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Stanford Children's Health Webinar - "The Status of COVID-19 & Our Schools"

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The Moreland School District partnered with Stanford Children’s Health to answer questions about the status of COVID-19. This webinar was presented by Dr. Lee Sanders, Division Chief for General Pediatrics at Stanford Children’s Health and Co-Director for the Center for Policy, Outcomes and Prevention at the Stanford University School of Medicine, Sherri Sager, Senior Vice President and Chief Government Relations Officer at Stanford Children’s Health, and Dr. Clover Codd, Superintendent. We are so grateful to have this partnership with these incredible healthcare professionals and community partners. Over the past two years, they have been with us, educating our community through webinars, providing free Covid-19 testing to our families and students through their Teen Van, as well as access to free vaccination clinics for our students and community multiple times since the pandemic began.

Show Transcript

I didn't Spanish on our website this week so I want to thank you all for joining us tonight my name is Doctor Clover Cod I am the superintendent of the Moreland School District we are thrilled to be able to bring this webinar to the Moreland community our goal tonight is to provide our families and staff information about the status of covid-19 as it stands currently and as a district we have implemented and will continue to implement mitigation strategies and ensure we do our part to minimize Community Tran yesterday our families and staff should have received an email from the district that included a link to our covid-19 safety mitigation plan for this coming school year the plan does closely follow the guidelines established by the California Department of Public Health and the Center for Disease Control tonight we are partnering with Stanford Children's Health to be able to answer some of your questions about the status of covid-19 and I am so elated to be able to beat this evening by dr. Lisa Sanders was the division chief for General pediatrics at Stanford Children's Health and co-director for the center for policy outcomes and prevention the Stanford University School of Medicine and then Sherry singer who's the senior vice president and chief government relations officer at Stanford Children's Health we are so grateful to have this partnership with this these incredible Healthcare professional and Community Partners over the past years if you know since the pandemic begin we have been partnering to educate our community through different webinars y'all have provided free covid-19 testing to our families and students through the team as well as access to free vaccinations thanks for our students and commuting multiple times for that and after a panelist have presented we will have some time for questions and answers thank you to those of you who submitted ahead of time we've got those and then again just raise your and after we get through the the ones that have been submitted in advance and will Tanya and I will help moderate those questions so if we so we can get to those as well so at this time dr. Lisa Sanders we're going to turn it over to you and you are going to be able to present your presentation thank you so much. Your car. I'm excited and humbled to be here to be coming back to the moral District I'm to share with you some data and some framing for continuing to move together through this covid pandemic that you know it's feels like yesterday we thought this was going to be a two-month Affair and we're now in a well over two years into it I'm so I'm going to share my slides now just want to make sure the technology Works can you guys see this does that working thumbs up okay so so great thank you and his doctor had mentioned associate professor of Pediatrics and health policy and chief of division of General Pediatrics and I want to express my gratitude to you Doctor, to the Moreland school district and two three special people back home here it's Alfred Bonnie Maldonado increase Lee our leaders of our pediatric infectious disease program actually bunny Maldonado has been its division chief for many years and my personal Mentor gracely is in that division in all play the national role in leading the advisory committee on immunization practices across the entire country which is advised the development and implementation of vaccines for covid in other recent countries that have been very influential and I'll be borrowing some of their slides and of course Sherry Sager who's our government and community relations ahead here at Stanford Children's Health and when Sherry says would you mind I aren't even ready wait for the rest how do you say yes Cheri of course I will help out so that's why I'm here so here are the three or four things I thought we'd covered today covid symp act on child health and Health Equity covid-19 vaccines and treatments evidence a strategies as they've evolved and been informed by the CDC to prevent covid disease spread in schools and communities and finally get as quickly as possible to your questions a reminder that I'm doing my best to pull together a lot of evidence-based guidance play as well as from the local County Department of Public Health and wheat we can't endorse or reject any specific school-based policy I really am deferential to you Doctor caught on the rest of your team in terms of how you've also interpreted a lot of the guidance and you've done an amazing job of that over these past couple years but let me just try to get a real job this week to try to refresh an update a lot of information in these three areas covid in packed on child health and Health Equity this is evolved over over the past couple years child cases of covid-19 are becoming increasingly common you might remember the beginning of the end they were relatively rare in and it was really we're talking about an epidemic that was mainly affecting out all's well for a lot of reasons largely because adults were the first to be given access to the vaccines are cases among among children are rising I'm disproportionately but overall not quite 150 18% of covid-19 