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Transcript For 'Vermont Health Official And Winooski Mayor On Children And COVID-19'

This transcript is for the Vermont Edition show, which aired Monday, June 22, 2020. 

Jane Lindholm: This is Vermont Edition. I'm Jane Lindholm. Kids are not immune to COVID-19. As we've seen in the recent outbreak centered in Winooski, nearly half of the positive tests associated with that outbreak are in kids. Though the vast majority in both children and adults in this outbreak were not showing symptoms when they tested positive. Child care centers have been allowed to be open for a few weeks in Vermont now after being closed in March, alongside schools. And summer camps are starting up, those that were able to operate at all this summer. As summer progresses, Vermont schools are also trying to figure out how to open safely for in-person instruction in the fall. So we thought we'd do our Monday health update today with a focus on children and look at what's happening in Winooski with the city's mayor a little bit as well. We're joined now by Breena Holmes. Dr. Holmes is the director of maternal and child health for Vermont's Health Department. Nice to have you with us. 

Breena Holmes: Hi, Jane. Great to be here. 

Jane Lindholm: So let's start with a little bit of an overview about what is known so far about kids and this virus, because that knowledge and information has been evolving over time. I mean, obviously, this is such a new virus to begin with, but how it affects children, how often they're affected by it, whether and how they transmit the virus. All of this keeps getting updated. So let's start with how often we think children actually contract the virus at all. 

Breena Holmes:So a great way to start. It is one of the most unusual viruses for pediatricians in that kids are the lowest percentage affected. And the younger the kid, the less likely to be infected with the virus. So it appears with all of the international and the national data so far that in kids under 10, it's less than one percent of all the cases are kids under 10. And that in kids about 10 to 18 or 19, it's somewhere in the three or four percent of all the cases. So we're talking about a very low percentage. 

Jane Lindholm: Why do you think that is? I mean, that's not typical for most coronaviruses, right? 

Breena Holmes:That is correct. So I was going to say at the top of the hour with you all that I am a pediatrician and I am not a pediatric infectious disease specialist. I have incredible colleagues at UVM who have been guiding our work from the start. And the infectious disease folks read all the studies every day and keep me up to date that so far not a clear explanation. We're just grateful because it's for people that take care of children. It's much less of the outbreak or of the pandemic. 

Jane Lindholm: That must be so different, though, because as a pediatrician, you're used to a lot of runny noses and coughs and young kids coming in with all sorts of things and then giving it to their parents and caregivers. And so does it feel strange to have this one be in some ways a very different kind of coronavirus?

Breena Holmes: Yeah, it's been a shift in the way we talk to each other and to parents, but a really important shift that's based on science. I think to your point, one of the hardest parts has been we need to exclude kids who are sick from child care and schools so that they are symptom free when they return. But we do that knowing that the vast majority of kids that we're asking to stay home do not have coronavirus or covered. So it just is an important feature of our response, as you know, that sick people stay home, all aged sick people. But when we do that with kids, we know that we're sending kids out of their developmental opportunities and in the fall out of their school environments for run of the mill viruses. 

Jane Lindholm: Well, not only that, but given how frequently people who have covered 19 who have an active case of COVID-19 are asymptomatic, and that seems to be especially true for children. You may be turning kids away who are symptomatic, but have something else. While children who are asymptomatic but don't have any reason to think they may have COVID-19, but do could still be in their child care setting or in their school.

Breena Holmes: No, that is correct. It's one of the many, many, many complexities of this place we find ourselves during the response. And I am not the expert to talk about asymptomatic spread, but I am very happy to report with numerous studies that almost all the kids who tested positive for COVID-19 received it from an adult and almost all of them. It was a household contact. So in one CDC study, it was 91 percent of children who tested positive for COVID-19. They had a household contact who had COVID-19. So we have so much to learn about this in the weeks and months ahead. But we're standing in a very good place knowing that this virus is not being spread readily by children. 

