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'We Don't Want To Go Back To School In The Middle Of A Surge,' Says USF Health Pediatrics Chair

A video by Hernando County Schools shows children wearing masks with desks spaced six feet apart
A video by Hernando County Schools shows children wearing masks with desks spaced six feet apart

The number of cases of coronavirus is rising every day in Florida, including among children. As of July 10, more than 17,000 people under 18 in Florida had tested positive for COVID-19, according to state health data.

WUSF’s Kerry Sheridan spoke with Dr. Patricia Emmanuel, chair of pediatrics at the University of South Florida Morsani College of Medicine, about what this means for back-to-school plans.

What's your view of the situation, with cases rising in Florida right now?

Well, we're certainly in a very concerning time, with the positivity rate and the number of cases that have increased. This has been the most challenging time period for us in health care right now in Florida.

Schools are considering opening now, and I was wondering what you think about the safety of that?

One of the things that I think has challenged all of us in this epidemic is what a changing landscape it is, how frequently guidelines have been changing. Our knowledge is emerging very frequently. And then, there is the epidemic itself. We breathed a sigh of relief in April and May when it appeared that we had flattened the curve in Florida and we were not having a lot of new infections. But now we certainly are in a surge.

So I am a proponent of going back to school. I do agree with the American Academy of Pediatrics that school provides just so many things even beyond education. However, I hope that we can provide our schools with flexibility and guidance and resources more importantly, to be able to go back to school safely.

Dr. Patricia Emmanuel is a pediatric infectious disease doctor and chair of pediatrics at the USF Health Morsani College of Medicine
Credit USF Health
Dr. Patricia Emmanuel is a pediatric infectious disease doctor and chair of pediatrics at the USF Health Morsani College of Medicine

Do you think there's any kind of measure by which we could know if it's safe? I've been hearing public health experts and doctors say it really depends on the situation on the ground. Is it a case where we should see declining cases for 14 days? Or a certain level of virus in the community?

Certainly that has been the original guidance. If you look at the phased plans that we have seen from the CDC and from other organizations, we do want to base our decisions on the data. And it's very local data.

For example, Florida is a very big state with very different epidemics throughout the state, and very different infection rates. So I think that the local districts have to utilize their data and look at the number of flu-like illnesses, the number of ER visits, and the test positivity rate, and make sure that we are making progress.

We don't want to go back to school in the middle of a surge. I would think that would not be beneficial.

And we are in the middle of a surge right now.

We are, although we are starting to see some data this week that is very reassuring. We're starting to see a little bit of a decrease in our hospitalizations and a stabilization in our positivity rate in Hillsborough County. I'm only speaking about our region. But it remains to be seen how that progresses.

And there has been some research about children being less likely to spread coronavirus. I was wondering about your take on that. What do we know about the risks of children spreading this?

Some of that data comes from China as well as from Europe. In general for most viruses, children are the vectors, you know, they are little petri dishes full of viruses and they bring them home. Any new parent who has a child in kindergarten knows that.

However, with this virus, it does appear to be different in that the majority of children get the virus from their family, they're not the ones bringing it home, they are getting infected from their home. And so there does not seem to be as much spread.

There is some basic science evidence that children may not get infected as frequently because they don't have the receptor that the virus uses. They don't have as high numbers.

But we do know for sure children do get infected. They have the virus. They can pass that virus, so I don't want to give a wrong impression. It's just that they are not passing it as frequently as adults.

The Florida Department of Health puts out statistics on children who have the virus. These numbers  have gone from around 7,000 three weeks ago to 11,500 two weeks ago to last week about 17,000 pediatric cases (those under 18) of coronavirus in Florida. And also then when you look at some of the positivity rates of the testing, they're very high. What do you think of these numbers? Do we understand what's going on here?

First, we have known that children account for -- and in this even with 17,000, we have almost 300,000 positive cases in our state. So it's still less than about 5% of all infections, and only about 2% of all hospitalizations.

So children are not getting tested as frequently, partially because they're not as symptomatic so they don't go to the hospital, they don't go to the emergency room as much. And it is not quite as easy to get testing universally and in every place for children. So the numbers are definitely lower.

There is a high positivity rate and most likely that's related to children who are getting tested are those that are sick. They are sick enough to go to the emergency room, or to go to the hospital, or their pediatrician is testing them. So they are high rates. So we know children are getting infected, they just may not be as symptomatic.

Do you think we know enough yet about how much they really spread it to make a decision about whether it's safe to go back to school?

We don't know everything. By far. We're still learning as you can tell, you know, we're changing the guidelines all the time and the literature is coming out very rapidly. As an infectious disease physician, I can tell you, it's hard to keep up with all the literature that is coming out and kind of assimilate it. But we do know things that work and what has worked in other countries in terms of social distancing, masking, cleaning. That can help with going back to school.

I think the most important thing is that these are going to be really individual decisions. Parents have to look at their own family's risk, their child's risk, and talk with their school and with their pediatrician to help decide what's best for them. I hope that we will have the opportunity to have in-person school, and that it will be safe. And there'll be a lot of mitigation measures to help. But it's all going to come down to individual decisions.

On the topic of individual choice, a lot of people are saying we have to give parents the choice. But it's interesting in a public health perspective, if some people choose to wear masks or some people don't, we end up putting other people at risk by the very nature of that choice?

I agree with you. I think that masks should be mandatory in school, and I'm very glad that Hillsborough County commissioners agreed to that. Because in school, if we don't have a universal policy, if you have a 13-year-old who isn't wearing a mask, then none of them will wear a mask. So I do think if people choose to send their child to school, they have to follow the rules. There can't be that individual choice.

Another area that's very interesting is whether we should mandate flu vaccines for every child that goes to school. We're concerned about the interaction of both influenza and COVID at the same time, and so we can prevent a lot of influenza disease with vaccines. So I think that there is an onus on families to keep themselves and their child safe, but also to keep their community safe.

And are there any recommendations you feel you'd like to weigh in on? Maybe you haven't heard much of, or that needs to be heard more in the community?

I think we need to continue to make wearing a mask a social norm with our children. I think that younger children -- not under two or three -- but younger middle and elementary school children can learn to wear a mask if they are modeled and their families embrace it. I also think it's important that we teach children about distancing, washing their hands, and make sure that their vaccines are up to date.

We can't forget, as I mentioned earlier about influenza, the other important vaccines. Right now in Florida, our numbers of MMR vaccination for kindergarteners is not what we would like. All we need is a different viral epidemic on top of COVID-19. So don't forget the things that we always do, like the well-child check-up before school to get your child vaccinated. Those are very important.

And I hope that everyone stays safe and washes their hands and wears a mask.

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