cases since the start of the pandemic have been among my children under age 18 none-the-less from the beginning of the mc2 now child cases of covid-19 have been remarkably mild this at the beginning of the pandemic surprised us pediatrician and continues to do so while we have had some spikes most recently with Omicron early on less than 2% of children who have gotten infected with covid-19 I've actually been hospitalized that represents less than 2 in in 100,000 children nationally and death is extraordinary less than 10.1% of children with covid-19 have died there is a new syndrome that was characterized 10 about a quarter of the way or so into the pandemic called multi Oregon Oasis X syndrome it is serious but rare so overall with a millions of cases of covid 8 in wide among children we've had just over eight thousand cases of the syndrome and very few children have died nine children have died and these are our case reports but they're very rare and then the the final fact about covid-19 us is vaccination is working on vaccinated children I'll show more date on this in a moment I'm have to 10 times the risk of hospitalization and serious morbidity and death so it's really important to get all of us back to me but including children now I'm going to bore you with slides of a figures many of these come from my dear colleagues by way of the CDC just to show you this is the whole pandemic in one slide so on the left hand side you can see January 2020 on the right hand side which of these graphs some of the most recent data which is now about a month of July of 2022 and what you can see is what we experience these these big surges the spikes covid first there was that first crazy winter before we had the vaccines that's November 2022 that January and then we have these these couple other surges late-summer last year and then sit and then the big one of all running in the most recent winter and now we're still having a bit of a very slow Surge from Omicron so that's that's what the cases of look like and and you can see on the right of the trends deaths have roughly parallel battle though they they lag by couple months and we're really coming down really nicely from from a big surge of Des mainly among the general population in January and February of this so that's kind of the big bird's eye view of what covid is done at least in the US over the past couple years more slide same time span of the weekly friends in New inpatient admissions at top stations for all ages again follows the same pattern but what's really important some of these boxes here so most cases 97% more than 97% of cases of people being supplies were among adults over age 18 so less than 3% were among children and then you can see the weekly friends were training of week-by-week even the recent increase in hospitalization rates over the summer mainly in the older age groups relative to the younger age groups to over age 70 that was really the highest risk group same thing or of mortality greater than 99% of deaths were among ages greater than 18 so it's a vanishingly small mortality among children the high value to our division to Shannon and also our community and I think it's important early on we were we were observing this but this is continued even in the post vaccination era that cases of covid in continued to be disproportionately felt ethnic minority groups but particularly cases are much more disproportionately felt among Hispanic and Latino population compared to their relative proportion of the u.s. population so you can see there that cases then you know experience by nearly 30% of the of the US Latino population in comparison to their proportion in the community at any one time the upper left-hand graph in the lower right-hand graph we look at hospitalizations by ethnicity and the groups most at risk for hospitalization or American Indian Alaska native Black and Hispanic and Latino for the for black and American Indian population twice the rates of hospitalization compared to the white population and if you actually adjust for their populations much greater than that that's what we're seeing regardless of of age and socioeconomic status is ethnic differentiation but here's another thing that we haven't been talking about in terms of disparity and that is aged and a variety of outcomes and I want to point out age disparities in vaccinations some of this was expected we we only in recent months have had vaccines that are approved for the younger age groups but still this is why I can still fewer than 50% of under age 12 on have received at least one vaccine against covid-19 though it's been available for several months and only 70% of our middle school and high schoolers have received at least one vaccine that that's in contrast to the elderly Inter-Community more than 95% of them been vaccinated and Well on middle-aged some over 50 so it's so 93% but even younger how to open one of my better job so we really need to increase the vaccination rates among among children and why do we need to do this well we know that cases of covid vaccine or much higher in back three times higher all along the way from from the beginning of the end I make from the beginning of when vaccines became available to mouth Three Times Higher among unvaccinated people than among vaccinated people hospitalization rates are for higher among unvaccinated people compared to vaccinated people and deaths are are more than 9 times higher among unvaccinated people so that the vaccine is clearly in the early trials were working and now. have them out in the community we see this we see this in the hospital and we see this in the in the stories that we hear with Elsa see the number and I'm finally there the in directs the facts of covid-19 in this is what's hit our families and our communities of young people most hard I'm from the very beginning and and continues to this day this is food and Security Financial and security learning loss and achievement from those early days of being out of school and then I'm remote learning I'm in a lot of anxiety and depression if you came into Primary Care with me that's what you be saying across the age groups lots more anxiety and depression than we treated ever before and and it's a