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UCI Podcast: Why low-income children suffer the most during remote learning

Schools will still need COVID-19 mitigation measures as they reopen, say UCI Health doctors

February 16, 2021
UCI Podcast: Why low-income children suffer the most during remote learning
Dr. Dan Cooper, a pediatrician, along with colleague Dr. Chulie Ulloa, discuss school reopenings on this episode of the UCI Podcast. Steve Zylius/UCI

Many students in California have barely seen the inside of a classroom  since the COVID-19 pandemic began nearly a year ago. In that time, low-income students and families in low-income school districts have suffered the most.

With more and more people receiving vaccines, the end of remote learning is in sight. But schools will still need to implement COVID-19 mitigation strategies, according to doctors from UCI Health. In this episode of the UCI Podcast, Dr. Dan Cooper and Dr. Chulie Ulloa discuss school reopenings and the impact of distance learning on children.

In this episode:

Dr. Dan Cooper, general pediatrics

Dr. Erlinda (Chulie) Ulloa, pediatric infectious diseases

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Transcript

AARON ORLOWSKI, HOST

As more people receive COVID-19 vaccines, California schools are growing closer to fully reopening. It will be a welcome relief for children and parents in Orange County struggling with the stress and mental health effects of nearly a year of remote learning. But we’re not quite there yet. Why is it important to get children back in the classroom? And what have UCI researchers learned about how to open schools safely?

From the University of California, Irvine, I’m Aaron Orlowski and you’re listening to the UCI Podcast.

Today, I’m speaking with Dr. Dan Cooper, a pediatrician, and Dr. Chulie Ulloa, an expert in pediatric infectious diseases. Both of them are at UCI Health.

Dr. Cooper and Dr. Ulloa, thank you for joining me today on the UCI Podcast.

DAN COOPER

Our pleasure.

CHULIE ULLOA

Thanks for having us.

ORLOWSKI

Dr. Ulloa, students in Orange County were sent home almost a year ago now at the start of the pandemic. How many of them have actually seen the inside of a classroom in person since then?

ULLOA

Yeah, so at the start of the pandemic, Orange County was very unique in the sense that many schools initially did open. The majority of them were private schools. Some of them were charter schools. And then we had a subset of public schools. However, when the governor had a mandate, a lot of the schools had to close again. And so in order for them to then essentially reopen — and how they reopened looked very differently depending on the school — but in order to reopen, period, then they had to fill out a school waiver. And so this was a long application that they had to fill out and send it over to our local public health department to review. And those schools whose applications were accepted were able to reopen. And so the majority of the schools ended up being private schools. And I will say that a lot of those schools that were able to reopen have been wonderful examples of our ability to interact safely and implement COVID mitigation procedures when we have a lot of resources.

ORLOWSKI

So for many public school students, they really haven’t been in the classroom at all, or if they have, maybe just in a very limited capacity, for almost a year now.

COOPER

Right. And let me just add to what Dr. Ulloa said that, you know, unfortunately the schools, the kids that have been most impacted by not being in school have been kids in the low-income, largely Hispanic neighborhoods of our county. Some of the public schools, as Dr. Ulloa mentioned, in Orange County did open. It sort of tracked with socioeconomics, where the schools like Irvine Unified School District, Tustin Unified School District, had enough expertise from parents of the kids that they formed advisory groups. The UCI and CHOC (Children’s Hospital of Orange County) formed an advisory group for some schools that asked for our help. But the majority of low-income kids in Orange County have not been in school since the beginning of the pandemic.

ORLOWSKI

Let’s go back in time a little bit to those first decisions at the beginning of the pandemic when officials were making the choice to start locking down society. In the K through 12 education world, what were those conversations like? What was the feeling and what was the reasoning behind closing schools at that time?

ULLOA

So at that time, very little was known about COVID-19 with regards to children. And even now we’re just barely learning a lot more about that. But I think they were just extrapolating data and kind of from prior experiences where we’ve been in situations where we’ve had epidemics. And so based on the projections, they didn’t know what to think, whether schools were going to be kind of hotspots for transmission and outbreaks in the community. And so I think that’s why everyone kind of proceeded with significant caution in terms of reopening.

