WEBVTT - How to Safely Reopen Schools 0:00:15.356 --> 0:00:23.076 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:23.116 --> 0:00:26.196 where we explore the stories behind the stories in the news. 0:00:26.716 --> 0:00:31.236 I'm Noah Feldman. Since July, President Trump has been calling 0:00:31.276 --> 0:00:34.076 for schools to open this fall for in person learning. 0:00:34.996 --> 0:00:38.236 Some schools that have already opened, though had to close 0:00:38.516 --> 0:00:43.436 after coronavirus cases were detected, like a district in Georgia. 0:00:43.796 --> 0:00:48.076 How should schools be making good decisions about whether to open, 0:00:48.716 --> 0:00:52.396 what criteria are relevant to that decision making? If they 0:00:52.436 --> 0:00:55.076 do open, how do they make sure things are safe? 0:00:55.436 --> 0:00:58.876 And what do they do if cases break out? To 0:00:58.956 --> 0:01:04.836 discuss these complicated, difficult questions questions without easy answers, were 0:01:04.916 --> 0:01:09.436 joined by doctor Sean O'Leary. He's Professor of Pediatric actious 0:01:09.476 --> 0:01:13.556 Diseases at the University of Colorado, of practicing pediatrician, and 0:01:13.636 --> 0:01:16.916 he's the vice chair of the American Academy of Pediatrics 0:01:17.276 --> 0:01:21.676 Committee on Infectious Disease. Sean, thank you so much for 0:01:21.916 --> 0:01:26.676 joining us. Let's just start with basics. What is your 0:01:26.756 --> 0:01:30.636 view about the criteria that school districts should be using 0:01:31.116 --> 0:01:34.756 to decide whether they should open in person and if so, 0:01:34.956 --> 0:01:37.876 just how open they ought to be? So, Folks who 0:01:37.876 --> 0:01:40.756 are using various metrics to decide how to reopen. I 0:01:40.796 --> 0:01:43.436 think all of us all along have been saying we 0:01:43.476 --> 0:01:46.876 would really love to see community transmission as low as 0:01:46.876 --> 0:01:50.636 possible before we safely reopen schools. The metric that is 0:01:50.716 --> 0:01:54.396 used most commonly is the percent positivity. So of all 0:01:54.396 --> 0:01:57.156 the tests that are done, what percentage are positive? Because 0:01:57.196 --> 0:02:01.116 that is a little bit better measure than just pure 0:02:01.196 --> 0:02:05.356 number of cases. Pure number of cases reflects your testing capacity. 0:02:05.636 --> 0:02:08.636 The percent positivity is less sensitive to that. So the 0:02:08.716 --> 0:02:11.796 numbers I've seen thrown around. Some places are using ten percent, 0:02:11.876 --> 0:02:15.516 which I think is clearly too high. Others are using 0:02:15.516 --> 0:02:18.316 five percent. That's probably the most common metric I've seen. 0:02:18.796 --> 0:02:21.116 That's also saw the Harvard School of Public Health is 0:02:21.116 --> 0:02:24.156 recommending three percent. Ideally, I'd love to see it under 0:02:24.196 --> 0:02:26.556 one percent. Honestly, I think there are states in the 0:02:26.676 --> 0:02:30.436 US that are under one percent positivity, and I think 0:02:30.436 --> 0:02:32.956 the fact that they have been able to get there 0:02:33.156 --> 0:02:35.996 says we can all get there, and so the lower 0:02:36.116 --> 0:02:39.916 the better, basically, because the higher you go, the more 0:02:39.956 --> 0:02:42.196 likely you're just going to have to immediately shut down. 0:02:42.836 --> 0:02:45.476 That's striking to me because if we were to aim 0:02:45.556 --> 0:02:47.196 for something, I mean of course it's great to go 0:02:47.236 --> 0:02:50.076 as low as one percent, but if we did only 0:02:50.196 --> 0:02:52.916 reopen schools physically in places where the rate was that low, 0:02:53.756 --> 0:02:56.516 we would really be having many fewer in person reopenings 0:02:56.556 --> 0:02:59.316 than it looks like we're about to have. So am 0:02:59.316 --> 0:03:01.196 I right in hearing you as saying that we're about 0:03:01.236 --> 0:03:05.396 to reopen too many schools physically. I think if someone 0:03:05.436 --> 0:03:10.436 tells you that they can answer that question accurately, they're wrong. 