Dr. Wendy Slusser 00:02
With over 1.4 million students in kindergarten through 12th grade, Los Angeles County schools had the enormous task of protecting the health and safety of its children. When the COVID-19 pandemic hit, teachers and administrators quickly became experts in online education, and environmental health and safety. UCLA pediatrician and medical epidemiologist for the LA County Department of Public Health, Dr. Nava Yeganeh, joins us today to address concerns for our children and discuss how schools continue to respond to the pandemic to ensure the safety of their students. Dr. Nava Yeganeh, such a pleasure to have you here on our UCLA Live Well Podcasts. I’m really looking forward to talking to you about concerns regarding children and COVID, something that’s very top of mind for parents as schools are opening back up and in person instruction is taking place. So to start off, what can we look forward to with this return to in person education?
Dr. Nava Yeganeh 01:09
Well, it’s really wonderful to be here. Thank you for having me on this podcast. So we are all very excited to resume in person education. As you know, COVID-19 has obviously had a devastating effect on our society. More than half a million individuals have died in the United States, and millions have fallen into poverty. Some people are losing their homes and livelihoods, struggling to feed their families. But we also appreciate that this devastation has not only been felt by adults, but by the children, especially those low income children and children of color. The silver lining is that we know so much more about the pandemic. And we know exactly how to now mitigate the risk to children and to adults as well. And so we can really, hopefully, help create these safe environments for in person education and allow our children to resume a more normal sense of well-being.
Dr. Wendy Slusser 02:02
That is really top of mind for so many people with their children having missed a year and a half at school, some two years. And I’d like to know from your point of view, what are some of the main concerns that these parents might have going back to school at this stage?
Dr. Nava Yeganeh 02:18
Yes, I think every parent that things that they want from their child is to be healthy and to be happy. And they want their children to enjoy school, but they also want their child to be safe. And like you mentioned, kids haven’t been in school. Some kids haven’t been in school for 18 months. And although they’re incredibly resilient, it is a scary time for a lot of children and parents. It is going to be a transition, and some families do better with transitions. Some struggle a little longer. And I think it’s very important for all of us to be really patient with each other. And to have a lot of compassion as we all try to navigate, you know, this new change and new time in our lives.
Dr. Wendy Slusser 02:56
So what I’m hearing you say, Nava, is one, it’s a transition, which might require different kinds of focus areas to work on as a parent or caregiver, or child. And the other is make sure people are safe.
Dr. Nava Yeganeh 03:12
Exactly. I think all of us here, you know, and I work for the Los Angeles County Department of Public Health, as well as being a pediatrician. I’m looking at the epidemiology and trying to figure out how to keep people safe. And that’s really our focus is to create these safe environments for children can thrive and develop more well-being.
Dr. Wendy Slusser 03:31
And so these health and safety concerns, they’re really now bifurcate, I would think between the under 12 year olds and the over 12 year olds, given the approval of the vaccine. How do you differentiate that in policy? And is there any difference in the way you handle those different age groups at schools?
Dr. Nava Yeganeh 03:52
Yeah, and I think overall, the way that we’ve been thinking about COVID-19 is that there’s not one clear way to mitigate all risk, that you really need to have a layered approach. And so for children less than 12, I think, again, you know, there’s layer strategy. So really improving ventilation in the buildings as much as possible, whether that will be through open windows and doors and affordable HEPA filters and improving filtrations in school systems, which I think many schools are taking advantage of some federal funding to do that. And then we also need masks. So with another layer of protection is, you know, making sure every individual wears a well fitted mask that covers their nose or mouth and their chin. And then finally, you know, even though kids can’t get vaccinated, and that’s, of course, very frustrating. We know that the adults can get vaccinated. We know that the older kids can get vaccinated. We know that the parents and grandparents can get vaccinated. And we’re hoping that, you know, with these high vaccine rates and these vaccine eligible people, we can kind of cocoon the children as much as possible. But it really does require everyone in the community to take advantage of the vaccines. So it is definitely something of concern.
Dr. Wendy Slusser 05:03
Yeah. Well, clearly, if you look at the national statistics, the vaccination rate really does impact the prevalence and also the hospitalization and even mortality rates from COVID. And so what you’re saying is the onus is on all those eligible to get vaccinated to protect our next generation or less than 12 year olds?
