VIDEO AND TRANSCRIPT AVAILABLE: COVID-19 Expert Panel: Children's Health, Mental Health, and Education During the Coronavirus Outbreak.

Newswise Live Expert Panel discussion of unique angles to the COVID-19 outbreak of interest to the public and the media, with a focus on children's health, mental health, and education. 

Experts from institutions including Binghamton University, West Virginia University, and more will participate in a two-part series of moderated expert panels covering a wide variety of topics, with questions prepared by Newswise editors and submissions from media attendees. 

Who:

1. Laurie Theeke, PhD, FNP-BC, GCNS-BC, FNAP, Nursing Professor, West Virginia University
2. Robert Franks, PhD, President and CEO, Judge Baker Children’s Center
3. Mobeen Rathore, MD, Chief, Pediatric Infectious Diseases and Immunology for Wolfson Children’s Hospital 
4. Jennifer Wegman, PhD, Binghamton University

When: Monday, March 23 at 2 PM EDT

Where: Newswise Live event space on Zoom - https://newswiselive.zoom.us/j/7459578068

Registration for media, as well as colleagues from participating Newswise member institutions

Below follows the transcript of this Expert Panel:

Thom Canalichio: Welcome to this Newswise Live Expert Panel. We have four experts here to talk today about various topics related to the Covid-19 outbreak and the Coronavirus crisis that we’re currently facing. With particular emphasis on children’s health issues. Children’s health and mental health as related to this whole event. I wanna introduce and get started with Dr. Mobeen Rathore. He’s a pediatric infectious disease specialist from the Wolfson Children’s hospital in Jacksonville Florida. I would like to ask you a couple questions about some of the medical issues related to Covid-19. And in particular, some reporting early on that the disease was not affecting young people very much. And then with further reports in the last week indicating that a small percentage of young people actually have been becoming seriously ill. With the coverage about this whole issue, they’ve been a lot of differing pieces of information coming out about this. I wonder if you can explain and help us to understand that more fully.   

Dr. Mobeen Rathore: Thank you very much. I think we need to interpret the data carefully. I think that young people, children, adolescent, and even Millennials, they’re not at any lesser risk of getting the infection. Their risk of getting the infection is perhaps as much as anybody else. It just appears that the younger children, less than 19 years of age or so are not get a serious infection. They often are asymptomatic or they have a mild to moderate infection. And it also appears that they are not dying from this disease. The kid's fatality rate is smaller. There are a couple of studies that have now been published, that indicate that this to be true. So, the fact that they are not having severe disease or not dying of it, does not mean that their risk of getting the actual infection is any less. So I think it’s a very important thing. There is a little bit of a misinterpretation of that information, that I wanna make sure I’m clear on that. That, yes. Anybody can get infection. In fact, you know, what we have seen recently within Millennials, you’ve all heard that they’re thinking that they’re not gonna get the infection. That’s not true. And if they’re not going to follow the social distancing and other important activities that have been recommended, there may actually be an increased risk of getting that infection because now they’re congregating, whether it's on the beach -- I know most of the beaches have been closed in case of Florida. But that in of itself may increase their risk of getting the infection. But there’s not an inherent reason that children or young adults do not get infected. 

Thom Canalichio: Thank you for clarifying that. And what do you make also of the further reports that even a small percentage of young people that do get the infection could have severe complications? And what do we know about that in more detail? 

Dr. Mobeen Rathore: So, I think yes, they can get complications but if you look at the two published studies of Covid-19 infection in children. Each of them report one death. One in a 14-year-old. And one in a ten-month-old. Both these studies are from China. And the ten-month-old had other comorbidities and such. So I think they’re not dying of this disease. They’re not having -- yes as the number of kids who are infected increases; it's going to include those kids who have underlying health conditions. And as we know the adults and elderly. Those elderly who have chronic underlying health conditions, who are more likely to have them than children do, they’re going to be more likely to be having complications of Covid-19 infection. So yes, we are going to see some kids who are going to be hospitalized. We’re going to see -- there’s this report from Chicago of I think this 11-year old who’s very ill and in the hospital. Yes, we are going to start seeing that. But that is to be expected as the number of cases increase.   

Thom Canalichio: And can you talk a little bit more also about the risk even if they have very mild symptoms, the risk for young people to be spreading the disease further in the community and especially in their families, where they may have elderly family members or family members with other kinds of pre-existing chronic risk conditions.

Dr. Mobeen Rathore: I believe that’s the important thing here. As I said many of these children are going to be A-symptomatic or they may have mild disease. And you know kids get runny noses and colds and low-grade fevers all the time. That’s where the problem is. They may not be sick by themselves but they can transfer this infection to somebody else who may be at an increased risk for developing complications and even die of it. And in fact, just before the call I got a call from one of my friends and she has several grandkids and they are keeping away and apart from them. And so I think that’s tough of course for the grandparents. And grandchildren. So I think that risk exists. I believe it was -- I can’t remember it’s one of our leaders who was asked, “What would happen if the young people don’t follow social distancing and isolation… what can happen to them?” And the answer, “well you may kill your grandfather”. That’s true.

Thom Canalichio: Very stark warning but absolutely true and something that people ought to know and consider. Thank you, Dr. Rathore. I wanna move next briefly to Dr. Robert Franks. Dr. Franks is the President and CEO of the Judge Baker Children's Centre. And he has a background in child psychology. So Dr. Franks, Dr. Rathore just really put it very candidly, “if you’re not careful, as a younger person, even though you, yourself, may not have a very bad case of this disease, you could be the one that transmits it to your grandparent and ultimately it could kill your grandparent”. That’s pretty startling. How do we talk to kids about it? And is it okay to say it in those quite clear but candid terms? What’s your opinion on that Sir?

Dr. Robert Franks: Well I think like so many of these issues that are confronting children and adolescents, it really depends upon their age and their developmental level. So you’re not gonna talk to a five-year-old the same way you would talk to a teenager. But I think it’s also really important that they understand how serious this is. And it’s also important for us to remember as adults that kids take our cues from us. That’s probably the most important thing that we all have to remember. So, they pick up on our anxiety. They pick up on our fear. If we’re watching the news 24/7 in our house, they’re gonna see it too. And they’re gonna see the way we react to it. As well as, you know, take our cues from us in terms of how seriously we’re taking social distancing. So, if we as adults are not taking it very seriously, our kids are not gonna take it very seriously. Kids really need routine. So that’s one of the most important things that we can remember. And, their routines have been disrupted. So, they’re used to going to school. They’re used to having a certain time to wake up in the morning, a certain time to go to bed. Suddenly their parents are home with them all day. Suddenly they are -- perhaps had some expectations to do some school work, perhaps not. In some cases, you know, those limits that were put on video games, are suddenly feels like a free for all to them. And they don’t understand why they can’t go in the corner and play with the kids in the street. And if parents try to talk to them about that, it's really hard for them to understand. So I think sometimes personalizing it, helping them understand that it is about the health of our neighbors. It is about the health of our grandparents. I think that can be helpful. But we also don’t want to do that in such a way that it’s going to scare them or terrify them. We wanna be supportive. We wanna be encouraging. And help them make sense of this as best we can. 