Jane Lindholm: We're talking today about the coronavirus in our Monday health update. But we're focusing specifically today a lot on children and what's known about children and COVID-19 with Dr. Breena Holmes, who's the director of maternal and child health for the Vermont Department of Health. Dr. Holmes has also been working with child care centers and camps and schools in figuring out the best approach to reopening safely, safely, not just for students, but also for caregivers and staff members at these places. Dr. Holmes, you mentioned what's known so far about children who are acquiring the virus, who are getting the viruses that have been transmitted by an adult. You said, and most often an adult in the household. Why is it an important distinction to point out that children are getting the virus from an adult? 

Breena Holmes: Well, it kind of heads us into a really important community conversation about cloth, facial coverings and the recognition that adults around children need to wear them. Because they are more likely to transmit the virus to a child than the other way around. And so, as with a lot of things with this virus, we're really counting on each other to put the mitigation steps in place to prevent other people from contracting the virus. And in pediatrics, that's especially noted that adults around children are giving them the virus. So there's that piece. And, you know, also acknowledging, I think, as we think about child care in schools, that there's low transmission to child to child. That doesn't mean they're zero and there are some studies of one child contracting the virus from another, but in general it's less transmission, which is why the physical distancing piece of our littlest kids, you know, which is impossible, and we acknowledge that right at the beginning with child care, keeping two year olds six feet apart was not possible. But as you layer in that working on hand hygiene and keeping sick people home and also acknowledging that kids, when they are with each other, have a lower risk of spreading to each other. It's all part of the layered risk discussion, an important conversation that we need to all be having. 

Jane Lindholm: Yeah, it's interesting because I hadn't necessarily thought as much in the guidelines for child care centers and the ones that are coming out for schools, which are hoping to start in-person learning again in the fall, that the guidance for having all of the adults wear the masks and not the children was also a guidance designed to protect kids from adults who could have the virus. I mean, that makes sense. You know, everybody's supposed to be protecting everybody. But specific to that question of adults giving the virus to kids, that wasn't sort of clear to me that that was part of the reason for having the adults wear masks, even in a child care setting where you might have infants and two and three year olds who aren't wearing masks. That's interesting. 

Breena Holmes: Right. I mean, I hope Vermont knows we work so beautifully as integrated public health and clinical medicine are very well integrated in Vermont. I think in particular in pediatrics. And so the fact that pediatricians and infectious disease specialists are talking and meeting frequently is a really nice sort of bedrock to all of this guidance. So the child care, the summer camp and the school guidance were all informed by those without physician teams and thinking, OK, where's the nexus of science and common sense and how do we bring the best information forward to protect our kids? 

Jane Lindholm: We got a note from Christina who says, Can you include guidance about how to think about outdoor activities now like camp versus indoor school when it starts in August? 

Breena Holmes: Sure. So just a little shout out to our team. I mean, we have four public health nurses who answer the phone or do e-mail every day, all day from child care providers and now summer camp directors, Parks and Rec people and school nurses have started to come into our fold as we think about schools reopening. And those folks do a lot of nuanced guidance about the difference between outdoor and indoor settings. And what I will say is our original guidance described the wearing of cloth facial coverings for the adults all the time. And we changed it. We've actually revised that document three times since the beginning of April. And in changing it, we included much more specifics that outdoors you can take them off as long as you're six feet apart. And we really want to encourage people to see the commonsense piece of this that they're absolutely required to and the science is really there that they help us prevent the spread of this virus. But you've got to take breaks from them, especially in this heat. And when folks are outside, that's the perfect opportunity to take a break when you know you're not going to run into someone that's six feet mark. So the guidance is already pretty clear on the difference between indoor and outdoor facial covering wearing. But what I always ask folks when we do when we talk is if it's not clear or if you want more clarity, give us that feedback and work. This is the most iterative set of guidance we've ever had. And we do change it every three to four weeks, depending on the feedback. 

Jane Lindholm: Could you talk about the difference between child care settings and schools in terms of asking the kids as students to wear masks? Because it appears in child care settings and it appears that in camps as well, children are encouraged to wear masks when and where it's appropriate, but not required to. But the guidance coming out about schools when schools start up again in the fall says that kids should be wearing masks whenever it's possible to do so. 