Dr. Nava Yeganeh 05:22
Exactly. I mean, that’s the entire idea behind vaccines. If you are able to get enough people vaccinated, you really do cut the transmission significantly. And even if this vaccine isn’t the perfect vaccine for the Delta variant, there are some breakthrough cases. First of all, it is incredibly powerful to prevent hospitalizations and deaths, like you mentioned. The second it does seem to decrease transmission as well. So if you’re able to get in that high enough level of vaccine, you are going to cut down transmission significantly.
Dr. Wendy Slusser 05:54
Yes. So you talk about this layered approach, brings to mind Michael Lewis’s book, The Premonition, and his description of that layered approach being thinking about Swiss cheese and putting Swiss cheese on top of each other. So eventually, there’s no way you can go through it from each hole. And one of your layered approaches you mentioned were masks. To the parents listening, what would you recommend them to use for their children?
Dr. Nava Yeganeh 06:22
Yeah, so I think this is a an area of intense interest as well. In general, the mask that I recommend is the mask that your child will wear and is comfortable for them. So something that they can keep on their face for the entire duration of school. And a lot of kids are doing extracurricular activities and sports, and they still have to wear the mask. So they’re, they find the mask uncomfortable, they’re not going to keep it on their face. So number one is comfort. As far as quality of masks, we want masks that have multiple layers. And if you’re able to do it, you know, to have that extra filter. Like there’s the masks that have the area that you can add an extra filter. And then some people’s kids actually tolerate surgical masks, as long as they’re appropriately sized for their face. I think there is some benefit to having a higher quality mask. So it really depends. I think, in general, the mask that I would recommend is the mask that your child will wear and just trying out different masks. And making sure they fit their face comfortably, especially for younger kids, to like be able to teach them how to adjust their masks and pull them on and off. I have a five year old, and I noticed that if I have a certain type of mask, he’ll keep it on. Other masks, the lanyards sometimes slide off his face. And he just doesn’t notice. He doesn’t really, you know, he doesn’t adjust it appropriately. So just making sure that your child is able to keep their mask adjusted on their face in a way that is protective.
Dr. Wendy Slusser 07:42
That’s really a pediatrician being practical. And I so agree with you. And also being a mother of a five year old and a nine year old, that helps too. You know exactly firsthand how to advise people. I want to back up a little bit about what you said about filters, so people are aware of what you’re describing. Because they’re, the filter you’re describing is one that would fit into a little pocket of the cloth mask that was often made homemade even. But the filter itself you purchase. That’s what you meant, right?
Dr. Nava Yeganeh 08:15
Exactly, that’s what I meant. There’s these little rectangular filters that you can put in a pocket of a mask, and some masks come with that pocket already. And there, so you just slide in the filter to add additional protection.
Dr. Wendy Slusser 08:27
The other question I have, if you were to use a face covering that was reusable, how often would you wash it?
Dr. Nava Yeganeh 08:33
That’s a good question. I tend to wash my children’s face coverings every day just because they tend to get dirty. They are very active children. They wear them all day. They’re wearing them indoors, outdoors. So, you know, I do like to wash them regularly. I think if the face covering is soiled, if it’s wet, it’s not going to work as well. So I would say to have more than one face covering for each child for their day at school, so they can replace them in case they get wet or dirty.
Dr. Wendy Slusser 09:02
Ah, so bring an extra one in their backpack. That’s a great tip. And you hand wash them.
Dr. Nava Yeganeh 09:08
Yeah. And now I’m hand washing them. He’s using a type of face covering that is has been really great for him for sports. It’s more of the duckbill. So it doesn’t get into his mouth as much when he’s playing sports. And that one requires hand washing. Yeah, I would just follow the instructions for the face coverings.
Dr. Wendy Slusser 09:27
You are an infectious disease doctor and also a pediatrician, and you talked about transition. What advice would you give to families with the transition and how to alleviate fears of the child who might also be fearful of infection or safety issues?