Thom Canalichio: You brought up something about screen time and video games. So, I’d like to ask you about that. And I’m sure more than one parent out there is negotiating may be new terms for that. What do you recommend about changes to things like screen time? Especially if kids are doing online learning now. They’re engaged with those screens to an even greater degree than normal. What do you recommend? 

Dr. Robert Franks: I tell you why this is a tough one right now. And I feel like there's a real upside and there's also a potential downside. So, I’m also a parent. I have teenagers. We deal with issues of screen time in our house every day. I tend to have some pretty strict rules around that. Things like you need to have your homework done. And, video games are for weekends. And, you know, looking at the content of those games. But the other side of that is that while we’re saying, “Hey you can’t go out in the street and play in a group with your friends”. Video games do present a way for kids to maintain their socialization with other kids. So, I think there’s a balance. You know you can play an online soccer video game. And you can communicate with your friends. And be part of a team. And continue that social contact with each other. So I think that the big thing is that parents need to be engaged in their kid's lives. They need to have those conversations. They need to make sure the kids are, once again, not sleeping till noon and then rolling out of bed and playing video games till 4pm. I think it’s important to try and maintain as much of a semblance of that school schedule as possible. But having some balance in there, seeing it as an outlet can also be somewhat of a positive thing. 

Thom Canalichio: Thank you, Dr. Franks. If any of the media attending have any questions for Dr. Franks or Dr. Rathore, please do chat those to us. I’ll review those and relay those to the experts as we go along. I wanna go next to Dr. Laurie Theeke at West Virginia University. Dr. Theeke is a Professor of Nursing. And she has a background doing extensive studies on the effect of stress and loneliness as a predictor and effect on overall health. So Dr. Theeke, as we’re dealing with kids being cooped up at home. We’ve talked about screen time. We’ve talked about, they can be the one to transmit an infection to an at-risk family member. What are your thoughts about how we talk to our children about how to be responsible going about during this crisis? 

Dr. Laurie Theeke: Sure, well, you know, first I think it’s important to recognize that the kids have these various emotions at this moment. And that’s kids of all ages. You know I have 13 children. Eight adopted from foster care. I still have three at home but I have children of all ages. And so I’ve heard from all my children that they’re experiencing things like fear. And it’s not necessarily an older relative being killed or by this disease. But its, “I don’t want to make you sick mum, I don’t want to come home”. Things like that. “I’m afraid I shouldn’t visit this or that person because I might make that person sick”. We need to remember that, I think as of yesterday, 38% of the people in the hospital, were between the ages of 20 and 54. So you know focusing, I think on drawing on that empathy that for a kid that they might have a feeling for their grandfathers important. But also remembering, just in general, helping the kids and telling the kids like, “I know you’re afraid, you could make any other person ill”. But acknowledging that fear. You know, acknowledging that kids worry. The kids really worry. They don’t know how they’re gonna stay in touch with their friends. How they’re gonna get their school work done. In many cases, kids might be home without a parent. Or kids might be home with two parents. But it’s a nice idea to think that those parents who are working at home can also home school their children. But those parents are actually under that stress and expectation to work. And so it can evolve into this really stressful situation where parents have to work at home. Kids have to do school work at home. Everybody’s very stressed and fearful and worried. And so we have to have some outlets for these negative emotions. You know, it might be laughter. It might be exercise. It might be just conversation validating, “hey we’re having this feeling. Let's take a moment. Let’s meditate. Let’s do a five-minute breathing exercise. Let’s take 30 minutes on video games and then 30 minutes on a household chore”. Having frequent breaks and frequent change of thinking can sometimes help with stress. And so, just things of that nature, I think might be helpful. I do think that I’ve tried to really brainstorm ways for the kids to stay connected. You know, how can you do it with your phone. Everything seems to be a screen. You know, you’re supposed to be on a screen for school and on a screen for video games. And then on a screen, if you’re on your phone. And maybe face-time, that’s a screen. And so then I think we can send out a confusing message to parents if we say, “Screen time’s bad at this moment”. It might be that engaging in different activities, including not screen, and with a screen, are what’s going to be important. Varying the activities so the child doesn’t get bored. And then checking in. Frequent checking in. we know that kids who are isolated could become lonely. We know that loneliness can lead to anxiety and depression. And so we do need to check in on some of these symptoms and say, “how are you feeling today? Are you having any negative feelings today? What are your thoughts today?” Just really being present and checking in with your children if you can to assess how they’re doing. And so that we recognize, in the face of this whole big mess that we’re in with the coronavirus, we don’t want to miss a child that’s developing some other problems in reaction to it. And so we do have to stay vigilant as parents and health care providers. 

Thom Canalichio: Thank you, Dr. Theeke. I wanna kick it back to Dr. Franks who -- Dr. Franks do you have something to add to that?

Dr. Robert Franks: I do. I really appreciated those comments. And I think what we also need to really pay close attention to, you know; we have a center that treats kids that are experiencing mental health challenges. And a lot of those kids receive outpatient treatment and other supports. And right now they’re at home. So if you have a child that has anxiety or depression or other behavioral health challenges, then this situation is likely to exacerbate some of those challenges. And so it’s gonna be really important for parents to be supportive to kids. Know that most providers now are making telehealth options available. So that they can continue in their treatment. And also parents can get the support they need. I think it’s really important that folks don’t worry alone right now. And if they do have those conversations with their kids, they do recognize changes in behavior. And they try to get them the support they need when they need it.  

Thom Canalichio: Thank you, Dr. Franks. I wanna go next to Dr. Jennifer Wegmann. Dr. Wegmann is a Lecturer in the Decker School of Nursing at Binghamton University with a focus on health and wellness studies. So Dr. Wegmann, in particular with the college-age community of young people, what recommendations and tips do you have for them? In particular, as they’re kind of, maybe, governing their own activities more than their parents are in most cases. But they may be thrown into having to go back and live at home again for the first time in several years. What kind of factors are of concern there? And what recommendations do you have? 