0:03:10.476 --> 0:03:12.356 I don't think anybody knows what's going to happen here. 0:03:12.356 --> 0:03:16.676 We've never done this before, and the US has done 0:03:16.676 --> 0:03:20.316 an abysmal job controlling this pandemic as a nation. There 0:03:20.356 --> 0:03:22.036 are some places that have done it well. So I 0:03:22.036 --> 0:03:24.196 think what we need to do right now is look 0:03:24.236 --> 0:03:27.076 to the places where they are reopening where they do 0:03:27.156 --> 0:03:30.196 have low rates of transmission, and see how that goes, 0:03:30.276 --> 0:03:33.276 and be ready to adjust as we see that happening 0:03:33.316 --> 0:03:36.676 over the next weeks to even months. Let's talk about 0:03:36.716 --> 0:03:39.996 the dynamics within a school, and to do that, I 0:03:39.996 --> 0:03:41.956 want to start with the question that again has been 0:03:41.996 --> 0:03:46.796 widely discussed, which is the question of probability of transmission 0:03:47.436 --> 0:03:53.436 as between children and teenagers, and probability of them then 0:03:53.556 --> 0:03:57.676 bringing COVID home to other family members. What do we 0:03:57.756 --> 0:04:02.996 actually know about the odds of young people both getting 0:04:03.156 --> 0:04:08.436 and spreading COVID relative to adults. Yeah, so we're talking 0:04:08.556 --> 0:04:11.876 on what is at August seventeenth today, So what I 0:04:11.916 --> 0:04:15.356 tell you today may not be true tomorrow. But at 0:04:15.396 --> 0:04:19.156 this point, probably the best study I can tell you 0:04:19.196 --> 0:04:22.596 about in terms of older children, meaning over ten, is 0:04:22.676 --> 0:04:26.916 the South Korea study, And in that study, it appeared 0:04:27.156 --> 0:04:31.156 that adolescence between I believe ten and nineteen was the 0:04:31.436 --> 0:04:34.756 ages they used in that particular study, were as likely 0:04:35.276 --> 0:04:42.236 to pass the infection to a household member as older adults. Now, 0:04:42.476 --> 0:04:45.276 if you look closely at the numbers in that study, though, 0:04:45.316 --> 0:04:48.836 there were far fewer adolescence in that age group than 0:04:48.836 --> 0:04:52.636 there were in the older adults, and so that raises 0:04:52.876 --> 0:04:56.676 the possibility that they were also less likely to get infected. 0:04:56.836 --> 0:04:58.316 It also may be that they were not out and 0:04:58.356 --> 0:05:00.876 about and so we're not getting infected to be eligible 0:05:00.916 --> 0:05:04.396 to the index case. So there are still some unanswered 0:05:04.436 --> 0:05:08.716 questions for sure in that age group. For the younger children, 0:05:09.396 --> 0:05:11.236 you may have seen a study that was published a 0:05:11.276 --> 0:05:15.596 few weeks ago showing that the younger children particularly children 0:05:15.676 --> 0:05:19.276 under five had higher viral loads when they tested the 0:05:19.316 --> 0:05:24.436 amount of virus based on a PCR test in their nose. Now, 0:05:24.636 --> 0:05:28.836 we had seen a similar study in Germany in April 0:05:29.836 --> 0:05:33.396 where they estimated that the viral loads were similar across 0:05:33.436 --> 0:05:36.196 age groups, it didn't matter what age you were. We've 0:05:36.276 --> 0:05:39.996 not seen that the epidemiology follows that though, based on 0:05:40.156 --> 0:05:43.196 most of the studies we've seen, younger children appear to 0:05:43.276 --> 0:05:45.876 be less likely to get infected and less likely to 0:05:45.876 --> 0:05:49.396 spread the infection to others. I'll give as an example 0:05:49.836 --> 0:05:53.836 the childcare centers in the US. So if you look 0:05:53.996 --> 0:05:58.716 at the places where the states published their outbreak data, 0:05:59.116 --> 0:06:01.436 the vast majority of the outbreaks are in places where 0:06:01.436 --> 0:06:06.036 adults congregate. If you look at the childcare center outbreaks, 0:06:06.356 --> 0:06:10.436 in the vast majority of cases, the number of adults 0:06:10.476 --> 0:06:13.476 in the childcare center outbreaks outnumber the number of children 0:06:13.556 --> 0:06:16.636 in those same outbreaks. And so what that tells me 