Dr. Nava Yeganeh 09:44
Yeah, I think every child is really unique. And I always say that every person has this unique relationship with COVID-19 and the pandemic. So some of course have lost loved ones to the disease. They’ve seen how it can devastate a person they adore, you know, they love. All obviously suffered some losses, but it’s different levels. So I think it’s really important to gauge your child’s concerns and questions about the virus. And so I think, you know, asking probing questions like, “Do you have any questions about this virus that’s going on? What do you understand?” And then, you know, being very calm and reassuring and being able to answer their questions. The other thing that I think is very useful is to try to have your child do specific things to feel in control. So talk about how they can keep people safe, whether it’s through hand washing, wearing their mask, being able to adjust their mask themselves. And then letting them know that even though this is devastating, you know, tragic pandemic, there are a lot of ways to prevent infection. And to make sure they understand that there are vaccines that prevent people from getting sick. There are treatments if someone does get sick, and there’s ways to prevent getting sick. So I think giving that information to children will help them feel a little bit more in control of the situation.
Dr. Wendy Slusser 11:04
So one is having a sense of control for the child and the parent, sounds like. And also anticipating the day and what the day would bring for their child. What do you advise parents? If you get a question that says, “Well, my child is more of a follower, and if their friends take the mask off, they might take their covering off?” What kind of advice would you give to that parent?
Dr. Nava Yeganeh 11:29
Yeah, I mean, I think that, again, every child is so different. But I think it’s very important to help them understand why we’re recommending masking, and how important it is to just to keep their body safe. That it’s meant as a way to improve the health and safety of everyone in the classroom. That being said, we here in California, especially in Los Angeles, we’re requiring masking. It’s not really an option when you’re indoors. When you’re outdoors, I think some, there’s some more flexibility, especially if you need a mask break. And again, we are trying to have as much flexibility and compassion for people who maybe have a lot of discomfort with the mask. So we do want to acknowledge that and give them a space to take it off and take a few deep breaths. But in general, it is mandated in Los Angeles County that every single person wear a mask for the duration of the school day, especially, you know, indoors.
Dr. Wendy Slusser 12:22
I like that concept. So instead of recess, you know, go outside, six feet apart, and take your mask off and smile at everyone and wave.
Dr. Nava Yeganeh 12:32
Yeah, and some schools aren’t allowing that. So I don’t want to say every school, but for LA County, we are requiring indoor masking. They’re not requiring outside, so that would be a good time for someone, who’s really struggling with a mask, to take a break. Yeah, we just need to have compassion and empathy for people who might have a more difficult time keeping that mask on. It’s a process for all of us.
Dr. Wendy Slusser 12:52
Sure is, and it’s an ever changing fluid process, isn’t it? What age do you recommend using a mask?
Dr. Nava Yeganeh 12:59
So I would follow the AAP guidance. To start after the age of two. Again, I think that it is a process. So a two year old is learning how to potty train and learn using, learning how to use their words to ask for things. So there’s a lot of processes going on. So some two year olds will need a little bit more time to learn how to use their mask appropriately, and some get it right away. But just being patient and ensure they know you’re doing it to improve their safety.
Dr. Wendy Slusser 13:26
There are a couple of areas I’d like to talk a little bit about with you. One is the first stage of sheltering at home in March of 2020. Give us sort of a 18 month, sort of 30,000 foot description of the process that has happened with the school district in regards to COVID.
Dr. Nava Yeganeh 13:47
So as you mentioned, I think was March 12, March 13. That’s when most schools and Los Angeles County, if not most of the world, shut down. And at that time, it was a very quick transition to distance learning. So the buildings shut down. The teachers were trying to navigate this unknown territory of doing a lot of distance education, getting technology to every student. And I think that was a period that was very difficult because there was no preparation. Going into the summer, I think there was a lot of hope that we could reopen schools, that maybe there would be some opportunities for in person education. But unfortunately, some places, again, started having a surge in the summer. And because of those high numbers, especially in Los Angeles County, most districts chose to remain distance. So going into the new year, they had a little bit more time to prepare. There was more resources available to families to do the distance education. And so again, most students stayed at home. As you know, we started reopening in the fall. Unfortunately, then we had our second, very large surge end of 2020, November and December of 2020. So again, there was less enthusiasm about restarting schools at a time when we had such high community case rates. So distance education was continued. Starting in 2021, our case rates started going down. We were able to give vaccines to the most vulnerable in our communities, including and, you know, grandparents and skilled nursing facilities and health care workers. And then by March, we were able to start vaccinating teachers. And I think that really made people feel like going back to in person education would be a safe option. And Los Angeles County, that’s where a lot of schools began opening, was in spring of 2021. Most of the individuals who were in the public school districts decided to continue distance education. They had, you know, a lot of anxiety back going back to school. So children were going to school, but a lot of them were still doing that distance learning.