consequence of also what's happening in the living rooms not just in the exam rooms of our communities so when parents are asked in the past year whether an adult in their household has left a job or change work set schedules as result of the panda on a great proportion of them respond yes and they're more likely to say yes if they have younger children in the household if they're younger if they live in ethnic minority communities or low-income communities I'm in as I mention mental health is Ben become such a problem in in our exam rooms in our living rooms in our communities that recently all of the major pediatric organizations including the American Academy of Pediatrics and the Children's Hospital Association I declare this year a National Emergency in child mental health we're seeing more ER visits suicide attempts and death in households and then we have at least in my memory might Decades of being a primary care provider so it's something we really need to attend to him happy to answer questions later on about what we're doing to address this and what we might be able to do but there's a talk about covid-19 so I want to focus on that and I want to give a little more information about covid vaccines and treatments much of this is now out there you can read about it the CDC and the FDA have excellent consumer-directed information on this but I wanted to summarize this I'm for all of you because it's always evolving so we now have not two but three authorized covid vaccines in the US the first two are the ones you're most familiar with the Pfizer vaccine in the moderna vaccine both of them those are now license were authorized for children from 6 months for diaper people from 6 months on up 6 months to Juno 106 and boosters are allowed for both of these vaccines primero right now for the teenagers although they're most likely going to be recommended for school-aged children brace so I'll show you that second novavax is the newest one and it's been around for a while but it was Reese Lee authorized by the FDA but this is only for adults and I should have Johnson & Johnson here as well I'll just bet it's not authorized for children so I can put that on the booster dose has there been my questions about booster doses here's a summary slide so less of those graphs to just a simple summary of who is recommended to get booster doses now where people are recommended to get their booster. but this is boron Dion That's for people ages 50 years of older people ages 12 years and older who are moderately are severely immune-compromised so these are people who have diseases like cancer or Hy-Vee that's Leatherman system or have to be on a music rest of medication like I do steroids before and then people ages 18 and older who received that J & J vac seeing as a primary and booster doses for now recommending that they get booster doses of these mRNA vaccines the the madeiran are the five here's another schematic and we will share this with everybody cuz I know I'm going through a lot of things break quickly to show what that Commendation is so again for the 5 to 11 year olds we recommend a series 3 group doses the first two doses + 1/3 booster dose at least 4 weeks after that second one for children ages 12 years and older we recommend that same series of 3 + 1/4 booster dose and then possibly were getting into the consideration of these additional booster Doses and we'll probably have some discussion about it's recommended that be at least for a six months later and really only in the children Within These high-risk conditions my same thing from a Darren has a really Madera buys her becoming the same recommendation and then you C4 John J & J it's recommended that we booster with the Mr mRNA vaccine and so we can talk about those little bit later so that's that's about the vaccine for covid treatment there now on a number antivirals but the one that you're probably hearing most about the most efficacious one more outpatient settings this pill is called pacslo that it's actually a combination of two medications to antiviral medications treatment for mild to moderate covid it's mainly for adults and older children on the stove for children have to be over the age of 12 and over 88 lb with high risk for progressions of your covid-19 so this is generally indicated or again that same group of children were immune suppressed or who have another serious chronic illness so it's a good you know case to really check with your pediatrician Family Medicine primary care provider about that indication it's important to know before you or your child get sick whether or not they're in that risk group that you need to have confirmatory testing and usually going to a lab add covid-19 Chester home test on any need to start this treatment within five days of the symptoms starting there are lots of other things to know about this medication is not all that will power it does have some side effects including gif I'm there is a rebound effect of our very own US president experience that if you maybe remember the headlines such that after you take the street minutes, never rebound but a wider but rebound infection after. but we do have this treatment as well as other treatment that can be delivered in Hospital off of Ivy and this is not really for you guys is for people like me people in the medical field there are known algorithms decision algorithms like this for us to help make sure they're the right people get the right treatment at the right time and this is really remarkable for people like me have been doing this for a while that you know we're now a couple years into this we have a number of Highly applications vaccines and now highly applications treatments for this disease and so it doesn't make it as nearly as scary as that as it was at the outset that's great that's all good news and then finally I want to return to where we began this this journey on and where I began giving talks to Moreland another school districts which are putting this all together around evidence-based strategies to mitigate the spread of covid-19 in our school and community so be a little bit of repeats here a little bit of controversy cuz I know all the questions always come up around this but you can see I