Breena Holmes: Yeah, that's correct. So the way we do guidance is with big teams of people and stakeholders and a lot of great thinking, always grounded in science. So when we very quickly had to stand up emergency child care for the essential workers in March, like literally the day that child care closed, it reopened for emergency child care for essential workers. We recognize the developmental stage of most kids in child care, the littlest. And we said, let's try to do the cloth coverings for developmental appropriateness. Let's figure out because we didn't know. Can kids tolerate the feeling? Will they want to model their behavior after the adults around them? The CDC only said children under two should not wear them. They didn't give us any guidance above that age. So we went with recommendations for children and it has worked beautifully. The innovation of child care providers and the acceptance of children trying them out, knowing the difference between wearing them when they're close up with their friends, but taking them off when they're distancing. Completely heartwarming. Incredible example of child care providers and children just coming along with, you know, this terrible pandemic and adapting. And then we had also youth serving organizations and we had school age kids that were getting care all during March, April and May. And we at that time, were thinking we'll do the same with those kids, will recommend it. And that worked beautifully as well. And then summer. And once we started thinking about summer in schools, we realized there was gonna be some nuance here. That summer is outside and we would leave the recommendations strong and hope that because everyone had learned how to do it, they would be wearing them, which is bearing out. And then we had a very different group that came together for the reopening of schools because we had a longer on ramp. And as you know, for the public education system, there are a lot of stakeholders. So we had infectious disease doctors, pediatricians, psychologists. We had superintendents, principals, special educators, Agency of Education folks, public health. And in that very thoughtful daily process, for several weeks, we landed on requiring them with children. And I think it's a lot about the indoor space that's ahead for us when kids are sitting together in December. It's about learning the habit and that kids are really in the groove now. But there's always the issue for developmental appropriateness. And I'm sorry I'm talking so long, but this is such a hot topic. We need everyone to understand that this was informed by child development and pediatricians really do and psychologists, we know that there's a whole subset of Vermont's children that will not tolerate a cloth covering for many hours during the day. And we're going to have to be adaptable to the specific needs of children.

Jane Lindholm: Right. So in that sense, there are paragraphs within the guidance that say if a child can't wear a mask because of certain reasons, then they shouldn't be required to. And similarly, if a teacher or someone who's working with that child needs to take off their mask even within a six foot range, that is sometimes allowable and appropriate. 

Breena Holmes: Yes. So we're having very important conversations about the district level implementation of this important guidance. So superintendents are going to figure out their communities and their teachers. And what are the individual needs of the staff in their buildings? But from a perspective of public health where we are requiring them for the adults. And as you noted earlier, as we discussed, the adults spread this virus to children. So we're gonna start there. But on the individual basis, if there are medical reasons why folks struggle or can't wear them, then we're gonna have to figure that out. And we did in child care. There were definitely providers who struggled with the wearing of them, but they took frequent breaks and they tried on different materials. As you know, there are many, many, many brands and cloth and, you know, strings versus elastic. And I think we're gonna still set the bar that this is a central mitigation strategy and we're gonna do it. 

Jane Lindholm: Let's go to Barry, who's calling in from St. Johnsbury. Hi, Barry. 

Caller, Barry: Hi there. Pleasure to be here. I had a question about something from much earlier in the segment. I was wondering if you could explain how experimentally or analytically you've ruled out that children aren't spreading the virus to adults? I imagine at some level it might be based on the onset of symptoms, but couldn't that be different in children populations versus adult populations? Furthermore, if it's based on some analytic, you know, frequency of children who are infected versus adults, couldn't that have to do with behavioral differences as adults have to go out and run errands that children just don't have to do? And I'll take my answer off the air. Thanks so much. 

Jane Lindholm: Barry, thanks for the question. Barry was going in and out a little bit. So, Dr. Holmes, just to repeat, he's asking, how do we know or how do you know that children don't transmit to other children or to adults? And I don't think you said they never do. But so far, what's known is that you said typically it's adults transmitting the virus to children rather than the other way around. So how do you know that? 