Dr. Wendy Slusser 15:51
In your role as an advisor to the school district: What was your role at that stage? And what did you advise? And what did you observe as we were opening?
Dr. Nava Yeganeh 16:02
So in the spring, when our case rates were to a level where we felt very comfortable opening the schools, there was a lot of advice being given about how to maintain safety in the school. Going back to school in the era of the pandemic requires a skill set that many schools had not developed yet. So as a school administrator, you are now holding vaccine events for your faculty, or staff. You are also doing exposure management and contact tracing. So you’re, you know, finding people who are infected, trying to figure out who their close contacts are, and working with the Department of Public Health to identify these individuals and asking them to either isolate if they were infected, or quarantine, if they were exposed. You were also trying to navigate the system of making the school more safe. So you were learning about ventilation, and filtration, and HEPA filters. So you were learning how to encourage masking. There was just a lot we were asking our schools to do in a relatively short amount of time. And again, they went beyond what we asked, often. They really did want to make the school as safe as possible. But it does take time. And again, this was a big transition for us to ask schools to start bringing students back in for in person education. Again, the schools that did it, did it very successfully. With a group at LA County published and MMWR that was out today, that showed that our case rates were actually much lower in the schools as compared to the case rate for children in the community. So schools were very safe and this spring.
Dr. Wendy Slusser 17:33
Dr. Nava Yeganeh 17:34
Yeah. So going into the summer, we all had a lot of enthusiasm thinking that our case rates were really very low. And we were very excited to reopen schools. Of course, in the middle of summer, as you know, the Delta variant became the predominant strain of the virus and transmission rates went up. Our case rates started going up again, unfortunately, schools had to reopen for all students, kind of in this background of a higher community transmission rate than we hoped. But again, schools are committed to creating safe environments for their student body, and they’ve done everything. And at this point, they’re becoming experts in exposure management, of creating safe school environments, of doing vaccine clinics for their students and their staff. And they’re really looking at different ways to continue to keep kids safe and engaged in schools.
Dr. Wendy Slusser 18:24
That makes me proud of the Department of Public Health here in Los Angeles and also the partnership that they have with LA schools. I wanted us to go back to the MMWR that you mentioned. Can you please translate the acronym MMWR for our listeners and also the significance of actually publishing something in that journal?
Dr. Nava Yeganeh 18:46
Yes, so the the MMWR is a morbidity and mortality weekly report. It’s a series of publications that the Center for Disease Control publishes every week. And so it really is trying to, it’s so it is a series of reports. They’re usually brief. It’s trying to give you as much information about what’s going on on the ground all over the United States in a very timely manner. So they try to get the publication out quickly, but it does go through a peer review process. So it does go through several different groups at the CDC, the Centers for Disease Control, to make sure that that reporting is accurate.
Dr. Wendy Slusser 19:23
So your finding: Can you explain it one more time to the audience so that they can really understand and why it’s so important that it did come out at this stage where people are opening up schools.
Dr. Nava Yeganeh 19:35
So the MNWR really looked at COVID-19 case rates, looking at transitional kindergarten through grade 12 and the community, and it looked through the dates of September 2020 to March 2021. And I think it’s important to note that we have 1.7 million children who are age five to 17 years old in Los Angeles County. And what it really looked at was comparing the case rates amongst children and adolescents and adults, who were in school, versus those who did not attend school, who were in the community. And you could really look at the figure where they show that it seemed like the case rates per 100,000 were higher in those who were in the community versus those who are attending in person education.
Dr. Wendy Slusser 20:18
Wow, that’s really powerful message for everybody to hear, especially parents who are very concerned about returning their child to in person education, that they might be actually safer in the schools based on what you’re describing.
Dr. Nava Yeganeh 20:31
Yeah, I think it’s because we have such a high standard for safety at schools right now in Los Angeles County. We are really recommending every single mitigation strategy layered on top of each other. It’s much harder to do all of that in the home setting, obviously, wearing your mask all the time, being in well ventilated spaces. It’s much easier to do them in a school where children tend to listen to the adults.