missed number here because I took a few things off because of covid-19 should say 123 poor but you know I was putting this together earlier today and I guess I didn't change the 5 to 4 but but these are really the for keeping back scenes which we talked about and I'll give you a little more data on and 2nd using masks were appropriate and where preferred my teachers parents and students and staff hand hygiene physical distancing in ventilation I'm going to talk all about as one item and then home surveillance / symptoms of a monkey running household contacts 3 or something that I think we should discuss and refresh particularly with new CDC guidelines that came out this week so vaccines sorry to repeat this but we really need to get the best things out there three vaccine approved at out for with with the novavax for adults on to that are approved for children over age 6 months with boosters allow they are very safe common side effects for children as there are four myocarditis that the heart inflammation that we heard about early on does occur rarely after very very rarely after getting the covid-19 but still is far more rare covid-19 then actually getting the disease so if you actually get the disease your much higher risk for the myocarditis and it's a much better profile you get that myocarditis from a vaccine it gets better quickly and with treatment admire courtesy get with the actual live infection it is 4 into 1 it stretches on for longer anyway it's rare we seen it a few teenage boys not not anything to get too excited about and it's very effective at preventing serious disease or Hospital station in adults and children to be honest with you the efficacy of a little lower and children just because of what I presented before children get less sick with the disease but it's still more than 90% effective but here's another way Raymond all of us I have two children those are good children have gotten used to giving our children the vaccines for vaccine-preventable diseases that are necessary to enter school okay so I put a few of these Akira I'm not all going to show you more in the next slide Hepatitis A varicella and vaccines against pneumococcal disease so pcv13 to look at your kids fixing record here is the relative hospitalization of those diseases compared to covid-19 in the periods of time before those vaccines became available okay so put your mind or so if we didn't have the vaccine we would be happy 1 hospitalization per 100,000 kids for Hepatitis A 29 to 40 or chickenpox this with varicella is 44 pneumococcal disease and now in this year to at the back of the of covid nearly ninety house possession per 100,000 population Cooper covid-19 if it was an unvaccinated population so there's another way of saying covid vaccine works better for preventing hospitalization on your kids than any are these other vaccines that you commonly gets your kids you're already doing that or we are I should say you we are so we should take private this vaccine is much more effective against hospitalization but here's the big whammy it's all so much more effective against death so I'm covid vaccine is more effective against death in the other vaccine-preventable diseases hepatitis A varicella are on this map but also meningococcal disease rubella and rotavirus these are all things that we develop. themes for because they had relatively High death rates before the vaccine most of our kids have them not quite not yet the case for most of our kids have been covid vaccine covid-19 vaccine so that's why we play recommended I'm some more data and numbers and you probably expected see you today but I just I wanted for those of you or data-oriented I wanted you guys to see that face masks there's a lot of controversy now that we're going back to school who should be using them in I would love to hear from you guys when doctor called what what your your current recommendations are when when family is coming to me in the exam room I say you know do what's comfortable for you and your family and Noah risks so this might work pertaining to adults in the school setting is so if you're an adult staff member or Karen or or or teacher going to school and you feel that you're at risk for whatever people at home or yourself with a chronic illness that struck feel free in 02 to use a mass particularly in those indoor settings bring me closer to others if you are going to be using a mask in series and clear mask your kids have hearing impairment and other special Healthcare needs in there other ways of adapting masks for for that use I'm I'm sure some questions are going to come out up with this but please by now we know how not to wear a mask so if you see people wearing it make it useful and use it I'm hand hygiene and ventilation are still very very important for preventing not just the spread of covid vaccine but so many other wintertime virus has RSV rhinovirus at Novi they're going around and don't let up on the good things that you've learned about making sure kids are washing their hands especially at routine times of transition and there is good evidence for ventilation and helping prevent the spread of respiratory viruses covet another's I'm in one of the things that I love about having to move back to Northern California is one of the few places in the country where when it's allowed all week we can have more ventilation please please you know provide that that's not always available and I'll classrooms but please do that so this is you know that's why I haven't really changed very much I'm not going to get too much into testing I'm sure the questions will come up but this is a really really important principle to stay home if sick so if you are sick stay home your child isn't sick stay home there are tensions around my child the second I have to get to school or work for something important I might say oh they're not that sick it's just a tickle in the back of the throat remember this not just about your child but it's about keeping the community safe so it's really important to monitor for the many symptoms covid other seasonal viruses and and keep children or other adults at home if you're beginning to get sick your most infectious the other reason why we say this in Primary