Breena Holmes: Well, first of all, I really encourage you to have pediatric infectious disease specialists. They would be much more able to quote all of the literature. I do know that most studies show that when kids are with each other, they're not passing the virus. There are a few cases and case reports out of other countries that do show child to child transmission. So I want to be clear about that. I think the most interesting part was your early question. What is it about a child's behavior that, what is the hypothesis of why that is? And that would be important for our infectious disease colleagues. There are interesting theories about the force of children's cough and the force of the way they speak is not as aerosolizing. But that's the only theory I'll put forth today because I'm not the right person to talk it through. 

Jane Lindholm: Now, let's go to Carol, who's calling in from Westmoreland, New Hampshire. Hi, Carol. Nice to talk with you. 

Caller, Carol: Hi. Good to be here. I have a question concerning the ages of children. So I work in a high school. And my question is, are high schoolers up to the age of 18 in the same bracket as the younger children who are not spreading the disease as much? 

Jane Lindholm: Carol, thanks for the question. Dr. Holmes?

Breena Holmes:Hi, Carol. No, older kids transmit it more than younger kids, but not as much as older adults. So as you age up, as you head from zero to 18, more kids contract the virus and more kids to spread it in the high school setting and your education colleagues in which I am not one, but I was part of the task force that wrote the guidelines for reopening or are grappling with that right now and deciding how does this look in a high school setting to reopen schools, which will be different than an elementary school. 

Jane Lindholm: And different again from colleges and universities, which are also really struggling with how to do this and how to maintain financial stability if they can't have all of their students there and how to have professors who are teaching, he'd have to in person and have to zoom rooms. I mean, how are you working at all with the college level questions around this, Dr. Holmes? 

Breena Holmes:You know, I am peripherally involved. And many of the principals are the same. And except the residential components of college make, you know, very big challenges. But the idea, the cohort of kids and that sort of upper level high school, college, university are still at low risk for the virus. But it's just higher than that zero to 10 or 12 age group. And the reason that was so important is that some of the public health guidance is just so hard to heed when you're two or three or four, or any age. But the littlest I feel so confident that so few of them have the virus that if they do need to be in the lap of the caregiver, it's still a low risk situation. 

Jane Lindholm: Is there a problem with having an I mean, under two year olds aren't recommended by the CDC to wear masks. Is it a physical health problem to have young people wear a mask? Is it just a compliance issue or are there other sort of developmental issues and perhaps mental health issues that go along with very young children being required to wear masks that you're considering? Or is it some mishmash of all of those things? 

Breena Holmes: The primary reason for the under two is just cognitive capacity to understand. And, you know, the conversation with a two year old or under was not going to be developmentally appropriate. And what we find so fascinating about the work we've done with these incredible child care providers is there's a subset of three and four year olds who just get it and they put the cloth covering on and they never look back. And then there's a subset that it's just it's more difficult. And then eventually some of them come around because their peers are doing it. You know, it tracks beautifully with the child development team as kids come into the sort of preschool ages, there's much more awareness of each other. That's when they come out of the parallel play, you know, when they start to say, huh, I don't want to wear that thing, but everyone else is. So there's some beautiful, beautiful posters and work going on with, you know, teddy bears and posters that say make a choice. You can play alone with no cloth covering. You could play with a friend six feet apart or you can play with a friend closer if you choose to wear one. It's all about choice. 

Jane Lindholm: Yes. So much of parenting is about giving children choice, isn't it, that the choices that you'd like them to choose from. Let's go to Rachel, who's calling in from Shelburne. Hi, Rachel. What's your question? 

Caller, Rachel:Hi, thanks for taking my call. I have a question around transportation. We run summer programming for kids and have to transport. In the past, I've been transporting kids to our job sites, mostly high schoolers and middle schoolers for summer camp activities. We have policies in place to make sure kids are in the backseat. But we are in the car for sometimes greater than fifteen minutes here. Up to 45 minutes, maybe two hours sometimes. I'm just wondering if there's any guidance around that or if that's even appropriate, at this point. 

Jane Lindholm: Dr. Holmes?