Dr. Jennifer Wegmann: So as adults who are in the midst of this crisis layered with so many things like working, people are getting furloughed, losing jobs, what it looks like to work from home, college students lives are just as layered. So we have, I’m just thinking as an example, thinking of my students and we’re at an institution in upstate New York, where some students are choosing to stay, some students are choosing to go back to their respective homes. Where now the transition, not only going from being in the classroom but to being online, is now layered with a whole bunch of other things that are happening in their homes. And just to echo the things that Dr. Franks and Dr. Theeke were talking about in terms of what our children, anywhere from preschool to college, are dealing with. As far as like emotions and being able to validate the fear that most of us are experiencing. College students are running into the same things. So they’re trying to figure out how to transition to a model where they’re set in place and they’re getting access to their education in a very different way. But layered with that, the fear of what's happening right now. And also how things are changing in their life outside of academics. So I think that just to echo what’s been said already for college-aged students, whether we’re talking about how parents are dealing with them or how they’re trying to transition themselves, is validating the fact that they have emotions tied up into what’s going on. And what they’re experiencing is probably very normal. Most of us are probably experiencing it. But how do we help them transition? And I think one of the best things that we can do, as leaders, as professors, as doctors, as educators, everything, is model how we make it through these kind of uncertain and unknown times. And one of the things that I’m trying to do for my students is to lay a path for everybody to make it through in a way that can allow for healthy coping in the midst of these uncertain times. But I think one thing I’ve noticed a lot with my students is -- and my best recommendation would be to get out of bed. College students are loving staying in bed. And we pop up on Zoom and I would say ¾ of my class is actually still laying in bed. And I get that it's comfy and it's easy just to like wake up and throw your computer on. But in terms of motivation and intention of getting through this isolating part of our life right now is -- I would recommend that all college students would get up and stay in some kind of routine through the day. And I think that’s important for all of us. Especially as a person who is now online, it would be really easy for me just to lay in bed and try to navigate my classes. But we know that that’s not necessarily the healthiest way. So routine. And my biggest piece of advice is to get out of bed. I would also say too that, I think that we have a perception of how college students are navigating this based upon what we’ve seen in the media. With the students who were all on the beaches for spring break. And I think that that really is, for my experience anyway, a small percentage of how we see students navigating what's happening right now. And maybe it’s because I’m in New York.  We have maybe a little different feel cause New Yorks cities, you know, considered now the epicenter. But I actually see many of, my population anyway, taking this very serious. And understanding their role and how important it is for them to be social distancing.

Thom Canalichio:  Thank you, Dr. Wegmann. I wanna toss it back to Dr. Theeke and build off of some of what Dr. Wegmann said, especially in terms of establishing a new routine. And some simple kind of self-care practices. Not just joining your online class directly from your dorm bed. Dr. Theeke what do you think also about maintaining certain kinds of routines? And other beneficial kinds of self-care for both college as well as younger children and how that can have an impact here.    

Dr. Laurie Theeke: Sure. I’ve seen here at WVU, I’ve seen two things that are really majorly impacting the students and young people of that age group. And one is that we need to remember that these are people who are also losing their jobs. Many of them working in these restaurants that closed. Do waitress jobs. They’re doing various things for little bits of money and they’ve lost their jobs. So I've seen a lot of students and young or older adolescents and college students be very financially stressed at this point. And then at least in our state and our university, we’ve closed all the recreational facilities of course because we had to, to maintain social distancing. So their normal pattern of getting up, going to the rec center, getting on our public transportation, going to class, knowing where they’re getting their meals. Since they aren’t in the dorms, we’ve closed many of the places where they can get meals on campus with their meal plans. And so there's things that universities being put into place to sort of help the students out. But I think it’s an age group from age 16 up to 24 that we really need to think about, when it comes to financial insecurity, losing the ways that they exercise. I think really some public criticism about being on the beaches and while they weren’t really observing social distancing may be the way they should or could have. We also have to remember that for many, many students it was really, really emotionally very hard to not go on trips that you’ve paid for. I know of several personally who paid thousands of dollars for trips they were not able to go on. And it’s caused them great financial stress. And so I think this group, is a group that is really having some problems. Sort of re-navigating a new normal for the time being. And getting that new structure into place. And I know I’ve had students say things to me like, “How am I supposed to teach myself calculus now online?” You know that is their fear. How am I supposed to do this? How am I supposed to keep connected with my friends when they aren’t all coming back to campus? And they are very, very stressed. And so I think we need to have compassion and empathy for them. And we do need to encourage them to set a schedule for themselves. But we need to check in a say, “Hey, how are you eating today? Where are you getting your lunch today? How are you about getting up out of that bed and maybe going for a walk while maintaining that social distance?” You know. And, “how are you staying connected with peers?” And then, you know a piece that we’re missing, that’s important to many, many people is how are people staying connected to their faith? And so I think that’s something else that we could talk about with students. Many of our students are involved in faith groups that are no longer meeting as well. So, they’ve lost that support. And so all of those things, I think we could consider. And they do need -- maybe they could do things like joint scheduling, virtual study groups. Using some of the technology to continue with their classes. And we’ve encouraged all of our professors here at WVU to stay super connected with the students. We’re doing some proactive things. Just this week I’m going to set up some online mentoring sessions and online tutoring sessions for students in my classes. And so that’s maybe some things we could do to help that specific group. 

Thom Canalichio:  Alright, thank you, Dr. Theeke. We have a question in the chat from Joe at Helios Psychiatry. I wanna direct this to Dr. Rathore. Asking from a clinical perspective. How can clinicians aim to mitigate the mental effects of things like quarantining, social distancing, etc.? So we have several psychology experts talking about some of their recommendations but from a clinician’s point of view, what do you think doctors need to be doing? Dr. Rathore.

Dr. Mobeen Rathore: So I think mental health, of course, is something that we as pediatricians are on the forefront of when we have to address all the issues not just during the Covid pandemic but every day when we see patients. I think before I answer that question, I think it’s important that we understand there is a difference between individual patient advising them, counseling them, helping them, and then there is a public health issue. And I think the public health issue doesn’t change. Whether somebody's having difficulty or not, I mean the doctors [00:24:58 – inaudible] are having difficulties. You know, they are having challenges of their own. There’s a public health aspect [00:25:03 – inaudible] going to be very clear. That the social distancing, not going to the beach. Those remain. Those are public health intervention. But then when it comes to individual, I think we have to be very concerned about that. We need to; first of all, we as providers, as parents, as adults if you will, need to stay calm about it. Cause children are very quick to understand that the parents are anxious. Their health care providers are anxious. They’re not -- kids are very smart. Their animal instinct is very high. I think that’s something we need to look at. 

I think this is an adverse childhood experience.  We’re so concerned about adverse childhood experience, that it’s going to impact children’s lives.  Many of us have never seen or heard of anything like this, we are struggling, you know, staying home, not going anywhere, is not an easy thing.  Not even going to exercise, or whatever else you do. So, I think this is an adverse childhood experience that we need to make sure, first of all, many of these kids are not going to be seeing their pediatricians for regular visits, because of obvious reasons.  But whenever we have an opportunity to interact with our patients, we have to ask them the questions, how are you doing, how can we help. The screen time is a very challenging issue. Screen time is something the American Academy of Pediatrics has been advising that we should decreased the screen time, but the reality is at this point the issue of the pandemic is so much worse, that we will have to work with each of our patients individually.  There are others, maybe we have to encourage them to go support ball games, or whatever else.  

Thom Canalichio:  Thank you, Dr. Rathore, and as you aptly, I think, describe this is a defining moment and something that we have not seen.  I am just told that the Governor of the Commonwealth of Virginia just announced that public schools will be closed through the end of the school year.  My wife happens to be an elementary school teacher here in Albemarle County where Newswise is located, and there was a lot of speculation about how long this shutdown would go.  They’ve confirmed now, through the end of the year. So I want to ask Dr. Franks, as we look at this possibly happening in other states, happening more widespread, we have a whole generation of children who are going to be potentially missing out on several months of a more routine school experience.  I know this is new information to ask you to respond to, but what do you think we’re looking at? 

