Hugging, Day Care, Playdates - What's Safe? Expert Q&A

Hello and welcome today on At the Forefront Live. UChicago Medicine Comer Children's pediatric specialist will discuss summer safety for families during Phase 4 of COVID-19. Is it safe for your child to give someone a hug without spreading Coronavirus? Can your children visit their grandparents now that some restrictions have been lifted? Parents and experts, Dr. Allison Bartlett, Dr. Rochelle Naylor, and Dr. David Zhang will answer these and other questions from you during this Live Q&A that's coming up right now on At the Forefront Live.

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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. We're going to start off with having each of you introduce yourselves and tell us a little bit about what you do here at UChicago medicine. And we're going to start with Dr. Bartlett. You're a very, very busy person these past few months. You wear many hats here, and we were actually kind of joking before the show started about the last time you were on-- your pager was going nuts, and that was right at the beginning of the pandemic, I believe.

That's right. And it seems like it's been just a minute, and also years and years. So yes, I do wear a lot of hats around here. I am the Associate Hospital Epidemiologist for all of our infection control work here.

And I'm also clinically a pediatric infectious diseases doctor. So I split my time between those two activities, and I have to admit, I'm appropriately socially distanced from you here in the studio, but having a little bit of anxiety because I haven't been like this before in all of At the Forefront beginnings of our health care workers doing their hard work-- not wearing masks, which is not what it looks like now. Gives me a little bit of-- panic.

That's old video.

Old video.

So we want to point that out. In fact, a lot of that was shot probably at least a year or so ago. And I do have my mask right here. You wore yours in, I saw you.

I've got mine.

So until we were in the right spaces, we had our masks on.

Absolutely.

So let's go with Dr. Naylor next. Dr. Naylor, if you can tell us a little bit about what you do here at UChicago Medicine?

Yeah, so I am a pediatric endocrinologist, so that's my clinical hat. I am both relieved and maybe jealous that I'm not in infectious disease. I would've been more prepared, but I also would be more busy.

Fantastic. And Dr. Zhang, and tell us a little bit about who you are and what you do here at UChicago Medicine. Yeah so I'm Dr. Zhang, one of the pediatric infectious diseases fellows. And so what that means is that I'm training to be someone like Dr. Alison Bartlett. I have one more year left before I become a full-fledged attending. And so what I do here is mostly just clinical training, but also some research to advance the field of infectious diseases.

And I do want to point out since we have Dr. Zhang and Dr. Naylor remotely join us, usually we would have everybody on set again, pre-pandemic, and that's why we do it this way. So we have a couple of guests at remote locations and one guest on the set and then we can keep everybody appropriately spaced.

So I also want to remind our viewers that as we do our program today, we will take your questions live. So just type them in the Comments section. We'll get to as many as possible over the next half hour or so.

Dr. Bartlett, I want to start with you on the questions. It seems like-- you mentioned, it seemed like just a few minutes or a few days ago that you're here or a lifetime ago, and I think people are getting a little tired of the slog, but this is very important that we continue to observe things like social distancing, masking, because we're coming up to maybe a difficult time.

I think you're absolutely right. You know, one of the things that our health care teams learned early on is that the things that we know about COVID and things that we're learning-- based on both science and just lived experience-- changes all the time. I mean, it's confusing enough in the health care setting, but also even more confusing when we're changing our recommendations for the public. So masking wasn't a thing, and then all of a sudden it became vitally important. And that's kind of hard to explain, but people are getting tired and I get it. I'm really tired, too. But we have done such an amazing job here in the Chicago area and all of Illinois about taking this seriously and even though we're tired, hanging in there and following the rules and helping keep everyone safe.

You know, I think you make a really great point there, just with how things have gone in the Chicagoland area. And Dr. Zhang, we'll go to you next. And I'm kind of curious to get your thoughts on this because you see some of the other big cities in the country, and New York obviously sticks out I think, in most people's mind. They had a lot of really significant challenges with COVID-19. And I think folks have maybe learned from that and some of these lessons are very difficult ones to learn, but this is not the time again to get complacent. We need to continue with our efforts.