Breena Holmes:Thank you for your question. There is guidance in the both child care summer camp and schools about transportation. I will tell you, and maybe should have said at the beginning, there are really five solid public health strategies to prevent the spread of the virus. And one of them is the distancing. But we recognize in transportation that one isn't as easy to follow. The advice we give, which is frequent, is to double down on the other four. So no one sick gets on that bus or that van. Hand hygiene, hand hygiene, hand hygiene, wash down your surfaces, doorknobs, seats. Everyone's got a cloth covering on. And then the fifth would be the social and physical distance that it's impossible to be six feet apart in most transportation vehicles. So but keeping kids in assigned seats and making sure folks are facing forward with those other strategies, you'll be fine. 

Jane Lindholm: We're talking about children and coronavirus today with Dr. Breena Holmes, director of the maternal and maternal and child health for the health department in Vermont. And we're also going to talk for a little while now with the mayor of Winooski, which is a city that's had an outbreak centered there and an outbreak that, in fact, has involved a lot of young people. Winooski Mayor Kristine Lott, thank you for joining us today on Vermont Edition. 

Kristine Lott: Hi Jane, thank you for having me. 

Jane Lindholm: Do you have any understanding of why so many children have been impacted by the outbreak that was centered in your city? Because it's a little under half in children of the people who've tested positive are children. 

Kristine Lott: Yeah, my understanding is that the majority of these positive cases are multiple cases in one household. So I think a lot of what we're seeing is within the same household where there are families with children, transmission occurring. We don't have, you know, specific details of who is a positive case or what the household is made up of. So I can't really speculate too much further on that. 

Jane Lindholm: You don't have that information or you can't reveal that information? 

Kristine Lott: The health department does not reveal to us the specific households or individuals where the cases are located. For privacy and protection. 

Jane Lindholm: So how do you then reach out to your community to see what the needs are, what the worries and concerns are, and what you and other city officials can do to alleviate perhaps some of the reasons why there might be an outbreak in your city? 

Kristine Lott: Well, we have, since the beginning of the pandemic, had a weekly meeting, weekly phone call with various community leaders. So we've got city staff on there. Some of our faith leaders are on the food shelf. The director of the Housing Authority, USCRI and AALV. So a lot of folks that are providing services and in contact with various parts of our community. And so that's been a way to keep tabs on if there are concerns coming out, if there are resources that people need and when-- 

Jane Lindholm: And can I just stop you for people who are unfamiliar with the acronyms that AALV is the Association of Africans Living in Vermont and USCRI is related to refugee resettlement? Right? 

Kristine Lott: That's correct. These are two of the big service providers for new American members of our community. 

Jane Lindholm: And why is it important? I mean, just lay out why it's important to make sure that you have those organizations represented and the people who they work with represented, as you think about ways to address coronavirus in Winooski. 

Kristine Lott: Well, there are different needs for different communities and certainly primarily linguistically speaking. We want to make sure that any materials that are going out, any education that's going out has gone through translation interpretation. The Department of Health has been funding the multilingual task force, which we have been participating in as a city to try to do that work. But we're also able to talk to folks from these organizations and find out what's working and what is not. Are there particular needs for these? For example, some of these families are larger in size with more family members in the same household. And so their needs for support, if there is a positive case, could be different. If there are, you know, folks aren't able to isolate a single bedroom and bathroom. So it's important to hear from representatives of different areas of our community, what they are hearing on the ground. 

Jane Lindholm: Now, Mayor Lott, at some point toward the beginning of the outbreak, there were questions about what the health department is saying, you know, we need to make sure that our materials are provided in many different languages and communities. Municipalities also need to make sure that people who speak other languages in their community are able to access all of the information about how to protect themselves, where to get testing, et cetera. And, you know, I've also heard some pushback to that idea from people who are saying to organizations like VPR, you're buying this line that it's about translation services, it's not about translation services, it's about population density. In some cases, it's about poverty. And this line that translation services, or a lack of ability to understand something in another language other than English are one of the factors is a red herring. How do you address that? I mean, then we're also hearing from community members who say, no, actually, we do need more translation services. So I'm interested in how you would sort of navigate through those issues. 