1. FRANKS:  It’s something we’ve been thinking about at my center, because we actually have a special education school for kids who have behavioral health concerns.  You can imagine for kids who have behavioral health concerns, it’s even more of a challenge, because they don’t have those services and supports available to them in their home setting.  This is really going to be a challenge for our society. And I think as other of your guests have mentioned, the parents are under stress too. We are all feeling it. I think anyone, we’re feeling the financial constraints, we’re feeling trying to juggle keeping our own jobs while also being parents and teachers to our children.  My next door neighbor is a teacher and when we have spoken at sufficient social distance from across our yards, she said she thinks in some ways perhaps there will be a new appreciation for some of the work that teachers do each and every day, as parents are trying to help their kids at home. I think once again coming back to the theme that we have all talked about, of routine, is extremely important.  So, trying to set up something that has some semblance of a school day while your child is trying to navigate the end of this year. I’m from the Northeast so one of the first things that we were talking about when our schools decided to close was, giving parents advice, this is not a snow day. When you live in the Northeast you have a certain way of responding to a snow day, it’s a free day off where you can do whatever you want to do.  That’s not necessarily the case. These are really school days that we’re experiencing, so it’s going to require establishing a routine, thinking about how you put in that structure, identifying goals for each day, having some variety and variability in the types of activities that include both physical exercise and mental stimulation. I’ve told parents, dust off those board games that you probably haven’t used in a while. We have to learn new ways of connecting with each other.  It’s going to be really vital. And I also think is also important for parents to take care of themselves, because if we’re not in a good place, we’re not going to able to support our kids. The other evening, with a group of college friends from across the country, we did a similar Zoom conversation and it was so helpful just to be able to talk with some of my friends about what they’re going through, what’s going on. So, we need to support each other to get through this.  

Thom Canalichio:  Thank you, Dr. Franks.  I happened to do the very same thing over the weekend with friends right in the midst of some of these areas where they’re on more severe lockdown restrictions in Seattle and the Bay Area in California.  They did find, from what I observed talking to my friends, a similar kind of level of being able to cope as a result of that. So, leading from that, I want to turn again to Dr. Wegmann, as we’re looking at public schools, elementary and high schools now looking at maybe being closed in wider areas, a lot of colleges and universities are already thinking about preparing for that reality.  Based on, and again, this is kind of new, I’m just sort of spitballing a new question for you, we didn’t really prepare for this, but what you’ve seen your university community try to prepare for with what your students need, what can you, from that experience, point to that parents of younger and parents and teachers of those communities too, of public schools, need to be prepared for and maybe can learn from what the university communities have already looked at, what they’re going to need to be doing.  

1. WEGMANN:  I think one of the most important things that all of us can take away from this conversation and move forward and start applying to our lives is the concept of social connection.  If you look at research, especially as it relates to stress and it relates to coping, one of the most effective coping strategies that we all have is utilizing our social network. And that looks very different for us now because we’re used to connecting, or the most typically effective way is to connect when we’re face to face, you know, touching, seeing people.  But the fact that I get to be with my class every week still, although it looks different, I get to see their faces, they get to see my face, we get to connect in ways, allowing and encouraging adults, small children, college-age children, to connect socially, even though it looks different, it’s going to remain really important. One of the things that I’ve been talking about a lot lately is letting go of the burden of feeling like a burden.  And I know that something that college kids are experiencing, students are experiencing right now. Like wow, everybody is kind of going through the same thing and everybody has their own stress, nobody really wants to listen or hear my problems, they don’t want to have to hear me “complain” about what I’m going through right now. But the fact is that is one of the worst things that we can do, because that isolates us even more. And stress is isolating enough, as it is.  And so I think that, moving forward, it’s really for us to stay focused on our academics, whether we’re K-12 or we’re talking about higher education. But at the end of the day we have to think about, I think bigger picture, and that is mental health for all of us. And yes, we don’t want to see any child regress academically, same thing in college, we have kids who are preparing for MCATs or who are getting ready to go to med school, obviously it’s going to be important to maintain those academic connections, but at the end of the day when this is all said and done, we want to try to make sure that our students and our children are coming out as mentally healthy as they possibly can, and I think one of the best things that we can do for all of us, children included, is stay as socially connected as we possibly can.  

Thom Canalichio:  Thank you, Dr. Wegmann.  Dr. Theeke, in light of the possibility of public schools being closed for the rest of the year, one area that you’re particularly concerned about would be more of the at risk youth populations, those in foster care, other kinds of issues, special education, what are your thoughts in light of news that Virginia is closing public schools, other states likely to do the same thing.  What concerns there should we be discussing?  

1. THEEKE:  I have a lot of concerns about this particular population of youth.  I’d like to hear what Dr. Franks says, as well on this, because I feel in this certain situation that we’re in, this will be a generation of at risk youth who are left behind.  For example, in our county, if you have WiFi, you’re in pretty good shape to keep up with the expectations of the school and so much so that we have, every student has, for example a Chrome Book.  But if you don’t WiFi at your house, the solution last week was you can drive to the parking lot of the school, pull in, download what you need, go home, do your work, but then if your parent loses their job or you don’t have a vehicle, or you can’t get to a place where there is WiFi, for example I know prior to closing restaurants some students were sitting in McDonald’s to get WiFi, then you’re going to be a child who can’t get their academic work done.  And not only that, many of our children with behavioral health disorders and at risk youth in foster care relay on not only the meals at the school, which we are delivering now here, but also visits with the school nurse, visits with the school clinic, visits to get clean clothes at the school lockers, and also visits with the school counselors. And so these children, their day at school might be very different than an affluent youth and their day might include a discussion with a nurse, a counselor, going to see if there is an extra outfit in the clothing locker, things of that nature, and all of those resources are now not available to those children, particularly teens, I really worry about our at risk or behaviorally disordered teens who need help for various reasons.  It might just be anxiety or depression, it might be abusive situations, it might be in a home where the parent is not there to help with the school work because the parent is continuing to work. And so they are isolated at home. And so I have quite a few concerns about that group and I don’t know what we’re going to do nationally for children who don’t have those kinds of resources. It may be that the school is going to have to go to printing and mailing assignments to the students. I’m not sure how it’s going to happen, but it needs to happen for the good of the youth.  

Thom Canalichio:  Dr. Franks, anything you would like to add about those at risk populations, kids in foster care, kids with special needs, and other kinds of issues like that?  