Dr. Wendy Slusser 20:56
I think that that study and that data is really reassuring for parents to hear. I mean, as a parent and a pediatrician, that would be very compelling information for all of us to be sure our children go back to school, not only for the advantages of in person learning that many children really thrive in, but also the fact that it’s also potentially safer for them in the long run.
Dr. Nava Yeganeh 21:24
Dr. Wendy Slusser 21:25
I’m thinking one point that I think would be important for our listeners to understand is you’re talking about case rates. And are you talking about hospitalization, death, or the prevalence in the community.
Dr. Nava Yeganeh 21:38
Currently, we’re seeing high case rates of people who are diagnosed with COVID-19. We are doing a lot more testing in Los Angeles County. We’re doing hundreds of thousands of tests every single week. You can actually look up the data for how many tests we’re doing. But we are really robustly testing, especially in the schools. So many of our schools are screening children once a week to see if they have COVID-19. So we are expecting that because we’re testing so much we are going to see a higher number of case rate.
Dr. Wendy Slusser 22:09
Dr. Nava Yeganeh 22:10
Hospitalizations are creeping upwards. So that is unfortunate. It’s mostly predominantly unvaccinated individuals. And we are seeing a creep upwards in death as well. But again, unvaccinated individuals. So if we were able to get more individuals vaccinated, I think we would not see as many hospitalizations and deaths. And we could really prevent a lot of our transmissions in our cases, and again, keep our school safe. Because if you have lower community rates, you’re going to have less cases in school, you’re going to have less quarantining.
Dr. Wendy Slusser 22:41
Yeah, that’s a very important point, drill home to everyone. And again, to keep our children safe, and Pfizer’s now approved by the FDA for adults.
Dr. Nava Yeganeh 22:52
Yeah, so they received full licensure for 16 and above. Yeah.
Dr. Wendy Slusser 22:57
So you know, you also not only have been providing guidance to LA Unified School District about COVID, utilizing your infectious disease expertise in pediatrics, you also provided advice to the pre-K through 12 workgroup at the UCLA COVID-19 Response and Recovery Task Force. I just want to let our listeners know that this workgroup was specifically looking at the needs of pre-K through 12 at UCLA related to COVID issues, which is something that many people might not realize that UCLA also teaches and cares for zero to 19 year olds. But also the goals were discussed, new county guidance documents, track relevant data for reopening pre-K through 12. And I’d love to hear your words of wisdom about what you learned from that experience.
Dr. Nava Yeganeh 23:52
Working with a leadership for the pre-K through grade 12 group was really just such an honor. They’re just a fierce group of leaders, who really were willing to do whatever it took to create a safe environment for children. I would say that the things that I learned is that you have to be flexible, and it is really a very dynamic time. So I remember when we first started the ECE, the Early Childhood Education Group, you know, they reopened very quickly after. I think it was in June, so June 2020, that’s when they reopened. And we didn’t have as many of the guidelines and research showing how to keep schools safe. And that data and that landscape was very much evolving. As we, we were trying to build the plane as we flew type situation. So we learned, you know. Initially, we were just keeping the kids outdoors, but we weren’t using masks. Then data and recommendations came out about mask use, and then we were able to incorporate masking into our guidance. Then there was data and science showing the usefulness of HEPA filters. So again, that was something that we were able to incorporate. And, it just shows how incredible the leadership and the teachers were, that they were able to really roll with the punches and continue to serve the children throughout all of these changes that were almost weekly. So that was a wonderful experience. But I think the flexibility was key. And then also, we were just very lucky because we had the resources and support of UCLA. You know, UCLA has a great testing infrastructure in place. UCLA’s campus is beautiful on and outdoors. They have a engineering team that can come and help us with our ventilation systems. There are physicians who can help with symptoms monitoring, the symptoms tracking, so that, you know, there was so many resources available that maybe other districts would not have at their disposal, so.
Dr. Wendy Slusser 25:44
As I recall, a lot of those children were the children of first responders, right? So it was really critical to have that resource for people so their children can be watched, while they served either in the hospital system or on the campus itself. And so the lessons learned really sound like bringing together a group of people with varied disciplines to focus on a group or a problem that you did very effectively in terms of opening up the pre-k part of this pre-K through grade 12 system doing in person.