Kristine Lott: Well, it's complex and there is no one solution. Translation is important. That is something we have heard from community partners. But it's not just translation. The language that is used can be a barrier even for American born, English speaking residents. You know, hearing I need to quarantine might not make sense to you. You might not know what that means. So we really need to be cognizant of the language that we're using, being accessible, having multiple languages available to us, but also having a consistent message, because I think that has been part of the that's been confusing to some folks as well as the response to the outbreak or to the entire pandemic has shifted from staying home primarily as much as possible to now being able to go out in public places. There's just a lot of updates and things to keep up with. And so we're trying to get that out there in a consistent way to as many people as possible. And something I'm very cognizant of is that we have our sort of standard channels of communication as a city. And then we also work with these community partners to try to reach even more of our residents. But there are folks out there who aren't involved with any service providers, who don't follow city updates. And how we're getting to them, I think, is a bigger question in the future. 

Jane Lindholm: What kind of impact does population density and being an urban environment where there are a lot more people in, you know, sort of crammed into a smaller space, have and the socio economic factors of that as well. Because obviously, you know, there's poverty throughout the state and that doesn't always have any connection to population density, but it can in an urban environment. How are you addressing that? 

Kristine Lott: Well, we have through the support of the state and the Department of Health, been offering residents support for food and having food delivered to their home. Housing support, maybe some rent subsidy if they're unable to go to work and they need help with that. You know, we've heard about folks who have thought they might be sick, but we're still going to work because they simply don't have the choice to stay home and still be able to meet their needs and support their families. So trying to connect those resources and make sure people know they're available to them has been really key in helping folks who need to isolate and not have to go out into the community. I think it's certainly true that density is involved here. It's just easier to come into contact with more people in an urban area than it is in a rural, more country setting. And I think that plays out in where we have seen outbreaks throughout the nation. 

Jane Lindholm: When the governor started to allow restaurants to have outdoor dining and now indoor dining, he mentioned at the very beginning this is a statewide, you know, opening of the spigot. But different municipalities will be able to make different rules. And if certain ones would like to restrict restaurants and other retail establishments from being able to open at the same capacity as the statewide limits, they're able to do so. How have you thought about that in Winooski with the idea of restaurants being able to reopen and perhaps even indoor dining while still dealing with an outbreak? 

Kristine Lott: So we have our staff and have regular contact with a lot of our business owners and our business community. We talk to them about their ability to, you know, implement these guidelines. What is their desire to do so? We've had some businesses open up their outdoor dining and others just stick to curbside and delivery. We've also had discussions with folks at the Department of Health so that we can make data driven decisions in how we're responding. You know, our understanding to date has been that a lot of this transmission has been among families and personal interactions vs. people being out in public or inside of a business together. And so we are following those guidelines that we are just like the rest of the state right now. You can come to our businesses, you know, so long as you follow those tenets of public safety that Dr. Holmes is outlining. But our businesses have the choice in how they're going to respond to that. And so we have had some that while this outbreak was occurring, canceled some events or pulled back on how much they were willing to move forward with reopening. 

Jane Lindholm: Are you encouraging people to come to Winooski? I mean, we're not encouraging people from other communities around the Northeast that have as high a case of viral load as Chittenden County does to travel to Vermont. But do you think Vermonters and others from places with lower case counts should be traveling to Chittenden County now? 

Kristine Lott: We are following the same guidelines as everyone else. The Department of Health has not indicated any major concerns. It is just as safe to come here and patronize a business as it is anywhere. So long as you wear your mask. Keep your distance. Wash your hands. Like I said, our understanding is that the outbreak is following the trends that they would like to see at the moment, the numbers are not increasing and they have been in contact with, you know, the close contacts for these cases. And as far as we know, those folks are isolating and people are following the precautions that they need to. 

Jane Lindholm:Kristine Lott is mayor of the city of Winooski. Thank you very much for taking the time to join us today. 

Kristine Lott: Thank you for having me. 

Jane Lindholm: Director of maternal and child health for the Vermont Health Department, Dr. Breena Holmes is with us today answering questions about the novel coronavirus and looking more deeply at some of the ways we're learning about how children are affected by this virus. And Beth is calling in from Brattleboro. Hi, Beth. What's your question? 