Care actually most infectious to others in the 12 2 days before you get symptoms and the one to two days after you begin to get symptoms when that cold or fever is flaring like 2 or 3 days into it and into infection you've probably passed your most infectious. So it's important to stay home when you just begin to to feel sick so you know there's a way to summarize that you may have you seen my talks before we we have the Swiss Cheese model that no one of these strategies is really going to protect us we want to use as many of them as possible a hand in vaccines masks and staying home on sick the CDC is not yet adopted formerly the Swiss Cheese model but they did put it out this week you know when they when they change their recommendations this one visual which I think it's the closest we're going to get to it you can see how it lines up with these four strategies the one that they talk about knowing your risk that's knowing who at home is most susceptible protect yourself mainly with vaccines but also with early treatments if they're appropriate action of Step exposed to their new rules for isolating the sick person at home versus the contacts and how to use masks in the home and if you are sick test and if you're sick and or positive sale so that's that bull Hart at home love being at home stay safe at home if you're sick so one of the little Easter egg elad here is what happened there for Omicron these questions come everybody wants to predict the future so I have a big caveat before this next slide first of all it comes from my my friend colleague and Mentor. Carmel Bonnie Maldonado she's much smarter on this stuff than I am and secondly everybody including all the best experts have been wrong since the beginning about predicting the future of the stand up okay having said that you know we've had these variant wave since the beginning Alpha Beta Delta gamma Omicron I'm very thankful to be married to somebody is Greek so I know how to write these Greek letters so we're expecting new new variants in the future the question is what kind of variance and what will this mean for a community dr. Maldonado and her colleagues for this is not just for imagine four possible scenarios modeled on other respiratory viruses that we have good historical experience with so I'll just play these out there a lot of words here but the first scenario is a little kind of fade away that if we power path similar measles when you said the measles outbreaks we have good vaccination we have lifetime protection and the virus circulating largely on the basis of just new bird that is on an infant's but otherwise don't see it anymore this presupposes a couple things one that we don't have a lot of crazy new variants and secondly secondly that we have much higher levels of population back at vaccination particularly among the young will more likely but still hopeful in that is it a would perform similar to RSV or respiratory syncytial virus that's that nasty virus that sometimes I am faxing hospitalized infants and causes colds in the rest of us a most childhood and how tall this is her mild so more likely but hopeful but more like most likely or scenarios three or four and that is that covid will acting like either insulin a virus or influenza B virus is influenza A virus Global seasonal influenza epidemics that's why you get these annoying psa's every year make sure you get your flu vaccine you'll be getting that around your covid vaccine hopefully we'll just be bashing them together covid in flu vaccine seasonally and it will be propelled largely by spread among adults and particularly older adults will be at highest risk you know the more the earlier and the more frequently you get your flu vaccine the more you'll be protected and then the least attractive but also possible scenario is influenza B. Transmission is largely driven by infections in children who have less immunity little harder to vaccinate against than we have these sort of occasional spikes that's impossible for anybody to predict and so we continue in the into this uncertain future so that's the best from the soothsayers Among Us and the people were trying to model this disease but in summary I think it's really simple make sure that everybody in your community is getting a covid vaccine if you're eligible for Ed and a booster I seen if they've already begun the series and their eligible for that use multiple strategies in your school and Community to keep on transmission low and stay informed with with Resources with with events like this and I'm relying on relay Bible resources I know the CDC has gotten a bad rap they're still one of the nations in the world's trusted experts or summarizing this information sometimes they've been ahead of the curve sometimes behind the curb but they're still are reliable resource for myself or the Merritt Academy I'm in for infectious disease experts so that is my summary lots of numbers lots of rafts I am eager to try to answer your question so jacket should I stop sharing screen for this portion we have several questions I did come in and advance we will ask those a couple of those are for you all who are much more expert most of them are really about our planned here and Moorland which I can answer and then once we get through those people can raise their hair we will do our very best to call on people in the order in which they raised their hand so I ask that you all be very patient a few ground rules so once you do raise your hand when we get finished with the questions that we have in front of us I'm we can unmute you please be respectful of our presenters and everybody else that is here on the webinar we are all here in the spirit of being helpful to one another and creating a community here for our Moreland families and just know that we are promoting personal responsibility here and in this really is about keeping ourselves and each other and our community safe so I'll start with that and we have not had a problem in Moreland with with any unruly discourse a really proud of the community that we have here so I'll go ahead and just there been a couple questions about the the risk of long covid like the impact of long covid and children specifically and that's not something I know