1. FRANKS:  We do know that kids who are part of those more vulnerable populations tend to have higher risk factors, so they tend to often times live in communities that may be less safe, there may be higher rates of unemployment, high rates of poverty, there is potential that they may be exposed to other adverse childhood experiences, trauma, abuse, neglect, and I think these concerns are very real.  For many kids, school is the safest place for them, and when they’re not in school, they’re going to be exposed to a much higher level of community risk factors. So, I think the idea that we’re going to have a generation of children for a period of time that are going to be subject to higher level of risks, is real. And we’re going to have to really be thoughtful about that when we come out of this, hopefully, this terrible time, we’re going to have to really invest in mental health services and supports to try and offset some of those adverse effects that this generation of children is experiencing.   

Thom Canalichio:  Indeed, for all of us.  Dr. Rahthore, any comments from your perspective about these risk populations, kids in foster care, kids with special needs?  

Dr. Mobeen Rathore: I think this is our opportunity to advocate for these children.  I think children will often get forgotten, but this is the time for us to make sure that we are working with our local school boards, and working with the state, and that’s what we are doing through the American Academy of Pediatrics, all the chapters of West Virginia, Massachusetts, all the pediatricians and other child advocates, we need to advocate for children, get the resources they need, we cannot forget this now.  We’re talking about these kids who are going through adverse childhood experience, and that may impact the rest of their life. I think some simple things, like in our county today we started all online schooling in our county, but everybody doesn’t have computers at home, so all the computers, laptops that they have in the schools, they are now giving those out to kids who cannot afford. And then the issue of WiFi, so what are we doing.  I think this is our advocacy for our children. Used the school busses, we are taking them hard copies, these are just small things that I’m thinking, but we can talk about this at any level. We need to advocate for children, we need to make sure that there is counseling available to children when they come out of this. For example, those kids, the young infants who need vaccines, if they are not able to go the doctor, you will get over the pandemic of coronavirus,  but then you will have an outbreak in the United States. So I think we, as adults, we as child advocates, we need to be out there educating the government office. Everybody is so focused, and rightly so, in getting prepared to fight this, and that is what it is, it’s a war, fight this pandemic, we want to make sure, yes, those are all important things, but let’s not forget about these children. And when I talk about children, I have a 26 and a 30-year-old. My 30-year-old, he’s a consultant in DC, I said come home.  The statistics are that anywhere from 96 to 145 million infections are going to get this infection. It’s not a matter of if, but when. So I told him, if you want to get that infection, I want you to be home with your family so we can all take care of each other. So we need to look at that family unit, but we need to look beyond that, like here in our own area, we are working with the Florida Chapter of the American Academy of Pediatrics. We are going out and we are advocating with the state government, the local government, each one of us has that responsibility, because as somebody said, we’re talking about this whole group who will never, ever, the high school kid or the elementary school kid, they’re never going to forget this.  This is going to stay with them for the rest of their life, as something that was disastrous, and whether we like it or not, that’s what it is right now.  

Thom Canalichio:  I completely agree, Doctor.  I have a couple more questions for Dr. Rathore, some from the chat and some that we have prepared.  Any of the other participants have any other questions for our experts, please do chat them to me or chat them to the whole room, either way is fine, and we will continue to ask those questions as we have time.  I have a couple questions that I would like to get all of the experts to weigh in on, but first one or two more for Dr. Rathore about some specific medical topics. Dr. Rathore, you mentioned the possibility of some of these children undergoing this crisis, may not get other important healthcare, you mentioned they don’t get vaccinated for the measles and then we have a measles outbreak sometime in the next few years.  We had a question about getting the flu vaccination. If a child has not had the flu vaccination yet, should parents consider taking them to go get it now, so they don’t potentially get the flu and get the coronavirus, or would it be too risky to be going to a clinic to get the flu shot at this time, because others may be in there to get tested and somebody could have the coronavirus and be spreading it. What are your thoughts about that? 

1. RATHORE:  It’s all a risk benefit analysis.  At this point in time all the vaccines are important.  The benefit of getting the vaccine and getting the flu vaccine, and not get sick because of the flu and everybody thinking you have COVID-19, it’s important to do that.  Even with all the procedures, we are making sure that everybody understands that they can still go the pediatrician’s office to get the well child vaccinations. That is still going on.  So, to answer your question, yes, they should get the flu vaccine and all the vaccines that they’re eligible for. That’s also an opportunity for the pediatrician to evaluate for other issues.  Many pediatricians are working on this in different ways, they’re seeing sick patients at one time of the day, well visits at one time of the day, or if you have two practices, you’re seeing sick visits at one practice, well visits at the other practice.  We are constantly as pediatricians changing our practice pattern. A lot of tele health. In my own practice today we had zero face-to-face visits, all tele health visits. We can do mental health with that, we can do all our Ace evaluations with that, we can do counseling, we can do all those things.  There’s the challenge, every state, every insurance company does not pay for tele health, so that where we can advocate. We can say this should happen. All the mental health providers should say we need this, we need to be able to provide mental health services and get paid for it. So I think those are important issues.  I mentioned about getting a measles outbreak, but we could have some other mental health outbreak, if you will, if we don’t address these issues. We have to try to help our children to resilience, but the connection with your pediatrician who is the source for your medical care, also unfortunately because there is such a dearth of mental health providers, they’re often providing mental health services also.   

Thom Canalichio:  I’m glad you mentioned telemedicine, Doctor.  We did have a question from someone in the chat about that.  I feel like you answered that question quite well. A few more questions about the flu vaccine or other healthcare.  Are there any concerns or complications in getting other vaccinations if you have COVID-19 but don’t know it?  

Dr. Mobeen Rathore:  To the best of our knowledge, no, there is no known problem with that.  See, the vaccines should not impact other things. Now if we’ve got COVID-19 and you’ve got a fever, you’ve got other things, you probably need to focus on taking care of that and not the vaccines.  I mean, personally, I need my second dose of the shingles vaccine, I’m going to get it on Friday. I need to get that. I’m not a kid, but that’s something that protects me, and I want to get it on Friday, because I know I’m going to have a sore arm and a little bit of fever.  So you have to plan these things with children, also. So, if you have COVID-19 disease, don’t worry about the vaccine, get better, we’ll give you the vaccine before you go home.

Thom Canalichio:  And with COVID-19 and the flu, what is our knowledge about the possibility of coinfection with those two things, and particularly among children, is that possible?  Is that known or not?  

Dr. Mobeen Rathore: There are a couple studies out there that talk about coinfections, unfortunately I cannot tell you specifically for flu.  In one study, it’s on medium.com if anybody wants to take a look at it, it’s from Stanford scientists, they say about 20% those who have SAR-COV2 infection have a coinfection with another virus.  In another study it’s 2.3%. So, I would say it’s anywhere between 2 to 20%, you could have some coinfection, which is not surprising, we have coinfections with other viral infections, also.  

Thom Canalichio:  Thank you, Dr. Rathore.  I want to ask each of the experts a couple of questions, and if you can, just keep your comments brief so that we can get around to everyone.  The first that I want to ask all of you, about negotiating what is safe and what is not to do in the world these days, obviously going to a party where there are 50 or 100 people, or going to other kind of mass public events, that’s right out, clear cut, but with all these kids home from school, they want to see their friends, college kids, they spent money for a spring break trip that they’re now having to abandon, maybe they’re looking for some alternative to see their friends, what are your thoughts, what are your suggestions about how to navigate what personal responsibility we have to protect ourselves as well as to protect others that we could spread the disease to, but still wanting to go out and do things.  Is it safe to take your dog for a walk in the park, even though there might be other people there? Questions like that. How do we really answer that? I want to first ask this of Dr. Rathore, and I want to get all the experts to weigh in on this.  