Caller, Beth: Hello. Hi. My question for Dr. Holmes is, what are your thoughts about plastic face shields for children? And I asked for a couple of reasons. One is kids who can't wear masks. But the other is for socialization and facial expression and going back to school and meeting teachers you've never seen. And I don't know. I just think I mean, I'm a mental health professional and there's something about facial expression that is so rich and important. So I'm curious about your thoughts. 

Jane Lindholm: Thanks for the call. That's Dr. Holmes, what do you think? 

Breena Holmes: Think this has been one of the most important iterative pieces of our work. So for all the reasons Beth just described, we think face shields are a reasonable alternative. But we have to be clear on a few points. One. We still think the first line is cloth covering for most. And that's because of the way of the viral particles and the droplets. So face shields are an important second line for communication. So folks that read lips for people and children in particular who don't tolerate the cloth covering, but if they're they need to be fitted well and go all the way down to the chin because of the little droplets condense in the inside of the shield and then drip down. There's some risk associated with that. So this is a really important nuance. So the answer is yes, and. We also want to make sure folks know that the supply chain of something like a face shield might not be available or or cheap for many, many communities. So we also have such a long journey since March with supplies to get this right that we didn't want to add. Another thing you have to go procure, however, amazing community partners have stepped up and found these shields, made them really inexpensive and figured out a way to get them to our communities, especially for the care of children. So it's a yes. And we have some good scientific backup articles for those that question their use of them. it's being tested in all sorts of settings and it's a reasonable alternative. 

Jane Lindholm: Are there any specifications that people need to know about for face shields? Because there are some that appear to be fashion face shields that are totally open at the bottom. I mean, like, what do you need to know about a face shield? 

Breena Holmes: Oh, I am definitely not on the engineering side. I just know from this one article in the Journal of the American Medical Association to come as far out toward the ears and down to the chin. Those are the specs. But honestly, we've received several photos and asked us public health folks to weigh in on them, which is a little bit of an awkward background. But we are willing to take a look at people's shields to see if that at least meets that. The size has to be substantial, has to cover the whole face. And I do appreciate it from the mental health perspective. We've done some really interesting conversations with pediatricians and child care providers about facial cues for children when they can't see your mouth. And what can we do through our eyes? And there's some really neat studies about kids responding to our eyes, you know, especially because we're going to. We don't want this, but, you know, we need to do this. So trying to find a little bit of a bright spot that it's going to be OK for child development has been successful. 

Jane Lindholm: Just before we leave this sort of clear and clear covering conversation, there are people who are also making masks with a clear plastic covering in front of the mouth so that your mouth is visible to those who have hearing loss or who might need to see your mouth. Are you seeing some of those questions? 

Breena Holmes: We definitely are. Yeah. There was a time when they were backordered there were some national companies making them for the hearing impaired adults and children. And I heard they were backordered briefly in March, April. But I think we're back on a good supply chain there as well. 

Jane Lindholm: We got a question from Audrey who says, How do cloth masks affect children with asthma? 

Breena Holmes: Oh, it's a great question. You know, asthma is a really important wide variety of symptoms. So there are some kids with asthma that have very minor symptoms and they do great with the coverings. And then there are other kids who are quite ill and unfortunately, kids that have significant asthma, which in medicine we call either moderate or severe, which is a medical category. They really aren't good candidates to be in child care right now. So they're on the list of chronic conditions in children that we would want pediatricians to work with families, parents and child care providers to determine whether they even should take that risk to be in a care setting where there may be other kids. And also the decision about the cloth covering. So case by case. 

Jane Lindholm: Does that extend to school, as schools reopen? 

Breena Holmes: Yes. So, this summer, we're bringing together a group of special educators, children with special health needs, medical folks, teachers, parents and some health department staff to think about the special health and educational needs of children heading into the fall. Because when you look at that CDC list of what are the chronic conditions in adults and children that put you at higher risk for this virus? Some of those are pediatric diseases like severe asthma. So we have to create what I call and is known as team based care, where these decisions are made case by case about who would what is the risk to a child with a health condition for face to face learning, and what are the educational priorities in that arena. So a lot of individual case work ahead. 