0:06:17.636 --> 0:06:21.076 is that, for whatever reason, reasons we don't understand, those 0:06:21.116 --> 0:06:23.596 younger children seem to be less likely to get infected 0:06:23.636 --> 0:06:27.316 because remember, those are in settings where they're being investigated, 0:06:27.316 --> 0:06:30.156 they're being tested, and they're not finding the infections, and 0:06:30.156 --> 0:06:33.196 those younger kids. So you again, i'd say all of 0:06:33.236 --> 0:06:36.196 this today, it may change very soon as we learn more. 0:06:37.196 --> 0:06:40.756 Speaking of changes over time, in June, you were the 0:06:40.876 --> 0:06:45.396 lead author of a series of recommendations for school reopenings 0:06:45.396 --> 0:06:49.596 produced by the American Academy of Pediatrics, and at the 0:06:49.636 --> 0:06:55.076 time you were arguing to characterize your view that we 0:06:55.156 --> 0:06:58.396 actually ought to be able to do a reasonable amount 0:06:58.996 --> 0:07:03.636 of school reopening in person, more than some skeptics were 0:07:03.636 --> 0:07:05.716 saying at the time. But that was a couple of 0:07:05.756 --> 0:07:09.116 months ago. How are you thinking now about the guideline 0:07:09.396 --> 0:07:11.796 that you wrote them? Yeah, just to be clear, those 0:07:11.836 --> 0:07:14.996 guidelines were absolutely a team effort, and I did write 0:07:14.996 --> 0:07:16.556 a lot of it, but there were a number of 0:07:16.636 --> 0:07:18.196 us that worked on it, and it's not one of 0:07:18.196 --> 0:07:21.476 those things that we claimed individual authorship on. It really 0:07:21.516 --> 0:07:24.316 really was a team effort from the entire academy. But 0:07:25.036 --> 0:07:27.676 in terms of that, I think, you know, in some 0:07:27.716 --> 0:07:29.756 ways a lot has changed since then. In some ways 0:07:30.116 --> 0:07:33.356 things have changed not at all. Right, So, I think 0:07:33.756 --> 0:07:36.396 many of us who work in the fields of caring 0:07:36.396 --> 0:07:41.716 for children, whether that's pediatricians or teachers, really recognize that 0:07:42.156 --> 0:07:45.916 children really need to be in school. The impact that 0:07:46.196 --> 0:07:48.356 children being at home is going to have It's going 0:07:48.356 --> 0:07:52.476 to impact all children, but it's going to disproportionately impact 0:07:52.556 --> 0:07:56.836 our most vulnerable. This pandemic has laid bare the just 0:07:58.436 --> 0:08:01.796 mind boggling disparities that we have here in the US 0:08:01.876 --> 0:08:05.116 in terms of how we take care of our poor, 0:08:05.116 --> 0:08:08.196 how we take care of our elderly, and kids being 0:08:08.316 --> 0:08:11.076 home from school is just going to widen those disparities 0:08:11.076 --> 0:08:14.076 even further than they already are. So I still do 0:08:14.156 --> 0:08:16.956 feel strongly that we somehow need to get kids back 0:08:16.956 --> 0:08:20.116 in school. One of the things that happened shortly after 0:08:20.156 --> 0:08:24.476 we released that guidance was that, in a sense, became weaponized. 0:08:24.916 --> 0:08:27.036 It became a political tool to say we have to 0:08:27.036 --> 0:08:31.516 open schools, and then it was being used in ways 0:08:31.516 --> 0:08:35.876 that we're perhaps not for the betterment of children, but 0:08:36.156 --> 0:08:38.876 for other reasons. We have to have schools open so 0:08:38.916 --> 0:08:41.636 we can reopen the economy. You know, as you've seen 0:08:41.676 --> 0:08:46.396 all along, where decisions about this pandemic are made for 0:08:46.516 --> 0:08:50.156 political reasons. That's when things go the wrong direction. When 0:08:50.436 --> 0:08:53.596 the decision makers are listening to the public health professionals 0:08:53.916 --> 0:08:57.716 and the medical professionals regarding how to handle the pandemic, 0:08:57.796 --> 0:09:00.436 that's where things have gone better. And so that's where 0:09:00.476 --> 0:09:02.196 I say, you know, things have changed in some ways, 0:09:02.196 --> 0:09:04.956 they're the same. I do really want to see all 0:09:05.036 --> 0:09:06.796 kids back in school. I want to see my own 