Yeah, absolutely. As Dr. Bartlett said, you know, we've done a great job as a city, but also just you know individual communities and as a medical center, as well. I know like all the restaurants here and I feel like a lot of places here in the city have just enforced face-masking policies in their respective enterprises. And so I think yeah, just to echo what Dr. Bartlett said, we really just have to keep on with everything that we've been doing so far, individually, but also just communally, as well. Because I think the faster we want to get to normalcy or pre-pandemic life-- to our pre-pandemic lives, the more we have to keep on with hand-hygiene, social-distancing face-masking, et cetera.

Yeah, you know, Dr. Naylor, it's interesting, the better we are at this now, that will shrink probably-- I think-- the time frame of some of the challenges that we face. It's just so important and obviously, it helps people, so that's important.

We are getting questions from viewers already. So this is great, and I want to get to as many as possible. So Dr. Naylor, if you can tell us a little bit, one of the first questions we have from a viewer is back-to-school.

So that's obviously on a lot of parents' minds, and we were even discussing that before the program started. How do schools overcome some of the restrictions, or will they have the same restrictions that you see in the general public? And I know you can't speak as you know, to what the public schools are doing, but what should parents know, in your opinion?

Yeah, so this has been coming up a lot when I see patients, a lot of times virtually, and you know we do have some in-clinic visits, as well. And so it's on everybody's mind. The very first thing is that I understand a lot of schools are, I think sending out information today, or in the coming week. And the very first thing is that parents need to read very carefully all of the precautions that the schools have put in place and decide for themselves their comfort level for sending their children back. I think a lot of families will actually have the choice.

The things that you want to look for are, of course, plan for temperature-checking, plans for masking, plans for keeping the kids separate, and also how they're going to plan to kind of cohort children. You want children to kind of have the same peer group each day so that it's much easier to track if someone does have a possible case of COVID, a possible exposure.

So you want to look for those plans that the school has put into place. At the end of the day, though, you have to really think through your home environment, whether or not you have people that are higher risk, and your own comfort level. You

Know, it's interesting that you bring that up because my son, who's a senior in high school, or will be a senior in high school this next year, they just came out with the information for his district, and that was one of the things they mentioned was, that there were there would be an option-- distance-learning or appearing in person, but with some obvious restrictions. So that's something that we're debating right now and going through. He doesn't want to stay at home, which I can't really blame him, but we also want to make sure everybody's safe.

And so these are challenging conversations. And Dr. Bartlett, I don't know if you have any thoughts on, how do you talk to your kid about this? You want-- you want to stress safety, but you also-- they don't want to stay inside forever.

Absolutely. And it is really tough. So I have three boys-- 10-year-old twins and an 8-year-old. So staying inside and calm and quiet is not in the plans for us.

Not in their DNA is it?

It is not. And it's a really-- it's a busy time. But it's important to talk to them. And they're pretty savvy, not just because their mom does infectious diseases.

Sure.

I think one of the things that a lot of younger kids notice is all the people out there who aren't following the rules. Why do I have to wear this mask? Why do you have all these stupid rules, Mom and Dad? It's just the same as-- so-and-so can play Fortnite and you won't let me play Fortnite, but there's all these not following rules. And so you have to have a discussion about why it's so important.

And kids these days are amazingly resilient, but also thoughtful. Right? And so they get you're doing this to keep other people safe-- if it's more specific-- Grandma and Grandpa safe. They get it, that we do things for other people. This struggle about school is real. My twins are probably going to be in the same class, which they haven't been since they were three. I don't think it's going to go well, necessarily, for them, but epidemiologically, that's one fewer exposure that all those kids in classes have.

Yeah. You know, I'm old enough to remember when seat belts started to be required in cars. And people fought that and fought that, and now it's just a natural thing to do. And of course, that's protecting yourself and the masks, obviously, are protecting others. So it's just-- I think it's just education.

They're both habits that you need to just get used to.

Exactly. So we have some specific questions coming in from viewers that are good ones. And I want to get to-- I don't know who wants to take this first one, but let me read the question off. My son has had a bone marrow transplant here, actually, about six years ago. So is there any advice for his condition during COVID-19? And that's certainly a valid concern. Obviously, you want to watch your children-- particularly they've been through a situation like that. I don't know who wants to take that one?