Jane Lindholm: Well, speaking of casework and figuring out things on a broader scale. Joanna wrote in to say, I was under the impression that we didn't really have adequate data on transmission in children and carriers without symptoms. These are such important decisions, I would think we'd want the most robust data possible. And then Joanna also goes on to say, Are the effects of COVID-19 more significant in the under 12 months of age group? So I think that's sort of a comment and a question there from Joanna. 

Breena Holmes: Yeah. So, first of all, I completely agree. The more science, the better. And there are studies coming out every day that are going to keep either confirming what I said earlier or start to say, you know, there was actually a set of circumstances where kids were transmitting and we're going to learn more and more every day. And this is a very humbling viral experience for all of us in the scientific field. And we will stay up to date. But so far, the preponderance of the studies show minimal transmission kid to kids as described earlier. And then the second part. Remind me of the second question. 

Jane Lindholm: Are very young infants so under 12 months of age, what are the effects of COVID-19? And are they more significant? 

Breena Holmes: So the last time I looked, we didn't have anyone under one in Vermont who had tested positive for COVID-19. So it is a rare experience to have an infant with the virus. And so I don't know much about that because that has not been a part of the Vermont response. 

Jane Lindholm: So let me ask you about something else that I don't know of any cases of in Vermont, but I assume you have some knowledge of because it's been a big concern, an inflammatory illness that can be associated with young people getting COVID-19 in it. My understanding of it is that it's not necessarily a symptom of the virus that sometimes occurs after what appears to be sort of an active case of the virus in a young person. Can you talk about this serious complication? 

Breena Holmes: Definitely. So the term it's now an official CDC reportable disease called the multi-system inflammatory syndrome in children. And it is, as Jane described, it appears to be post-viral, post-COVID-19 set of circumstances where children develop multi systems within all the different organs that become inflamed. And they have some evidence of shock, meaning that their blood pressure drops and they have trouble with their cardiovascular functions. Super, super rare, extremely serious. And we're on the lookout for it in Vermont. But we have had no cases. So we put out a one pager for our parents. We want all folks who are in the presence of children to be on the lookout for this unusual set of circumstances. But so far, nothing has been reported. I do know that it's similar to something we're very familiar with in pediatrics, which is called Kawasaki disease, that most children you can support through it. And it is sort of the medical treatment of multisystem inflammatory syndrome that is well understood and known to hospital physicians. So we're at the ready. There were several cases in New York several weeks ago. This is also, interestingly, more common in older kids, not seen very often under 10.

Jane Lindholm: Let's go to Rebecca, who's been waiting on the line from Salisbury. Hi, Rebecca.

Caller, Rebecca: Hi. Thank you for taking my call. I. I was interested in the reporter who mentioned that it appeared that a good many protesters were a large percentage of protesters were wearing masks as one cluster of people that the--

Jane Lindholm: So, Rebecca, your line is going in and out. But I think you're asking about tracking compliance for things like mask wearing and protocols from the health department and the state on what people should be doing to mitigate or limit their risk. As someone who works for the health department, Dr. Holmes, do you know about compliance tracking and do you think that would be helpful?

Breena Holmes: That's a great question. There's no compliance tracking to date. It's all anecdotal. You may hear this isn't so much true the last few weeks, but the health commissioner was doing his own, he was going to various supermarkets around and counting. And he's feeling quite hopeful that the number of people wearing them is increasing in all settings. I actually do think that's true as well. But in terms of compliance, no, I will tell you, we talk about it every day at the health department. What do we do? How much more behavior change could you do with talking and radio and social media and, you know, health professionals reminding people and how much would have to come into some sort of regulatory arena? And there's a wide range of belief systems about that in Vermont, whether it should be mandated or just strongly recommended. And other states are having similar debates. 

Jane Lindholm: Are you satisfied with this state of Vermont's response so far? 

Breena Holmes:Oh, gosh. So, so satisfied, so proud of this administration and my health department colleagues. It's been an extraordinary professional experience. 

Jane Lindholm: That's Breena Holmes. Doctor Holmes is director of maternal and child health for the Vermont Department of Health. Thank you very much for taking the time to talk with us today, Dr. Holmes. 

Breena Holmes: Thanks for having me, Jane.

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