0:09:06.876 --> 0:09:09.836 kids back in school. It's just not safe in many 0:09:09.836 --> 0:09:25.836 many places. What you're describing is incredibly complicated. You know, 0:09:25.876 --> 0:09:27.876 you said, and I completely agree with you, kids need 0:09:27.916 --> 0:09:31.076 to be in school. On the other hand, you don't 0:09:31.076 --> 0:09:32.516 want kids to be in school if it's going to 0:09:32.596 --> 0:09:36.476 mean jump starting the pandemic and we're operating, you're operating 0:09:36.516 --> 0:09:41.156 under tremendous uncertainty. How do you translate the quantifiable risk 0:09:41.756 --> 0:09:44.316 on the one hand and then the more difficult to 0:09:44.396 --> 0:09:47.996 quantify benefits of kids being in school on the other hand. Yeah, 0:09:47.996 --> 0:09:50.396 that's the million dollar question, right. I think, you know, 0:09:50.836 --> 0:09:55.756 we are stuck here between two unacceptable choices. So with 0:09:55.836 --> 0:09:59.236 that in mind, I think what we have to do 0:09:59.356 --> 0:10:02.076 is make decisions based on what we know and the 0:10:02.156 --> 0:10:05.356 best evidence at the time. And so, you know, one 0:10:05.356 --> 0:10:08.036 of the things that we haven't talked about that I 0:10:08.076 --> 0:10:11.916 think is worth consider is looking to other countries. There 0:10:11.956 --> 0:10:15.276 have been plenty of other countries who have been able 0:10:15.276 --> 0:10:18.876 to successfully reopen schools not with zero transmission, but very 0:10:18.956 --> 0:10:22.396 very minimal transmission. Now, the US as a whole is 0:10:22.396 --> 0:10:24.476 certainly not in the same place as any of those 0:10:24.476 --> 0:10:28.956 countries Denmark, Norway, South Korea, you all across the world. 0:10:28.996 --> 0:10:31.996 There are places that have gotten a pandemic under control, 0:10:32.836 --> 0:10:35.076 But there are places in the US that are Denmark. 0:10:35.396 --> 0:10:38.036 So there are places that do have rates of transmission 0:10:38.076 --> 0:10:40.476 similar to what they're seeing in those countries. And so 0:10:40.516 --> 0:10:43.796 I think in those places, if we can use the 0:10:43.836 --> 0:10:47.396 mitigation measures that we know work, then I think in 0:10:47.436 --> 0:10:51.476 those places we can safely reopen schools. By safe, I 0:10:51.476 --> 0:10:54.716 think we have to be clear we don't mean zero risk, 0:10:54.916 --> 0:10:57.276 because there's nothing in our society right now that is 0:10:57.356 --> 0:11:00.796 zero risk. And I should mention that just because schools 0:11:00.796 --> 0:11:02.796 are closed doesn't mean that none of the students are 0:11:02.836 --> 0:11:04.476 none of the teachers, or none of the staff are 0:11:04.516 --> 0:11:06.876 not at risk for getting the infection. Right if it's 0:11:06.916 --> 0:11:09.916 circulating the community, they're still at risk. And so it's 0:11:09.956 --> 0:11:13.756 not as simple as a binary calculation. Open schools there 0:11:13.756 --> 0:11:16.396 at risks, keep them closed, they're not. It's not that simple. 0:11:16.796 --> 0:11:20.796 So I think in the places where the virus, when 0:11:20.796 --> 0:11:24.836 it's under some degree of manageable control. Then you start 0:11:24.876 --> 0:11:28.836 with the younger kids, so the childcare centers, the pre K. 0:11:29.476 --> 0:11:33.076 Then you start with K through five, and as you 0:11:33.356 --> 0:11:38.756 achieve success with those students and in those settings, then 0:11:38.916 --> 0:11:43.356 you slowly reintroduce the older children and will also be 0:11:43.476 --> 0:11:46.396 learning best practices along the way in terms of how 0:11:46.436 --> 0:11:48.676 to manage the virus when it gets into school, etc. 0:11:49.276 --> 0:11:52.956 You know success stories about how to encourage younger children 0:11:52.956 --> 0:11:56.316 to wear their masks. You I'm sure seeing the picture 0:11:56.356 --> 0:11:58.516 of that went viral from Georgia, I'm sure that's not 0:11:58.556 --> 0:12:01.316 the only school where you know, kids were congregating and 0:12:01.356 --> 0:12:04.156 not wearing masks. But you know