September is normally an exciting time for parents and kids alike as it marks the start of a new school year. Kim Parlee speaks with Dr. Vipan Nikore, Chief Medical Director at TD Bank, on how best to keep children healthy and safe in school while COVID-19 cases continue to rise.
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- September is normally an exciting time of year for parents, where kids get to go back to school. It is particularly exciting this year because a lot of kids of course, have been missing that in-person time. And of course, we're waiting to see what's going to be happening with regards to protection and measures in schools because of COVID-19. Here to give us his take on what he thinks might be happening is Dr. Vipan Nikore. He's Chief Medical Director at TD Bank. Dr. Nikore, always great to have you with us. Let's just start with what you think we should be preparing for. Kids are going back to school. We've got rising cases with the Delta variant. What do you expect to see?
- Well, thanks for having me back, Kim. I think what we're going to see in the fall, we will see a spike. I think it's inevitable. You have a large group of unvaccinated people who are going to be congregating in various areas throughout the country. And I think it's inevitable we'll see a rise in cases. I think the question is, how much of a rise will we see? And for how long, and in what areas? And I think the answer to that is that it will be very regionally based. It will depend largely on how many of the parents of those children are vaccinated, because that's the number one factor in terms of spread amongst children.
So if you have a school with 100% of parents vaccinated, it's going to be very different than if only 60% of parents are vaccinated, as an example. So when we look at regions and communities, we think about the baseline, active number of cases, the vaccination rate in the community, and the protocols of the schools in that region that will determine how big of a spike we're going to see. And of course, kids do do pretty well, generally speaking, with the virus. So it's not all doom and gloom if we do see a high number of cases in a region of course.
- I want to touch on the fact, because one of the things, of course, is if these kids going to school are 12 and over, you know, obviously there's probability they will be vaccinated. They're allowed. Those 12 and under are not yet. Do you have any sense of when we're going to start to hear more about vaccinations for kids under 12?
- Yeah, it's a good question. So under 12, likely there'll be two different cohorts, sort of the 5 to 11 age group, and the below 5 age group. 5 to 11 will likely come sooner. There's some data going to the FDA, hopefully by the end of this month, that'll be analyzed over the next month or two after that. And as early as potentially October, November, and hopefully at least 2021. And then I would say for the under 5 group, probably trail about a month or so behind that one to two months behind that. So again, obviously depends on what that data shows. But obviously, this has been an outstanding and amazingly efficacious vaccine that I think-- I'm hopeful for the results of those trials as well.
- And for parents who are thinking about sending their kids back to school, especially those kids who aren't vaccinated, what are your thoughts around what they should do when-- you know, because kids are getting back together, we're not just going to see cases of COVID go up, but I would expect colds, flus. I mean, just the fact that they're back together, you're going to start to see these things happen. How do you distinguish what is what when you're a parent, and when to send your kid to school?
- Sure. And the bottom line is generally you can't, right, because these are often mild symptoms that we're going to see in children. And I think if we're going to be opening up schools, and I do think it's the right thing to do, because we've been in this a long time and the risk is relatively low, older people are vaccinated now, that getting them in the school is the right thing to do, but we have to be responsible.
So if your child does have mild flu like symptoms, or just sniffles, you probably do want to keep them out of school, because it's our responsibility to prevent the spread. And that is one important thing that we can do. I've reviewed thousands of cases, and sometimes people just they think they have allergies. And we have to catch those people and keep them out, and prevent them from spreading to others.
- What about the other risks that come with going back to school? And I can think about sports, and extracurricular activities, kids coming home, visiting extended family and grandparents, what should we be thinking about? Should we alter our activities as we get ready to go back-- or we're already back, but really get back in force in September?
- Yeah, I think for the age group under 12, that's not vaccinated, it's reasonable to alter your activities. And some of this, obviously there's lots of online guides, and you can sort of see the risks of various sports and activities, et cetera. But a lot of it is, to some extent, common sense. The ones that are more outdoor, less sort of clustered together people. So outdoor tennis is going to be much safer than a contact sport with 30 people, you know, up against each other, and then going into the locker room, et cetera, right.
