going to be studying at home, there needs to be workspace set aside for that student, a particular space where they are working. It’s a space that’s going to be their workspace every day, laptop set up, they need to have internet, if you don’t have it, do you need to get it if you can or find out where that can happen. Internet, laptop, and also the supplies that kids will have.

Dr. Caison-Sorey: The other last thing to do is prepare for the school year, it’s going to be different, but prepare. Students need to go home, they’re still going to need eight, maybe 10 hours of sleep, they need to start preparing for the school year mentally. So go to bed on time, have a schedule, make sure you stick to the schedule. So if someone is going to be at home, online at home, add some breaks in there where they can get up, they can stretch, go out and breathe some great air and whatever and then, bio breaks, lunch. So make it a normal day, don’t make school onerous if it’s online.

Chuck Gaidica:  Well, all good advice and all good tips and it is just a new normal. And Dr. Jann Caison-Sorey, thank you so much for being with us. Dr. Caison-Sorey is a Medical Director of Blue Cross Blue Shield of Michigan. It is good to hear your voice and I hope you will stay well.

Dr. Caison-Sorey: I hope so too, I appreciate it. And the last thing I’ll just say is make sure they get back to their doctors and get their physician visits. Those are still important, they still need their immunizations and all of that.

Chuck Gaidica:  Yeah. Good advice all the way around. Well, we want to thank everybody for listening to A Healthier Michigan Podcast. It’s brought to you by Blue Cross Blue Shield of Michigan. If you like to show, you want to know more, or you want to check out previous episodes because we’ve got a lot, we’ve got a great library, most, if not all of them, with story notes covering a lot of topics that are still pertinent today, check us out online at ahealthiermichigan.org/podcast. Or you can leave us a review or rating Apple podcast or Stitcher. Get these episodes on your smartphone, you can take it with, you can listen when you’re on a break, you can have them on your tablet. Be sure to subscribe to us on Apple podcast, Spotify or your favorite podcast app. I’m Chuck Gaidica, be well.