you're not seeing the 0:12:04.196 --> 0:12:06.516 pictures of the success stories, because there are there are 0:12:06.556 --> 0:12:09.836 success stories already. A lot of schools are talking about 0:12:10.116 --> 0:12:14.196 hybrid models, where they say, well, we can't necessarily accommodate 0:12:14.596 --> 0:12:16.636 all of the students who are enrolled in our school 0:12:16.676 --> 0:12:19.876 with social distancing, so we'll bring people in for a 0:12:19.876 --> 0:12:21.996 couple days a week or three days a week in 0:12:22.036 --> 0:12:25.436 a rotated fashion so that we have some in person 0:12:25.476 --> 0:12:28.676 experience and then we switch back to the online. What's 0:12:28.676 --> 0:12:30.476 your instinct about that? I mean, it sounds like a 0:12:30.476 --> 0:12:32.676 good kind of Goldilock solution. You know, it's not too much, 0:12:32.836 --> 0:12:36.556 not too little, but it also obviously will only work 0:12:36.636 --> 0:12:41.396 decently in places where all the kids have reasonable access 0:12:41.476 --> 0:12:45.596 to online learning possibilities. I agree it has some appeal, 0:12:45.956 --> 0:12:47.996 but you know, when you really think about it, what 0:12:48.116 --> 0:12:51.116 problems is it's solving. You know, yes, it does get 0:12:51.276 --> 0:12:55.676 some face times, some socialization for students, but it doesn't 0:12:55.676 --> 0:13:00.076 solve the problem of the disparities in internet access. It 0:13:00.156 --> 0:13:04.916 doesn't solve the problems of trying to figure out how 0:13:04.956 --> 0:13:08.356 a family handles a child in the home, particularly for 0:13:08.356 --> 0:13:12.956 the younger children. And so I think it does offer 0:13:13.156 --> 0:13:16.076 some potential solutions, but I think it's a short term solution. 0:13:17.036 --> 0:13:18.876 I mean, I think you can probably speak to this 0:13:19.236 --> 0:13:23.556 as well as I can having Zoom meetings. It doesn't 0:13:23.556 --> 0:13:25.876 work as well as having an in person meeting. People 0:13:25.916 --> 0:13:29.276 are easily distracted. I can't imagine how easily distracted I 0:13:29.276 --> 0:13:32.076 would have been as a high school student. I'm distracted 0:13:32.196 --> 0:13:34.316 enough when I try to have Zoom meetings, right, So 0:13:34.396 --> 0:13:37.236 I think trying to show that that that's going to 0:13:37.276 --> 0:13:39.476 be a good educational model I think doesn't really make 0:13:39.516 --> 0:13:40.676 a lot of sense. I mean, is it going to 0:13:40.716 --> 0:13:43.716 work for some students, sure, but for the majority of students, 0:13:43.756 --> 0:13:47.156 I think it's less than optimal relative to in person learning. 0:13:48.356 --> 0:13:52.356 I know you actually got COVID early in this process, 0:13:52.676 --> 0:13:54.676 and I think from what I read that your wife 0:13:54.716 --> 0:13:57.756 did too. So first, I hope you guys are feeling 0:13:57.916 --> 0:14:01.556 better now. Yeah, so we both got pretty sick. We 0:14:01.556 --> 0:14:04.036 weren't hospitalized, but I was sick for about two weeks. 0:14:04.036 --> 0:14:06.156 She was sick for about three weeks. She was a 0:14:06.156 --> 0:14:08.396 little sicker than I was, and it was, you know, 0:14:08.516 --> 0:14:11.076 as advertise, it was pretty miserable. It is one of 0:14:11.076 --> 0:14:15.676 the many frustrating and but fascinating aspects of this virus 0:14:15.676 --> 0:14:18.596 that you know forty percent of people are asymptomatic, because 0:14:18.596 --> 0:14:21.876 we sure weren't. But I actually have ended up being 0:14:21.916 --> 0:14:24.436 one of those long haulers. So I don't know if 0:14:24.436 --> 0:14:26.356 you've heard much about that. But I was well for 0:14:26.356 --> 0:14:31.036 about two weeks and then was you know, had gotten back. 0:14:31.076 --> 0:14:33.036 I'm a runner and I'd gotten back into running, and 0:14:33.236 --> 0:14:35.036 I guess I just pushed it a little bit too much. 0:14:35.116 --> 0:14:39.436 Then after a long run one day, I said, WHOA, 0:14:39.516 --> 0:14:42.716 that feels like when I was sick. And that's pretty 0:14:42.796 --> 0:14:46.436 much happened since then, so you know, I'm functioning. I'm okay, 0:14:46.836 --> 0:14:48.516 you know. And some of the people that have these 0:14:48.556 --> 0:14:50.916 long term symptoms are most it sounds like, are much 0:14:50.916 --> 0:14:53.636 worse off than me. They're having ongoing fevers and severe headaches. 