Dr. Nava Yeganeh 26:23
Most of the schools did have in person education last year. But I think that was really nice, because we had principals in that task force. They had a lot of lessons that they learned from each other, but also, they each had their own specific concerns. Even if we couldn’t solve their specific problem, it was good to have a group to hear about what they were experiencing.
Dr. Wendy Slusser 26:44
Really having this major stakeholders and leaders and at the table during the crisis was a critical piece to the success of reopening.
Dr. Nava Yeganeh 26:53
And I think so much of navigating this pandemic has been about communication. Communicate, not only amongst the leadership, but also with the stakeholders. And that includes the teachers, the labor groups, the parents, and of course, the kids.
Dr. Wendy Slusser 27:08
Yeah. So Nava, that’s tremendous. And hats off to you and your team for being such good advisors to our school system. We’re really grateful that we have you and your colleagues thinking about this, and really problem solving in a way that’s really giving to all of us. So I’d like to end with two questions. One is, do you think there’s anything that we’ve learned that is positive during this time, from your point of view from this pandemic?
Dr. Nava Yeganeh 27:36
Well, I think we’ve learned again, that we are stronger as a community, if we all think about each other and really work collectively towards shared solutions. You know, we can’t just depend on individuals to do the right thing. We need everyone in the community to work together, whether that’s wearing masks, whether that’s you know, getting vaccinated. We really do require every single person to do their best and do it for everyone else in our community. As far as schools go, I do hope that some of the money that’s being allocated to COVID-19 relief efforts is actually improving the infrastructure of the school. So I’m hoping that some of that funding is going to change the schools in a very positive way that will have lasting implications for years after this pandemic, whether that’s just improving the filtration systems, but also just recognizing the importance of digital technology and how we can actually incorporate that into our education systems.
Dr. Wendy Slusser 28:32
Yeah, and I’ve heard a lot of schools are also building outdoor spaces for learning, which will totally enhance not just learning, I think, but also well-being.
Dr. Nava Yeganeh 28:42
This is the most important thing, maybe we can do again. Probably the safest school for COVID-19 is one that’s outdoor, so the more we can utilize outdoor education, the better, then the safer we are.
Dr. Wendy Slusser 28:53
Well, to end this, what keeps you up at night?
Dr. Nava Yeganeh 28:56
You know, I think the the thing that keeps me up at night is that inequities. We just know that a lot of times, the pandemic has widened the inequalities between those who have resources and those that don’t. And I really hope that we can start addressing some of these gaps. So I think that’s really what my focus and the focus of the Department of Public Health is, is to make sure that everyone has the same opportunities for things like in person education, for vaccinations, for appropriate access to health care, things of that nature, so.
Dr. Wendy Slusser 29:30
Yeah, that’s really important. And you were talking a little bit before we started this podcast also about sport opportunities, or athletic opportunities, need to be equally available to all.
Dr. Nava Yeganeh 29:43
Exactly. And also, people have fallen out of their regular routine. So they’re not going to their pediatricians quite as often. They’re not up to date on some of their vaccines. They’re not getting their well child checks, which are really important for helping prevent health issues. So I think that’s the other concern I have is making sure that everyone, every child has a medical home and is able to get appropriate preventative care, as well as treatment.
Dr. Wendy Slusser 30:10
Yeah, that’s a really important message. All those parents who’ve deferred the checkups, please go. Because your child might even need a pair of glasses. And they’ll learn better with those if they can go and have their eyes checked even. And of course, vaccinations not only for COVID, but they are eligible for all sorts of other vaccinations. And that’s something that we could pursue at this stage, flu vaccine being one of them.
Dr. Nava Yeganeh 30:36
Exactly. And, you know, there’s a lot of vaccines that are required for schools, and a lot of children still haven’t been able to catch up. So really trying to get you, get kids back into their medical homes to get all these really important and preventative checks.
Dr. Wendy Slusser 30:50
Well, Nava, this was a really informative, powerful conversation with you. Thank you so much for everything you do. And you are a real treasure for all of us to have a resource like you to be able to guide all those millions of children, who really need to be cared for not only by their parents, but by our community and our public health system. So thank you for that.
Dr. Nava Yeganeh 31:15
Thank you. Thank you so much for all you’re doing to improve the health of kids as well.
Dr. Wendy Slusser 31:22
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