So those are just general decisions. Band, choir, that's going to be a little bit more risky for the next few months until we can get vaccines compared to some other things. So it's not unreasonable, I think, to alter your activities for the next few months to stay safe. An important thing also, is again, keep an eye on the case counts in your community, because if there's no COVID in your community, of course, and cases are showing that, the risks are much lower than if you're in the middle of a massive wave.
And I think educating your children on environments. As much as you think you know where they're going all the time, but they're going to do things on their own at school. And it's good if you educate them and let them know you can answer questions about what's safe and what's not safe for them.
- I'm asking a lot of parent questions because I am one of those parents who has a child under 12. So what if your child has symptoms, or I shouldn't say symptoms, but underlying issues? Let's say they have asthma. They have something else. And how do you manage all that?
- Yeah, these are really hard questions. You know, still the baseline rate generally for the hospitalizations, when we look at it amongst kids who get COVID, is about between 0.1% and 2% as an example. So if you were to say, you know those who have co-morbid conditions, it's going to be on the high end of that, and probably even a little bit higher than that, it's still relatively low. And that becomes apparent in family's sort of risk tolerance.
And it also depends-- it's hard to put all chronic conditions into the same category. Some are a little bit more at risk, and some are less at risk. So I would consult with your doctor. And of course, if they are in school, you can always take people out of school for the health of your children if you're worried, of course.
- My last question for you, a little more broad, but as we go back, and I remember we've talked to you before, and I've quoted you many times on wavelets that will be coming that we can expect with people congregating together, that's going to happen, in terms of variants, we've heard about delta. I've heard of something called mu that's coming through, different variants. What are you watching for?
- Yeah. So there's a list of sort of variants of interest. And I think we're always watching. But to be honest, I think we still have to keep watching and keep our eye on the delta virus right now. There's nothing coming in the next, I would say, two months prior to vaccination, that we can't take our eye off delta. We have to be very focused, getting people vaccinated, because we know it does generally pretty well against the delta virus. And we have to keep focusing on that. I'm not discounting the other ones in the pipeline. Of course, they're all very important. But until we start seeing something that's really taking over a major region or major continent, I think we keep focused on delta right now.
- Always a pleasure. Thanks so much for joining us.
- Of course. Thanks, Kim.
[UPBEAT MUSIC]
- Well, thanks for having me back, Kim. I think what we're going to see in the fall, we will see a spike. I think it's inevitable. You have a large group of unvaccinated people who are going to be congregating in various areas throughout the country. And I think it's inevitable we'll see a rise in cases. I think the question is, how much of a rise will we see? And for how long, and in what areas? And I think the answer to that is that it will be very regionally based. It will depend largely on how many of the parents of those children are vaccinated, because that's the number one factor in terms of spread amongst children.
So if you have a school with 100% of parents vaccinated, it's going to be very different than if only 60% of parents are vaccinated, as an example. So when we look at regions and communities, we think about the baseline, active number of cases, the vaccination rate in the community, and the protocols of the schools in that region that will determine how big of a spike we're going to see. And of course, kids do do pretty well, generally speaking, with the virus. So it's not all doom and gloom if we do see a high number of cases in a region of course.
- I want to touch on the fact, because one of the things, of course, is if these kids going to school are 12 and over, you know, obviously there's probability they will be vaccinated. They're allowed. Those 12 and under are not yet. Do you have any sense of when we're going to start to hear more about vaccinations for kids under 12?
- Yeah, it's a good question. So under 12, likely there'll be two different cohorts, sort of the 5 to 11 age group, and the below 5 age group. 5 to 11 will likely come sooner. There's some data going to the FDA, hopefully by the end of this month, that'll be analyzed over the next month or two after that. And as early as potentially October, November, and hopefully at least 2021. And then I would say for the under 5 group, probably trail about a month or so behind that one to two months behind that. So again, obviously depends on what that data shows. But obviously, this has been an outstanding and amazingly efficacious vaccine that I think-- I'm hopeful for the results of those trials as well.