0:14:53.916 --> 0:14:56.596 I just have some some chest tightness and sort of 0:14:56.596 --> 0:14:59.476 occasional malaise. I would call it just feeling kind of 0:14:59.516 --> 0:15:02.196 lousy that kind of comes and goes in a in 0:15:02.276 --> 0:15:06.196 a fairly unpredictable fashion. But it's a very, very strange virus. 0:15:06.196 --> 0:15:09.516 It's like nothing I've ever felt before. And through this, 0:15:09.636 --> 0:15:11.756 your kids manage not to get it. Yeah, well that's 0:15:11.756 --> 0:15:14.636 another thing, right, there's my n of two, my two kids. 0:15:15.276 --> 0:15:17.956 We initially had thought that perhaps we got it from 0:15:17.996 --> 0:15:20.676 them because we got sick around the same time, which 0:15:20.676 --> 0:15:23.236 suggested a common exposure, rather than say you bring it 0:15:23.276 --> 0:15:25.196 home from the hospital. Right. So, No, I was not 0:15:25.556 --> 0:15:27.836 doing any clinical time at that point. My wife was, 0:15:28.276 --> 0:15:30.596 and so it's possible that she picked it up at clinic. 0:15:30.636 --> 0:15:33.196 It was before that people were being really careful because 0:15:33.196 --> 0:15:36.196 this was in March, so it's possible. Although I got 0:15:36.196 --> 0:15:39.116 sick only twelve hours after she did, but our kids 0:15:39.156 --> 0:15:41.796 never got sick. We actually had their antibodies tested and 0:15:41.876 --> 0:15:45.236 they were negative. So you know, there's my n of 0:15:45.276 --> 0:15:47.436 two that kids are less likely to get infected. I 0:15:47.596 --> 0:15:50.236 don't know. You know, we were both sick enough that 0:15:50.236 --> 0:15:52.476 we were not being particularly good about distancing with our 0:15:52.516 --> 0:15:58.356 kids in the house. When you think about the broader 0:15:58.396 --> 0:16:02.916 cultural implications of this period of time for kids, how 0:16:02.956 --> 0:16:05.716 do you imagine they're going to come to make sense 0:16:05.756 --> 0:16:08.956 of this over the long run. And obviously that's going 0:16:08.996 --> 0:16:11.996 to be different if a year from now we have 0:16:12.036 --> 0:16:14.756 evidence of vaccines working and we have distribution of vaccines 0:16:14.756 --> 0:16:17.036 and things go back to normal, then it will be 0:16:17.156 --> 0:16:19.036 if a year from now we instead think that the 0:16:19.076 --> 0:16:23.236 vaccines don't work that well, or perhaps you know, heaven forbid, 0:16:23.276 --> 0:16:27.236 don't work at all, and we start to reintegrate our 0:16:27.236 --> 0:16:30.956 lives sort of accepting a high probability of getting the virus. 0:16:31.076 --> 0:16:33.836 But when you think just right now about what life 0:16:33.916 --> 0:16:36.556 is like for kids, how do you think they're going 0:16:36.596 --> 0:16:39.476 to make sense of this over the course of their lives. Yeah, 0:16:39.556 --> 0:16:43.516 that's a really interesting question. I actually when this all started, 0:16:44.356 --> 0:16:47.196 even you know, in February, I was trying to encourage 0:16:47.196 --> 0:16:50.316 my kids to write a journal this is a historic time. 0:16:50.356 --> 0:16:53.676 There's probably hopefully that could be another time like this 0:16:53.756 --> 0:16:57.316 in our lifetimes. How'd that work out for you? Well, yeah, 0:16:57.076 --> 0:17:02.676 they have not. I encouraged it, but they haven't, So 0:17:02.796 --> 0:17:04.876 I don't know. I mean, I think it's fascinating. I 0:17:04.876 --> 0:17:06.796 don't think I have a thing I can look back 0:17:06.796 --> 0:17:08.636 on in my lifetime and say, oh, they're going to 0:17:08.676 --> 0:17:11.076 remember it that because we really have not experienced this. 0:17:11.716 --> 0:17:15.036 You know, kids are fairly resilient, and I do think, 0:17:15.156 --> 0:17:16.716 you know, the majority