I think Dr. Bartlett, maybe.

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I think Dr. Zhang is perfectly able to, as well, but I'm happy to. So we don't know a whole lot about what might increase the risk of children for having a severe Coronavirus infection. There's more information in the co-morbid conditions in adults-- diabetes and high blood pressure and chronic lung disease. There are not a lot of kids with bone marrow transplants who've gotten COVID, because there's not a lot of kids who've had bone marrow transplants.

But we do think that that's probably an at-risk group. But I suspect that of all the families that we encounter in our lives, wearing masks and paying attention to not being around sick people and washing your hands is something that you guys just do as a matter of habit before and after COVID. So I think that really following the same sort of rules and considerations that everyone else is, especially when we're all being so careful, is the right thing to be doing.

So Dr. Naylor, I've got a tough one for you. And this is one of those questions that I think probably a lot of families are struggling with right now. And it's a tough one. The question is, is it safe for grandparents to visit a 12 year-old grandchild or grandchildren and family who don't believe in wearing masks?

Oh, yes. So you told me it's going to be a tough one.

That is a tough one, yeah.

Yeah, so I will actually speak from my own experience. My grandmother is visiting in Chicago-- not me, she's visiting my aunt. And I am going to take my children to see her. And they're going to wear masks. And they're-- we're not actually going to hug. And she's been here for more than two weeks, because she lives in Arizona. So that's a state where their control is-- they have a lot of COVID cases.

I know that my grandmother will not be happy with that interaction. To her, you're family-- you hug, you do all these things. And it's going to be a bit awkward, but that's how it's going to work, because I have to keep my children safe and I also have to keep her safe, you know? I work in the hospital, my youngest is in daycare. And so we may-- we have some potential exposures that I'd want to protect her from.

So I think in the COVID era, you just have to be tough and say, this is how-- these are the circumstances we will visit under, and otherwise, we cannot have you guys in contact.

Another question from a viewer I'm interested in daycare for younger kids-- two years-old. Mask complaints in that age category is likely low and hygiene and hands in mouth is high. What should I do? And I don't know who wants to take that one. Dr. Naylor maybe you could jump on that one?

Yeah, I will take that one, just because I have a kid in daycare. So my daughter is almost three. And you know, the daycare-- and I mentioned this before, when we think about school, you want to know what the facility has put into place. So once the daycare reopened, first off, they initially only reopened to people, to parents who were essential workers. Now they've expanded a little bit more. They have capped classroom sizes. You know, they keep all the teachers-- sometimes teachers would float around. That doesn't happen anymore.

So again, it's all about trying to keep the same group of people together, so that if there is an exposure, you've at least contained it. When we go and we have to answer every single morning five questions about our daughter's any exposures, any fevers, any symptoms, things like that. They temperature-check at the door. We drop her off outside. They take her inside. We're not allowed in. No stuff from home is allowed in. Obviously, for the younger kids, like the infants, they can have their formula and/or breast milk. But that's it. Like nothing can come in.

So you want to know that there's lots of precautions, and that's the first thing. There is a discomfort. Like I mentioned before, each family has to assess the members in their household-- what it means that they are potentially getting exposed. For myself and my husband who are both health care providers and going in the hospital setting, part of the day care is just a necessity.

And it's also that we ourselves have some exposures and I think that makes us-- I don't know what the word is-- it's certainly it's not lack, but it makes it seem that the balance of her going to take care is reasonable.

I will say, I don't think the kids do a great job keeping that mask on, but certainly my daughter puts it on herself. She asks for it. And so just as Dr. Bartlett was saying before, if you normalize it kids will get it. She says-- she's like, where's my mask? And you know, she'll say like I'm wearing my superhero mask, because I say superheroes keep people safe. You're putting it, on you're keeping people safe.

I think that's a great piece of advice, too, to kind of make it fun for the kids or give them that little hook there-- you know, it's their superhero mask. And you know, I remember, again, way back when my kids were younger and trying to burn into their brains that first of all, they had to be in car seats, and secondly they had to wear seat belts when they got a little older. And eventually, it's just second nature. And they won't even get in a car without putting a seat belt on now. It's just everybody's used to it. So I guess it's kind of the same thing.