how to answer yeah and I don't believe either so I'll tell you what we know the and I reviewed this data before we came here so it's got I just wanted to share with you date of that we have we still do not have reliable information on first of all the definition of what Long Cove it is and also the prevalence of lung covid among children so I don't know I know I want to give a balanced approach to this the best definitions that we have for a long covid are symptoms that let that persist Beyond a month or two from the infection that seem to be associated with the disease and so that those some of the most common ones worser for loss of smell than many people got an infection of talked about and some of the ones that are more concerning to parents are the neurological symptoms sometimes referred is brain fog what our best estimates are that you know somewhere in the 5 to 10% range of children experience this but we simply have not had at least in the US good enough cohorts to know what happens with that what is the long-term prognosis it you know the other thing that we also do know that I would have presented to you if I knew it is whether or not vaccinations at cell reduces the likelihood of long covid physiologically we think it does right because of his makes it less likely for you have severe disease severe enough to be hospitalized we think it would also reduce that that likelihood to get long covid but we still have not had really reliable studies to Desert there been a number of small studies but there was nothing that I could find out I'll keep looking as we go to the question but but thing that I could find you so much for that still so many unknowns so many of these questions are really about our school district code of calls and so I'll just go through a few of them and then more hands might raise as we kind of get through them so so last year with your sibling he had siblings and one of them. Covid the other sibling has to stay home and quarantine those rules have changed so they're there are no longer in school these quarantine rules for siblings if you come into close contact or contact with somebody who has covid-19 to where I'm at because that's just good safe practice because you my be exposed but not develop symptoms for a few days so mask-wearing is what's recommended there if you if you are if you do have symptoms of covid 3 tests and if you are positive for covid you must isolate for those what the CDC is also recommending and then have a negative test on day 6 through 10 come back to school but continue to wear your mask for the full ten days now mask-wearing for everybody is recommended but not mandated so this is about personal choice understanding your own risk factors people who live with you their own risk factors and making those choices for yourself however if you are coming off of isolation because you have been positive with covid and now you're coming back because your negative you are still weak we do ask you where I'm asked for the full ten days just to make sure where we're not accidentally spreading covid around the other and it's coming up is our vaccines are mandated for students and that is not the case so there was a lot of talk in the legislation about mandating covid vaccines for students as they came into this fall or winter that did not pass legislation did not pass covid vaccines are not mandatory but we highly recommend we will continue to promote I think if you just listen to dr. Sanders talk about the benefits of having your children vaccinated or being. read it for yourself but it is not on the list of mandatory vaccines for school age children and their I know that there are there is a list of required vaccines for school age children and you can find that on our website on start of news and resources we have posted that for you let's see other questions for more for me so Mass are not required strongly recommended I will tell you how to make a raised right now I will tell you we have received a few questions about monkeypox now I know today is webinar was not about monkeypox but there is still some anxiousness and hesitation in the community just because it's all over the news I don't know if you can speak to it my understanding just from what I've been trying to read and learn is that this monkeypox is mostly spread through close intimate physical contact and that a casual handshake or so is really not how monkeypox is spread but I know some people are worried about it can you say anything about monkeypox in schools or kind of been the general setting I don't know if y'all I can add probably very little but I I would ask people to stay vigilant that's why I've said has talked about staying informed you know where that when monkeypox by the way is a serious painful but treatable infection that very rarely results in death it's been endemic in Central and western Africa and it made its appearance in Europe in the US over the past year and all of us were hoping it would just be contained no on the way as we know it and now it's spreading and it's spreading in certain high-risk community Reginald Lee Nine States now if you know in May and now I think it's been more than half the states but mainly for intimate contact mainly through sexual contact where I am and I'm not even sure that we're Beyond a handful of child cases most of them are adolescent so it's not really in the Child and Adolescent population yet but it usually is in close physical contact that's required for that spread nonetheless in a primary care providers are being told to be vigilant certainly for those who have had close sexual contact with likely a problem with case you know was there are treatments and vaccines available the vaccine you may have seen in the news is in short supply so only available for Burberry high-risk people these are people who are you known to contact on  workers you know different areas of the community that were normal in contact with school so it's not anything we're concerned about yet we're watching it we're on the lookout for the primary care providers are well-trained in terms of how. recognize that it's not not the easiest of rashes to recognize cuz it it mirrors other rashes so don't get too concerned you know make