1. RATHORE: The quick answer is whatever you can do safely without interacting with other people, you can still do that.  You can still jog, you’re not interacting with other people. I would not encourage a soccer game, but it’s okay to go to the part.  Yesterday one of my friends called, can I take my kids to their soccer game, I said no. But you can take your kids to the part and just stay away from everybody else.  So, I think you have to take the personal responsibility and you have to do that. Unfortunately, there is no black and white answer for every situation , but just that personal responsibility of social distancing.  

Thom Canalichio:  Thank you, Dr. Franks, what are your thoughts on that question?  

1. FRANKS: I think this is a tough one, especially when you have younger kids, but as parents we do have to set those limits with our kids, unfortunately.  Older kids may be a little bit more able, teenagers may be more able to modulate those behaviors, but they also tend to take more risks than adults.  So, that’s a tough situation. I have two teenage sons and we get these questions on a daily basis. Can we go for a hike with our friends, can we go to the park with our friends, what if we walk the dog?  And I always say, if you can safely maintain at least 6 feet of distance between you and anyone else, you live in the house with your brother, you can’t be within proximity to anyone else, and really talk them through difficult situations.  What would you do? What would you do if your friend approached you? What would you do if somebody wants to pat you on the back or goof around? And when they begin to really think about it, often times they come to their own decision, hey, you know what, that’s not really a great idea.  We have though, as an example, as a substitution have gone on some family walks and some family hikes, and walked the dog together, because we’re already all in the house together. But this does make it very challenging for kids who want to spend time together. And unfortunately, we as adults, we have to really provide them guidance.  

Thom Canalichio:  Dr. Theeke, what are your thoughts about that question, how do we navigate and negotiate these responsibilities while we still have a relative amount of freedom to make those decisions?  I’ve heard that in other countries they’re clamping down even further, I saw a pretty humorous video earlier this morning of several different mayors around Italy using colorful language to convince their constituents to stay home.  What are your thoughts about that, Dr. Theeke?  

1. THEEKE:  Well, I think that social distancing is what it is.  We need to maintain a distance of 3 to 6 feet preferably 5 or 6, from other people.  So, I agree with Dr. Franks. We took a family walk yesterday and then I had to work with my son, we ran into some of his classmates, and they remained on the other side of the road.  Because I insisted, no, you stay over there, we’ll stay here, it’s a narrow West Virginia road, we had a conversation, we were talking to people as they sit on their front porch, but we have that safe distance.  So I think it is something that’s very important that we need to maintain. And we shouldn’t take it lightly and we should teach our children how to navigate it. We had some people yesterday who were playing, two people playing street hockey.  And so I thought that might not be too bad, they’re not touching the puck, they’re using the sticks, the nets were 20 feet apart, that might work out, just don’t touch the same puck, maybe don’t have one person touch it then the other person touch it, if you’ve been exposed to so many other people.  But the idea of, I’ve been telling my kids, you can say hello to a friend, you can’t run up and hug your friend. You just can’t do some of those things right now. I’ve had some experiments going on with walkie-talkies with neighbor kids and I think children love that, they think it’s fun. We think it’s ancient or archaic, but they think it’s fun to have a walkie-talkie and talk to a friend, and some of the walkie-talkies will go two miles, so that’s a different way that you can maybe connect with a friend that’s kind of fun.  We’re doing things like puzzles, and one thing I think to never not negate, is while we maintain social distancing, this is a great time to engage in some kind of solitary creative activity. We know that when you engage in a solitary creative type activity, you’re not as likely to become anxious, depressed, or lonely. So, trying to write a song, or using maybe some kind of app or book, we used to use books to learn to play an instrument. Or engaging in like a solitary art project, or you know how people do those group meetings where they do painting, you can have social distance, but be like, hey, let’s all try to do the same painting.  So, some kinds of things like that might work if you could engage kids socially in those kinds of activities. It keeps you from feeling go isolated and you feel like you’re in it with your friends. Like, my sister-in-law does jewelry making and so she’s texting me pictures of the jewelry she’s making and she does that to cope with being home with her children. So it’s all a way of connecting and appreciating each other. Some of those unique creative activities I think could really, really help people out at this point. I know I have one 20-year-old who is trying to write a song, that’s keeping him busy, just different things like that, you can think about what your personal passion is and how you can explore that with a little more depth during this time.  You’ll probably come out a more developed person.  

Thom Canalichio:  Thank you, Dr. Theeke.  Dr. Wegmann, same question to you, with policies in place, but not necessarily very harsh restrictions at this point in most areas, how do you recommend that we negotiate what’s safe and what’s not, and I also want to ask if you want to give a shout out to your students that have joined the meeting today.  

1. WEGMANN: Yeah, so I actually have seen, I’m scrolling through and seeing that I have a lot of students that have joined us today.   

Thom Canalichio:  Welcome to Dr. Wegmann’s class, thank you.  

1. WEGMANN: It probably helps that there’s incentive for them to come, they’re using it as a makeup opportunity, but that’s okay, sometimes they just need a little push.  But I’m excited to see a lot of them there, so shout out to all my stress management peeps who are watching. To think about all the recommendations that have already been given, to think of something maybe new that I could add, the thing is that adversity creates an opportunity for us to get innovative, and that’s what we need to do right now, when it comes to socially connecting and trying to avoid becoming just completely isolated.  I was actually talking to a person yesterday from New York City, an adult, but they had what they called a Zoom bar, where a bunch of people had gotten on, somebody created an event, and a bunch of people got on Zoom. Some people knew each other, some people were strangers, and it really was like a bar experience, but they were at home. So, some people were having drinks, some people weren’t, and they were socializing very much in a way you would socialize if you were out, but they just weren’t in the same place at the same time.  This is actually a really creative idea. If we give ourselves a little time and space and opportunity, we will see that we can come up with really creative ways to stay connected. And so if that’s still going outside but social distancing, remaining with your family, going for walks, like everybody else was saying, one thing that I was thinking as Dr. Theeke was talking about just even having a moment in time to do things in solitude, what if we connected that to also connecting socially in empathy. One of the things that has been a lost art is writing letters, and so we can use that opportunity and that works for really small children, all the way up to adults of any age.  What if you took a moment to write a letter to a student or to a friend, or to a grandparent you haven’t been able to see in a couple weeks, or somebody that you love and care about, just to tell them how much they’re loved and much they’re valued, and to reflect upon your relationship. Having the opportunity to express gratitude in the midst of writing a letter to another person is something that we just don’t necessarily do anymore, but now that we have the time and opportunity and somewhat the necessity to do it, that certainly could be a new, although not new, creative way to reach out to people that we care about and that we love.  