of kids are going to be 0:17:16.756 --> 0:17:18.636 able to bounce back from this when we get into 0:17:18.676 --> 0:17:23.516 a new time. But boy, I can't wait to get 0:17:23.516 --> 0:17:25.676 to the other side of this and see. I mean, 0:17:25.716 --> 0:17:29.796 I have to say, I'm astonished by how well my 0:17:29.916 --> 0:17:32.156 kids have dealt with it. And I can't make out 0:17:32.196 --> 0:17:34.956 whether it's because of the famous resilience of kids, which 0:17:34.956 --> 0:17:37.156 I would like to be the answer, or because so 0:17:37.276 --> 0:17:41.156 much of their social experience was already online that they're 0:17:41.196 --> 0:17:43.836 able to have much more continuity in terms of it 0:17:43.916 --> 0:17:45.916 being a percentage of what their social life is like 0:17:46.476 --> 0:17:49.036 than it was true for me or for other adults 0:17:49.076 --> 0:17:51.956 who aren't digital natives. That's a really good point. I mean, 0:17:51.996 --> 0:17:54.676 my kids have sort of been the same. I mean, 0:17:54.916 --> 0:17:57.476 you know, this is a whole other conversation, but what 0:17:57.676 --> 0:18:00.476 is the impact of all this digital time on our kids? 0:17:59.916 --> 0:18:03.156 All this screen time. It's I've certainly watched my fair 0:18:03.156 --> 0:18:05.596 share TV when I was growing up. I also was, 0:18:05.956 --> 0:18:09.436 like many other kids, out playing, probably at least as much, 0:18:09.476 --> 0:18:11.156 you know, with the kids in the neighborhood as I 0:18:11.196 --> 0:18:14.916 was watching TV, if not more. Whereas you know, nowadays, 0:18:14.956 --> 0:18:17.356 I think of many many kids are spending much much 0:18:17.396 --> 0:18:20.836 more time on screens, and I think that, in reality, 0:18:20.876 --> 0:18:23.196 you know, may have a bigger impact on our kids 0:18:23.196 --> 0:18:25.916 than this pandemic. But I don't think any of us 0:18:25.916 --> 0:18:28.956 really knows what that means in the longer term. Let 0:18:28.956 --> 0:18:31.956 me close by asking you a kind of what if question. 0:18:32.876 --> 0:18:37.556 As we get these reopenings, and as some districts, even 0:18:37.596 --> 0:18:42.596 districts with low prevalence numbers, reopen and then get salient 0:18:42.916 --> 0:18:47.916 cases transmitted in schools, there's going to be some reaction, 0:18:48.716 --> 0:18:51.196 and it could be in the line of panic reaction, 0:18:51.276 --> 0:18:55.036 Oh no, we have cases, let's shut everything down, or 0:18:55.076 --> 0:18:58.636 it could be a more moderated reaction in the form of, well, statistically, 0:18:58.676 --> 0:19:01.596 if we do this in lots of places. Inevitably, they're 0:19:01.636 --> 0:19:03.476 going to be some places where the numbers are going 0:19:03.516 --> 0:19:06.396 to go up. So let's all, you know, keep our 0:19:06.396 --> 0:19:08.876 clothes on and try to be rational and move slowly. 0:19:09.356 --> 0:19:13.516 This My questions are too, First, which should be the reaction. 0:19:13.556 --> 0:19:18.156 Should we say, oh, this isn't working broader shutdowns or 0:19:18.196 --> 0:19:21.156 should we be a little more cautious about it? And second, 0:19:21.276 --> 0:19:24.476 what do you think will actually happen in the real world. Well, 0:19:24.636 --> 0:19:26.916 you know, the reality is happening already in some of 0:19:26.916 --> 0:19:30.196 the places where schools have opened, and unfortunately, the examples 0:19:30.196 --> 0:19:33.636 are getting in the news media are in the places where, 0:19:33.916 --> 0:19:37.036 you know, where there's widespread community transmission, where it's completely 0:19:37.036 --> 0:19:39.796 not a surprise that they've had those problems. I do 0:19:39.956 --> 0:19:43.796 think we need to have rational conversations about how to 0:19:43.836 --> 0:19:46.476 handle it. We also need to recognize that it's going 0:19:46.476 --> 0:19:48.716 to happen. I mean, it's it's inevitable that there will 0:19:48.756 --> 0:19:51.716 be cases in schools, just as it's inevitable that there 0:19:51.716 --> 0:19:54.076 will be cases in the community. So we have to 0:19:54.156 --> 