So more questions from viewers-- should I get my kids tested for COVID before visiting grandparents for the first time since February? What do you think about that one?

I actually had this discussion with my physician parents before I took my children to see them. And I think it depends on a lot of things. One is where you're living and what the prevalence is in your area. So I think a lot of the things that we're talking about, the plans that we're making, are taking into account the fact that Illinois right now is at a much better place that a lot of other countries. The other thing I would take into account is what you have been doing for the past, essentially two-week period prior to going to see them. Right?

If you have been increasingly getting out and about and going and taking the kids to the grocery store and going to restaurants, your risk might be higher of having acquired COVID as opposed to just staying home and having one parent go to the grocery store once a week.

So the other point to remember is that just because you have a negative COVID test today, doesn't mean that you don't have a COVID exposure that may develop into an infection in a few days. So it really is that 14-day quarantine period, and then because of the risk of being asymptomatic, always wearing masks and socially-distance, unless you decide to expand your quarantine family.

Now the question from a viewer, how is contact-tracing going at UChicago? Are we able to notify all past contacts at campus within 24 hours? And Dr. Zhang, I don't know if that's one that you can handle for us?

I'll be honest, I'm not familiar with the contact-tracing program. You're welcome to pass it on to me. Contact-tracing is a really difficult labor-intensive process. And so I'm not exactly sure if the viewer is thinking about in the context of undergrad university, university? Or sort of within the hospital system?

We, in the hospital system, work on making sure that all of our patients are staying safe, our health care workers are all wearing masks and eye protection when they're seeing patients, and being socially-distant in a way that, for now, the contact-tracing becomes less critical, because really, we are really reliable in our personal protective equipment.

But I know there's-- we all wish contact-tracing across the country was up and running at a more stable way than it is now.

You know, I just know from personal experience, that our contact-tracing appears to be working pretty well. It seems like the contact with potentially-exposed folks has been pretty fast.

It is, and we have wonderful access to testing. And I think one of the most important things is our testing results are coming back in a day-- for our patients who come in and get curbside testing. Knowing a week from now that I was contagious today is not particularly helpful.

Yeah, it's interesting you bring that up because I was fortunate enough to get to see our lab area where we do the testing for the samples. And those folks are working 24/7. But it's amazing the output that they've been able to manage and the work they've done. So they really deserve a lot of credit.

Absolutely.

They're working very hard through this. Another question from a viewer, what's the implication of the recent WHO statement on airborne transmission? Does the Illinois guideline on reopening of child care facilities reflect the possibility of airborne transmissions? Not sure who wants to take that one.

That may be you, again, Dr. Bartlett, I'm sorry.

I was going to let you, but I'm happy to. This is-- hospital epidemiology Twitter is ablaze with controversy about this. And it really-- is an argument for argument's sake. Someone put a nice Monty Python clip on just having an argument for argument's sake. We make a big distinction artificially about what size particles are leaving your mouth. Are they big and they fall to the ground rapidly, are they small and they go a small distance? When of course, there's every size. And so really, rather than focusing on how long it's hanging around in the air, what we've seen from our lived experience is the vast majority of cases are not transmitted that way. And wearing a mask prevents either of those from happening.

And so people who have a lot of free time on their hands are welcome to go argue about it. I'll put my effort into reminding people to stay away from other people and wear their masks and wash their hands.

So Dr. Zhang, shields versus cloth masks-- that's another question we had from viewers. Personal preferences or is one actually better than the other? What are your thoughts on that?

Yeah, so I think when this all started masks was the way to go. And we didn't think about putting on face shields. And the difference is, the face shields, you know, gives us a little bit more protection for eyes. But in general, if everyone is wearing a mask, you know it-- the eye thing may not be as relevant. And so cloth masks should suffice.

Cloth masks, in and of themselves, have differences-- from mask to mask. It really depends on the layers within the mask itself. And there's also differences in the actual material that forms the cloth masks. Somethings like t-shirts, you know, when masks were being made by t-shirts, those may confer a little bit less protection compared to masks say made with higher thread counts.