sure you have primary care provider if if you know if if you're concerned about it in your community but they're there are some teams who practice of Aurora high risk their there a risky Health behaviors and for those and in our community and and Northern California's one of them where we are seeing right rates on those of the kids that were were more concerned about a man dies it's probably I should just leave it at that your work with your own primary care provider or protection there are no community-based recommendations right now sorry I see you for it was there anything else you wanted it saying that now that you're an expert on this Sherry but I'm wondering and it from a policy perspective of you and I think actually I don't have anything to add to what you're saying that he hasn't called the moment because it's mostly bad an adult diagnosis but we are paying attention adventurist I kept reminding frogs to follow basic health hygiene because we take that makes a big difference how do I get rid of a lot of potential viruses so really important I noticed I find myself washing my hands quite frequently whereas before I love this maybe not as much but always be, a good habit at the moment I don't see any hands but I did see a couple hands earlier Rosie I think you had your hand up Rosie I don't know if I know you but if you still have a question go ahead and raise your hand we can call on you and if anybody else has any questions about the returning to school this year with our code of mitigation strategies of anything for dr. Sanders please you do now is your chance to have a best to us to ask questions related to health and safety so other kinds of opening of school questions where that's not the purpose for tonight I don't see any hang on okay we've got Catherine Catherine can you unmute yourself hey yeah so I just want to ask how soon can you get the vaccine if he tested positive oh so if you've tested positive for covid-19 just clarify and you have not yet had the vaccine and you want to go get the vaccine when can you go get the vaccine is that your question Katherine at well it doesn't matter is being vaccinated I was reading and everything that you need you can only get it like a month or three months after your first Catherine actually it's a great Quest it's kind of a fun question for us and Immunology and ID so I'm going to be honest with you that that you've also if you're confused because the messaging has been confused so you beginning it was 3 months and then people went down to one and I think you're going to see people even reducing the little bit more basically it's it's it's a it's an immune problem and so what we think is that easiest answer I can give you to be concrete will be one month one month after ear infection the idea is that your immune system is back to its base line so you've recovered from that infection so for example if I'm seeing a patient who was covid positive but they hardly had any symptoms you know they got tested cuz there was a household contact and their other if they're going back to school or something I might give that vaccine to them earlier because I I know that they're back that their name system has come back so you know this is at the discretion of the in the medical provider now but you know closer to know if if all else being equal about a month from your infection is this probably safe thank you have a good question thank you thank you do I have any other questions out there I don't see any hands at the moment okay Lindsay Lindsay we've got a question is that the case for boosters is well as an associate 1 2 3 months if it's been a mild infection exactly cuz it's the same idea I would say closer to 1 months from that infection most likely if you've had two or more vaccines within the reason. You're actually most likely about a less severe infection so the one-month rule is a good one to lean on if you if you if you can't get in touch with a primary care provider to cancel yes thanks is it a d Leonardo I'm just trying to read the name here are y'all doing this yourself looks like you got a question hey it's Anna Lisa di lonardo I'm a teacher at Anderson sorry so sorry. My name is part of my email I think so just clarify so are you know in our household that's like a cohort what are classroom also be considered a cohort or not as much and how long does that take to build try and understand your question you said a family that lives in a household like let's say mom and dad a couple kids you know you don't have to wear masks around them because we're all in the same house would the classroom if you have see the same kiddos everyday would we kind of be in the same situation or not as much because we all go to our own houses and if so how long would that cohort take to form before we would be able to relax a little bit so I think I might be able to answer this because I think it has more to do with the co protocols that we had towards the beginning of the pandemic when we were really trying to keep students and smaller cohorts and we work not mixing cohorts of classes we weren't quite sure how the disease was spreading really in school settings and stuff we were doing hybrid learning so we haven't really been talking about cohort for quite some time and trying to think of when personally like masking made relax a bit as you know and stuff because I'm like Oh my immune system will be used to be kiddos and things like that this is what I'm saying making sense or is it only making sense in my brain I get it I don't know if I have a yeah I hear what you're saying there where you're going with this. Let me put in slightly different contacts so I agree with personal with doctor said that they that we moved away from that cohorting approach cuz it doesn't make sense anymore for a variety of reasons we understand how the disease spreads and we have more vaccinations for yourself I wouldn't burden you I agree that you know you're going through more mental gymnastics then you need to that's why I tried to pull together the best evidence the guy knew your own decisions so if you feel more comfortable masking for whatever reason your risks of the people that you're in your home find do that but don't think that keeping cohorts