Thom Canalichio:  Thank you, Dr. Wegmann.  A couple more questions for Dr. Rathore.  From the chat, Hannah Furfaro from the Seattle Times, right in the midst of one of the major outbreaks, she is asking about the testing of the COVID-19 vaccine.  Are there any trials undergoing for children with COVID-19 vaccine? I think we probably all have seen reports of a small trial of adults that have volunteered for a vaccine trial.  What do you know about any vaccination trial involving children, plans for, anything in progress? I also want to ask you testing about other possible antiviral drugs that may be effective.  

1. RATHORE: Let me answer the vaccine question first.  No, there are no trials ongoing for children.  The usual process is if any drug, any vaccine, unless it is specifically for a childhood illness, is first tested in adults, and if it is safe, then it will go for testing in children.  So I suspect at some point in time there will be studies in children, but not right now. The vaccine is in phase 1 trial in adults at this time. In terms of specific antiviral treatment for SAR coronavirus, there are some trial that are going to start, actually we were approached by the NIH to participate in this study, so those studies are going to be coming onboard soon to understand how these medications that you have heard of in the media, how they are going to impact children.  So, those trials will happen soon.   

Thom Canalichio:  And the antivirals that might be effective against COVID-19, I’ve heard reports about chloroquine, I believe is how you say it, as well as some others that are being tested or might be effective.  What do you know about that and what else are we looking at in that picture? 

1. RATHORE: Chloroquine and some of the other antivirals that are being looked at, we have no knowledge of how they work in terms of COVID-19 and children.  Chloroquine of course has been used for decades as an antimalarial drug. But we need to understand is how it will be used and how effective it will be in children.  We want to make sure first of all it is safe in children, and adults for that matter. So I think yes, the medicine is being used quite a bit around the world, actually, because it’s a medication that we have used for many, many decades for malaria, but we hopefully will have some science behind the use of this medication for COVID-19 infections.  

Thom Canalichio:  Another question from the chat, someone with Consumer Reports, I don’t know the reporter’s name, unfortunately, but is it possible to get a false negative?  We’ve heard reports of false positives, but is it possible to get a false negative?  

1. RATHORE: That’s always a concern.  First of all, there’s not a lot of information available on the specific tests, published information.  It is a molecular test, so it should be very specific. So, a false negative would be unlikely not impossible, so I think that’s something that we believe that if the test is positive we can put our confidence in it, that the patient is infected.  

Thom Canalichio:  Thank you, Dr. Rathore.  I have a couple more questions for Dr. Franks.  Dr. Franks, from the chat we had a question from Joe at Helio Psychiatry, is there a concern about a rise in pediatric suicide and of course depression, during this pandemic?  

1. FRANKS: Well, it’s certainly too early to specifically be able to answer that question, but we do know that increased stress , increased risk factors can contribute to challenges such as depression and suicidality.  So, this is something that we should definitely be watching for. This counsel sort of contributes to I think an important question about as parents, as caregivers, when do we worry about our kids, when do we worry about our adolescents?  I think this is the advice that I typically give parents, but it’s even more important now. You know your kids usually better than anyone else. When you see changes in their behavior that are significant, when you see changes in their sleep patterns, changes in their eating, withdrawal, symptoms of depression or extreme irritability, all of those things are normal if you know a teenager, you know all of those things are normal.  But when we’re seeing extreme changes where your child no longer wants to get out of bed, no longer wants to get dressed, doesn’t engage in self care, really exhibiting some serious signs of withdrawal, these are times when you should really engage your child, have conversations with them. If you’re worried, seek help, even though right now we’re not in a situation where we may be able to seek help from a live clinician, almost all insurance companies at this point as well as Medicaid have waived access on any restrictions to receiving telehealth, so you can actually call your insurance provider or your Medicaid provide, and they can link you with  qualified clinician that can do a screening or connect you to services. This is incredibly important. If you are worried about your child, if you’re seeing these significant changes in their behavior, please don’t worry alone and please seek help before the problem worsens.  

Thom Canalichio:  Thank you, Dr. Franks.  Any of the media in attendance, if you have any other questions for our panel, we’re going to be wrapping it up shortly, so please do get those questions in, feel free to chat them to me, and we will ask.  I do have one more question that I want to ask all of the experts, and again, if you can keep it a little bit brief so we can get to all four of you for this, and I’ll start with Dr. Franks, since your audio is live, what is some misinformation that you’re seeing out there that you think is important to address from your perspective.  

1. FRANKS: Sometimes, we’re hearing the situation, and I think this was addressed earlier a bit, but that kids can’t get COVID, you’re that kids can’t get it, this is something the only affects older people, so kids don’t need to worry.  This is a huge concern and we have to make sure that we combat that misinformation and that we understand that children and adolescents need to abide by the same social distancing as the rest of us.  

Thom Canalichio:  Thank you, Dr. Franks.  Dr. Theeke, any thoughts from your perspective about issues that you’re seeing that the media might not be getting fully right or misinformation in social media or other areas?  

1. THEEKE: I don’t really have anything specific to add.  One other thing I think we’re going to miss on this issue with children is thinking about is this kind of being at home situation going to contribute to increased substance use, along with behavioral health problems, particularly in our high school and college kids.  So I would just say let’s be aware and look for that as well, and see what kind of coping strategies the kids have. We know the kids who are resilient and have a set of coping strategies will do better. So, I think just be aware of that and be vigilant looking for negative coping strategies like vaping or smoking more, or all those things adolescents sometimes do.  

Thom Canalichio:  Thank you, Dr. Theeke.  Dr. Wegmann, any misinformation that you’re seeing that you want to address?  

1. WEGMANN: I think the only thing that I would add to this would be the perception of college students, just because that’s the population that I’m in the midst of.  I think this transcends even what we’re talking about today. There’s a perception that college students are selfish, a little self centered, and that’s not my experience at all, especially in the midst of everything that’s happening.  I’m finding college students to be very informed, I’m finding them to be very thoughtful and to be empathetic. So I think that if we could maybe just change our perspective as kind of grouping all college students together as people who just care about themselves and all they want to do is party, I’m actually seeing the exact opposite of that in our population.

Thom Canalichio:  Thank you, Dr. Wegmann.  I happened to notice, monitoring social media over the last few days that for a while it seemed like the trend was a lot of college kids still wanting to party and go to spring break, but then as some of them started to get sick, maybe the messaging started to get through to some of them, it turned a little bit to some more shaming of those kids by their peers, which I think is a welcome thing.  Peers talking to their peers is probably the best way they are going to hear that message. I want to ask Dr. Rathore, also, what misinformation are you seeing that concerns you that you want to address? 