- And for parents who are thinking about sending their kids back to school, especially those kids who aren't vaccinated, what are your thoughts around what they should do when-- you know, because kids are getting back together, we're not just going to see cases of COVID go up, but I would expect colds, flus. I mean, just the fact that they're back together, you're going to start to see these things happen. How do you distinguish what is what when you're a parent, and when to send your kid to school?
- Sure. And the bottom line is generally you can't, right, because these are often mild symptoms that we're going to see in children. And I think if we're going to be opening up schools, and I do think it's the right thing to do, because we've been in this a long time and the risk is relatively low, older people are vaccinated now, that getting them in the school is the right thing to do, but we have to be responsible.
So if your child does have mild flu like symptoms, or just sniffles, you probably do want to keep them out of school, because it's our responsibility to prevent the spread. And that is one important thing that we can do. I've reviewed thousands of cases, and sometimes people just they think they have allergies. And we have to catch those people and keep them out, and prevent them from spreading to others.
- What about the other risks that come with going back to school? And I can think about sports, and extracurricular activities, kids coming home, visiting extended family and grandparents, what should we be thinking about? Should we alter our activities as we get ready to go back-- or we're already back, but really get back in force in September?
- Yeah, I think for the age group under 12, that's not vaccinated, it's reasonable to alter your activities. And some of this, obviously there's lots of online guides, and you can sort of see the risks of various sports and activities, et cetera. But a lot of it is, to some extent, common sense. The ones that are more outdoor, less sort of clustered together people. So outdoor tennis is going to be much safer than a contact sport with 30 people, you know, up against each other, and then going into the locker room, et cetera, right.
So those are just general decisions. Band, choir, that's going to be a little bit more risky for the next few months until we can get vaccines compared to some other things. So it's not unreasonable, I think, to alter your activities for the next few months to stay safe. An important thing also, is again, keep an eye on the case counts in your community, because if there's no COVID in your community, of course, and cases are showing that, the risks are much lower than if you're in the middle of a massive wave.
And I think educating your children on environments. As much as you think you know where they're going all the time, but they're going to do things on their own at school. And it's good if you educate them and let them know you can answer questions about what's safe and what's not safe for them.
- I'm asking a lot of parent questions because I am one of those parents who has a child under 12. So what if your child has symptoms, or I shouldn't say symptoms, but underlying issues? Let's say they have asthma. They have something else. And how do you manage all that?
- Yeah, these are really hard questions. You know, still the baseline rate generally for the hospitalizations, when we look at it amongst kids who get COVID, is about between 0.1% and 2% as an example. So if you were to say, you know those who have co-morbid conditions, it's going to be on the high end of that, and probably even a little bit higher than that, it's still relatively low. And that becomes apparent in family's sort of risk tolerance.
And it also depends-- it's hard to put all chronic conditions into the same category. Some are a little bit more at risk, and some are less at risk. So I would consult with your doctor. And of course, if they are in school, you can always take people out of school for the health of your children if you're worried, of course.
- My last question for you, a little more broad, but as we go back, and I remember we've talked to you before, and I've quoted you many times on wavelets that will be coming that we can expect with people congregating together, that's going to happen, in terms of variants, we've heard about delta. I've heard of something called mu that's coming through, different variants. What are you watching for?
- Yeah. So there's a list of sort of variants of interest. And I think we're always watching. But to be honest, I think we still have to keep watching and keep our eye on the delta virus right now. There's nothing coming in the next, I would say, two months prior to vaccination, that we can't take our eye off delta. We have to be very focused, getting people vaccinated, because we know it does generally pretty well against the delta virus. And we have to keep focusing on that. I'm not discounting the other ones in the pipeline. Of course, they're all very important. But until we start seeing something that's really taking over a major region or major continent, I think we keep focused on delta right now.
- Always a pleasure. Thanks so much for joining us.
- Of course. Thanks, Kim.
[UPBEAT MUSIC]