unchanged is going to protect you we're no longer in that world that kind of made sense very early on when we're trying to come down and shut down society and and keep people from texting too much everybody's mixing now so that's not going to change your immune profile or your protection was going to change it is getting vaccinated staying home when you're sick masking when you're if you're at risk yourself and we're around people who you know we're actively okay thank you so much question you're asking it but I bet a lot of other people were thinking something like it so thank you Chris Sarah hi Sarah hi my question is about the masking if where I'm understanding you're saying the most contagious time is potentially asymptomatic or you starve so I'll try to be concise if you're if you're contagious while your asymptomatic wouldn't it make sense to suggest masking just in general so so what you're getting into details first of all I did for entirely dr. Khan so forth for really well thought-out for the calls that they've come up with for the schools that are consistent with the county and I wanted to prove that I was just giving you the infectious facts about one to two days before one to two days after we can't do in society we can't do much about the one to two days before we just can't let me know otherwise and we'd always be nasty and Society at 2 nrsv and lots of other diseases but we can once symptoms begin to appear so the reason why I was talking about that as it's actually more about the first couple days of a disease when you have that like tickling in the back of your throat and maybe a little bit of fever headache and I'm sure your kids having that kind of air on the side of caution and don't send them to school don't get you know I understand where you're going with that logically I get it cuz I deal with this and primer but control the things we can which is the symptoms and how we respond to it and not worry about the things we can't which is you know asymptomatic disease which is around us and it's a little bit there unless you're the reason to get vaccinated him wash your hands and all the rest okay thank you thank you want to give a moment to see if anybody else has questions it looks like Simon you've got a question sign language likes gone yeah I just had a question I heard that there was maybe thought about expanding the second booster to those under 50 do you know if there's any recommendations I may be forthcoming and then secondly since we're entering fall I heard about the potentially new formulations to Target Omicron specifically rather than the old formulation and if it's a Boosters are additional as booster is required is it better to wait for the new formulation yeah well there's a lot of people doing that second calculation right now that's a little trickier when they take the first one it is likely that you're going to see more liberal recommendations for additional boost booster doses as the pandemic continues to spread out member those scenarios 3 and 4 so you're just going to see that you're going to see that there's a recommendation for Roosters I can't say what they're going to say that's what you know Grace Lee Eric knows the three or four six months since the last one on and what age groups but you are probably going to see that age group, continue to drop for additional boosters that's what I expect that's what I anticipate as long as there's no Miracle doesn't turn that in the disease disappears in terms of how to time your individual or other people were listening and having the same question your individual next booster shot it's a tricky one and its individual so what I am saying to people is if you oh you're going into a high-risk situation in the near future going to be indoors with high-risk people would ever get the booster now don't wait for this next one that's taylortown macron because it's still pretty effective against and by the way we don't know what the next Marian is going to look look like if on the other hand it's no big shakes your your your lifestyle is staying the same and you want to wait till whatever it is I think it's probably going to be closed October by the time of them macron vaccines make it out here even in a pretty metropolitan area like this probably going to be well into October and you can wait and and get it then and it should work out fine I hope that answers your question but that's that's a lot of people's minds so thank you sister any other questions can we have time for one more Joyce hi Joyce hi. My question is what was Stanford and be back out at Anderson that's where I got my last shots from see if she knows what the schedule looks like Sherry might have quicker access to the vamps and plans than I do and werewolves doctor cried and and the district to see if we can arrange to come back out okay that was perfect, I really enjoyed the service you provided thank you and we were especially happy to be able last December to bring the van out to to the middle school and be able to do the vaccinations but also distribute bus with kids having their own Library thank you Cheri I just wanted to kind of and tell you how incredibly grateful I am for you dr. Sanders and for you Sherry to partner with us and be able to spend your incredibly valuable time with our very small District it means a lot to us treasure this partnership I feel honored to be able to just be here and have our community ask you questions up and personal so just thank you so much for being here tonight and we will work in the future to be able to bring more information keep our community safe work with you share to try to get the van in the out to different schools so that we can continue to work with each other but I just have to tell you I'm so incredibly grateful for you both and for your time tonight it's been our pleasure we really appreciate the partnership as well thank you and with that I think we're going to sign off so you all can go get back to your families and maybe eat dinner if you haven't already once again thank you hope hope you are all well I we start school tomorrow morning very exciting and hope you all feel ready so have a good night everybody

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