1. RATHORE:  I guess it’s very apropos, I’ll end with what I started, that is the misinformation that kids are low risk for infection.  It’s just that they don’t get as sick. The second thing that the millennials, the emerging adults, they can get sick, and a large number of those kids are represented in the hospitalized, I call them kids but the emerging adults, they are getting hospitalized, they may not be dying of it, but they are getting quite sick with this illness.  So I think it is extremely important to remember, anybody can get this infection, anybody can get very ill with this. It’s the older people who are dying of it, but anybody can get severe, severe infection. Lastly, we have a COVID pandemic going on, but we have also going on what I would term as an infodemic. There is so much information, we need to get our information from credible sources.  I also urge the media to get their medical information from people who know about medical issues, and not from people who just want to blow their horn. It’s a great responsibility of the media to keep the public informed, what is conjectural, and understand the basis of when some information comes out and make sure that the public understands that clearly.  

Thom Canalichio:  Thank you, Dr. Rathore.  Last chance for any questions from our media in attendance.  Please do chat to us as we’re going to get wrapped up here in ust a moment.  But I do have one other question for Dr. Rathore, and of course, if we get any other questions from media we will contractor.  But Dr. Rathore, and I would like to give the opportunity to speak directly to parents of children who might in fact get the infection.  First of all, what kind of quarantine and isolation procedures will be in place if a child as to be admitted to the hospital of if they’re sent home, what does a parent need to do to try to prevent themselves from getting sick or other family members, but still being able to care for their child, or if more drastic measures are taken, if they need to be isolated or whatever other issues might be involved there.  And also if outbreaks reach the levels that we fear might be possible, would children’s hospitals need to be opened up to patient of all ages.  

1. RATHORE:  If I forget one, you have several questions there, if I forget any, you remind me.  The first one, I think in the hospital if there is a patient with COVID-19 or suspected COVID-19, we put them in very strict isolation right now.  Most children’s hospitals have restricted visitation. Of course we can’t restrict for a child, and so we allow one parent at a time to come in there, they are protected, to make sure that they are also protected.  If you have a child with COVID-19 at home, depending on the age of the child, the development state of the child, you have to use different mechanisms, different processes to do that social isolation. It would be different for an 18-year-old than an 18-month-old, so I think I cannot answer that across the board, and I think this is where you call your pediatrician who is in the best position to answer your question.  I believe the last part of your question was if this goes the way it went in Italy and Spain, would the children’s hospital take the responsibility for adult patients. I hear from my colleagues in Italy that many of the pediatricians are taking care of the adult patients. I think if we reach that degree of severity of this pandemic in the United States, we will have to make lots of very tough decisions, this would be one of them.  I certainly as a pediatrician don’t feel qualified to take care of an adult, but certainly if your foundation is in that touch of a situation, I would be very willing to help in whatever way I can. I’m still a doctor, I spent 30 years of my life taking care of kids, but I think I’m reasonably intelligent to be retrained to do some things and relieve the adult internist and also take care of adults. So, that may happen. I hope it doesn’t, I hope this flattening of the curve that we are talking about does not get us there, but if it happens I think the pediatricians are going to be ready to face that challenge.  

Thom Canalichio:  Thank you, Dr. Rathore.  We do have one other comment in the chat that I want to give the experts an opportunity to respond to, a little bit of discussion is happening about public shaming of people who violate these isolation or quarantine or other policy recommendations and advisories.  I had mentioned college students on spring break and the social media shaming that started going on to discourage that amongst their peers. Dr. Franks made a comment about being supportive versus shame, but we have a comment from another one of our participants asking if shame has a potentially beneficial social function.  So, Dr. Franks, I want to give you a chance to answer that, as well as our other experts. What are your thoughts about that, about this notion of the public shaming? I don’t know if you saw last week Sanjay Gupta kind of had a little bit of a meltdown on CNN, not understanding why people were still wanting to go to Golden Gate Park or wherever it was, they were showing some B roll, what do you think about that debate?  Shaming versus not shaming.  

1. FRANKS:  I think there is such an important role that we need to educate each other and we need to help people understand the seriousness of the situation.  It makes me equally as crazy, particularly when you feel like you’re working so hard in your own family or your own community and you see others not taking this seriously.  But what else I’ve seen in some of our local community forums or chats, people really taking on this role of, “I saw a group of kids standing on the corner, where are their parents?” And identifying people by names, and I really think there is an opportunity for us to look in our own backyard, in our own home, in our own family and there is also ways to be supportive.  I actually witnessed something recently where a woman actually was driving down the road and she pulled her car over to a bunch of young girls on the side of the road, and said you know what, it’s really not safe for you to be doing this, do you understand that, do your parents know that you’re here? And the girls responded no, and she said, I think you need to get home right now, this is not safe for you.  And the girls dispersed and they went their own way. And she did it in a way that was serious but also supportive of them. And I think that as a society we’re so quick often to jump on others, to be judgmental, to be critical, and I think there is a way that we can be supportive and we can educate one another and help one another and look out for each other.  

Thom Canalichio:  Thank you, Dr. Franks.  Any of the other panelists have any comments they would like add on that question?  

1. RATHORE:  Let me say, his is Mobeen Rathore, I am opposed to public shaming, it does not help a child at all by public shaming.  I think it’s not good for them. I think we need to educate them, as Dr. Franks said, most kids will listen. And of course we have strong regulation in the cities and states to make sure that those sorts of things do not happen.  Public shaming is not an effective tool. They may start doing it secretly. So, I think we need to be very careful, yes, we are all stressed out, this is a major issue, but we need to structure it in a manner that we are educating and we are making them understand, as Dr. Wegmann said, kids do understand if you can explain to them at their level regardless of age what is going on.  They respond to that. I do believe it is the responsibility of the parents also, and the media, to explain this sometimes in harsh terms. I mentioned earlier when the politician said you may kill your grandfather, that’s a strong statement. Which grandchild wants to kill their grandfather?

Thom Canalichio:  Very good point, sir.  I think the question about shame versus accountability is maybe a good way for us to think about it.  An example that Dr. Franks mentioned where someone says to the children, do you realize the risk that you’re creating here by being gathered this way?  You give them the autonomy to make the right decision. We’ve gone a little over an hour, I really appreciate all of the panelists spending their time with us.  Thank you to all the media who have attended. I have a couple of notes as we wrap up, I want to first toss it to my colleague, Jessica Johnson, the CEO here at Newswise for any final thoughts before we finish up.  

JESSICA:  Thank you all for joining, and it was great, it was very helpful, so much valuable information you were all sharing, so I want to thank everyone for your time today.  Be well, be safe, and let us know if we can helpful if you have any other things you would like to share with the Newswise audience and hopefully further.  

Thom Canalichio:  Thank you, Jessica.  For all the media in attendance, we’re going to have a recording available of this expert panel, as well as a transcription of it, which we will have as soon as possible, hopefully within the next day or so.  And if you’ve registered for this event we will email you and let you know when all those pieces of information are available. We will also share with you the contact information to give you instructions on how you can get in touch with any of the panelists from today.  With that, I think we will close. Thank you very much Dr. Theeke, Dr. Franks, Dr. Rathore, and Dr. Wegmann. Thank you for your time and expertise on all this. Everybody please stay safe and healthy out there, and good luck.  

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