And so there's differences within masks, as well. I understand you know for some people, masks, just for whatever reason, whether it's claustrophobia or whether it's really hot outside, and they really don't like something covering their face. A shield could also be a viable option, as well. I would say those are less commercially available. Correct me if I'm wrong, Dr. Bartlett, but generally speaking for the general public, cloth masks should suffice.

Sounds good. And Dr. Naylor, this is an interesting question. There's a lot to unpack on this one, but somebody clearly put a lot of thought into it. I want to get your thoughts on this. The question or comment from a viewer is, kids do not seem to have the burden or severity of COVID disease relative to adults, but public officials seem to continue to advocate policy that impact children based on adult-driven data. How can we better advocate for the children of Chicago to ensure appropriate policies that are more specific for kids? What are your thoughts on that one?

Yeah, so I'm putting some of my own interpretation on it, so hopefully I'm answering the question they're thinking of. You know, kids are expected to wear masks. Kids who are two and older and don't have a medical condition that would make it unsafe for them to do so, should be wearing their masks. And the reason for that, again, is when we're wearing a mask, we're protecting people from us.

If they're wearing a mask we're getting protected from them. And even if the burden of getting COVID or more likely the burden of having very symptomatic COVID seems lower in children, which is wonderful-- that's not usually how diseases go-- but they can spread it. And so the more people who have it, the more at-risk everybody is. So ultimately, it doesn't really matter if the population we're thinking of is at a lower risk for either getting it or getting severe disease, the more people who have it, the more everybody is at risk-- including children, who can have that outcome.

So we want everybody doing hand-washing, masking, and maintaining social distancing because that keeps everybody safe, including children who have that out.

We've got two more questions for viewers that I want to get to. We're about out of time, so we're going to do these quickly, if we can. The first one, and this is a viewer from Arizona, which is nice. We're in Arizona schools and schools are set to open soon. In the midst of our high numbers, would you keep your kids at home and learning online if you were in our shoes? Now that's-- I know that's kind of a tough thing to tell somebody to do one or the other, but I don't know? Do any of our physicians have thoughts on this? Arizona--

My parents live--

--it's kind of a hot spot.

My parent's live-- yeah. My parents live in Arizona and I wouldn't be sending my children. That's just me, personally, but I wouldn't be sending my daughter to daycare. I wouldn't be sending my older two daughters to school.

Excellent.

Not while it's a hot spot.

Final question, oh, now we've got two more, but we're going to do one more. I'm in need of a kidney transplant. Are you doing transplantation surgeries, or is COVID-19 still a priority?

So yes, COVID-19 is still a priority, in that this is a new normal and we're learning how to operate in these conditions. But absolutely, our medically necessary transplant program is up and running. And actually, we've been doing quite a few transplants, and got back to it sooner than many were. We really have built a strong environment around the institution of infection prevention for influenza, and Clostridium difficile, and all of the other hospital things. And this is something we've been training for all along.

We're wearing more goggles than we were before and eye-shields, but really, we are open for business in a way that is safe for the patients and safe for our health care workers. We have fewer visitors that we're allowing in, to just decrease the number of people around and make social distancing easy. But yes, we are absolutely open for business.

And I'm glad we got that question, because I think that is important to stress to people-- this is a very safe place and it's a safe place to come receive care. In fact, even the design of the buildings, which we talked about last time you were on the program, which you were you were instrumental in, is they're set up to make it safer. So it's a very safe place to be. If you do need care, you certainly shouldn't put it off, because that's important.

Absolutely.

That's all the time we have for the program. You all were fantastic. That was a lot of fun, a lot of good information today. We'll have another At the Forefront Live. That will be next week, so just remember to check out our Facebook page for our schedule of programs coming up in the future. And also, if you want more information about UChicago Medicine or COVID, please take a look at our website at Uchicagomedicine.org if you need an appointment, you can us a call at 888-824-0200. You can also schedule your video visits by going to the website.

Thanks, again, for being with us today, and I hope you have a great week.

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