0:19:56.996 prepare for that. We have to plan for that, and 0:19:57.356 --> 0:19:59.716 you know, the districts and public health departments around the 0:19:59.756 --> 0:20:02.996 country are are already doing that. They're making those plans 0:20:02.996 --> 0:20:05.076 for what happens when a student gets sick, what happens 0:20:05.076 --> 0:20:07.596 when a teacher gets sick, you know, as you put it, Yeah, 0:20:07.596 --> 0:20:10.836 and we need to have a measured response to that 0:20:10.876 --> 0:20:14.036 and not close at the first sign of an infection 0:20:14.076 --> 0:20:18.316 has been transmitted in school. Now, if we do see 0:20:19.396 --> 0:20:21.116 I think this is not going to be the case. 0:20:21.556 --> 0:20:25.756 But for example, if we do see that in places 0:20:25.756 --> 0:20:27.916 where there is low community transmission, that all of a 0:20:27.996 --> 0:20:31.876 sudden the schools become sort of these super spreader events, 0:20:32.156 --> 0:20:34.716 then we have to take a big step back. I 0:20:34.796 --> 0:20:36.956 don't think that's going to happen, though, because if you 0:20:36.996 --> 0:20:39.876 look at the countries where they've done it right, that's 0:20:39.916 --> 0:20:42.916 not been the case. To me. The hard part is 0:20:42.916 --> 0:20:45.276 going to be we are a big country. Lots of 0:20:45.316 --> 0:20:48.636 places are going to reopen, and it's going to happen somewhere. 0:20:49.396 --> 0:20:51.076 I mean, when you say it's not going to happen, 0:20:51.116 --> 0:20:53.116 I agree with you that on the whole. Statistically, the 0:20:53.116 --> 0:20:55.836 best reading of the statistics is that probabilistically it won't 0:20:55.836 --> 0:20:58.196 happen in many, many, many places. But it's just in 0:20:58.196 --> 0:21:00.756 the nature of an experiment with a large n that 0:21:00.956 --> 0:21:04.316 some outlying events will occur, and then in our media world, 0:21:04.516 --> 0:21:07.196 it's guaranteed that those will be the ones that get 0:21:07.236 --> 0:21:10.436 the salient news coverage. And that to me is where 0:21:10.436 --> 0:21:12.836 the rubber meets the road. You know, when there's one 0:21:12.916 --> 0:21:15.396 school district or two school districts or even five around 0:21:15.436 --> 0:21:18.796 the country that do have super spreader events and those 0:21:18.836 --> 0:21:22.076 are being splashed all over the television, then what does 0:21:22.116 --> 0:21:24.636 everybody else do? That is a moment where people will 0:21:24.636 --> 0:21:27.556 come to you and say, okay, doctor Larry, tell us 0:21:27.596 --> 0:21:30.716 what to do, and how will you try to differentiate 0:21:30.756 --> 0:21:36.276 in that moment between outlying cases and a trend that 0:21:36.396 --> 0:21:39.316 does look like, boy, we need to reevaluate in light 0:21:39.356 --> 0:21:42.596 of the new data. You know, my approach. I think 0:21:42.676 --> 0:21:45.276 for many of us, our approach has been all along 0:21:45.796 --> 0:21:48.916 to just keep a very open mind and recognize that 0:21:48.956 --> 0:21:50.996 there's a lot we don't understand right now about this 0:21:51.076 --> 0:21:53.436 virus and that we're learning more every day. And I 0:21:53.476 --> 0:21:56.316 think we have to take that approach going forward and 0:21:56.636 --> 0:21:59.436 be ready to change course and not have our heels 0:21:59.516 --> 0:22:02.676 dug in that our course of action is correct. So 0:22:02.756 --> 0:22:05.076 I think that's the first thing. The other thing, you know, 0:22:05.116 --> 0:22:07.516 I'm Sarmont Colorado. And one of the things that we 0:22:07.676 --> 0:22:10.916 are trying to do is set up you know, somewhat 0:22:10.916 --> 0:22:12.716 of a buddy system for lack of a better word, 0:22:13.156 --> 0:22:18.916 between physicians, pediatricians, internists, family docs, and school districts and 0:22:19.036 --> 0:22:22.796 teachers so that we can all be in these conversations together, 0:22:23.476 --> 0:22:25.476 you know, the folks that are on the ground making 0:22:25.476 --> 0:22:28.756 these decisions, to be able to have a dialogue so 0:22:28.796 --> 0:22:31.756