COOPER

And let me just add to what Dr. Ulloa said, which is absolutely correct. You know, it really was, we didn’t know. The Europeans and the Asian schools were closed almost immediately. But one of the things we learned early on was that many of those schools in Europe and Asia reopened voluntarily, at least they didn’t mandate that kids go to school. So even by about May or June, the data was starting to come in that showed that if the schools were careful, if they really paid attention to the mitigation procedures, there was very little evidence that the schools were serving as a sort of a fostering bed for infection.

And two things happened here. One, there were some people who felt that the whole thing about closing schools was not a problem that you should just send your kids back immediately. There was no need to consider anything like face mask wearing. And the Orange County Board of Education at that point put together this symposium in which they actually advocated for simply opening the schools. And what that did really was have the opposite effect because parents, kids, educators, we knew that to just pretend that there was no problem would not give parents the sense of confidence that they needed. Rather, what many of us felt was that we really should put into place plans to keep the schools safe and healthy places. And I think had we done that more systematically the way some of the private schools did, the way the Catholic schools did, a lot more kids would be in school right now.

ORLOWSKI

Well, and Dr. Ulloa, how has our understanding of how children contract or spread COVID-19 changed since the very beginning of the pandemic? What knowledge have we gained about that?

ULLOA

So I think now we do have a little bit more information in terms of the role that children play in the transmission of SARS-CoV-2. And so I think — and more recently we conducted, Dr. Cooper and I conducted, a study within our schools in Orange County, a very small study, but a very impactful study, I believe. And looking at four very demographically diverse schools, where we specifically looked at that, the transmission of SARS-CoV-2 in children, so basically students and staff as the schools reopened. And in our study, we really didn’t find any evidence that children play a significant role in the transmission of the virus. In fact, thankfully in that study, we had a subset of kids that were in-person in school, and then others that were actually home learning, you know, distance learning. And we actually found higher, I guess, numbers of positivity rates in those that were in home learning, than in school learning. Nothing’s a perfect environment and certainly transmission can occur and it will occur whenever you have a bunch of people in close proximity. But the important thing is just following the mitigation procedure. But as children alone, they are mildly symptomatic. The majority of them — certainly I’m a pediatric infectious diseases doctor, so I see the full spectrum and kids do get hospitalized — but the vast majority are asymptomatic, minimally symptomatic. And it appears as though they don’t play a significant role in the transmission, although they can transmit the virus.

COOPER

One of the things that we did in this study was we adapted an approach that had been used to actually quantify physical activity and other aspects of school life in kids to look at the mitigation procedures. So we could quantify in a school how well face mask wearing was being adhered to, or how well the school was able to maintain physical distancing. And we think this is going to be a very important tool moving forward for schools to be able to gauge how well they’re able to put into place mitigation. And if they find they’re not doing a good job, they can take corrective action because even with the vaccine — remember no children under the age of 12 have even been in a kind of a test for a vaccine — I think these mitigation procedures are going to be with us for a significant amount of time.

ORLOWSKI

So are there any particular best practices that you’re able to draw from this study that schools should be implementing going forward?

ULLOA

Just starting with the basics of the best pact practice. So wearing your mask, wearing your mask properly, so it should be covering your nose and your mouth. Maintaining distance whenever possible. You know, I know there are certain scenarios where sometimes teachers and students need to be in closer proximity, but it’s very important that when they are in closer proximity, that they continue to wear their masks. And then when they don’t have to be in those situations to try to maintain their distance of six feet or more. And hand hygiene, just washing hands. So I think if you follow those three basic rules that we’ve been encouraging throughout the pandemic, it really works and it helps to decrease the spread of infection.

COOPER

One of the things that we found with our direct observation, which I think is fairly intuitive, is that the most dangerous times are lunchtime. And so if the school, if we’re going to start thinking about this correctly, that’s where we should really think about where we sit the kids at the tables, making sure that they have their masks with them. That’s something we can actually do something about. One of the things we discovered from studying healthcare workers who were actually dealing with COVID-positive patients is that they were not being infected predominantly at all from their patients. But when healthcare workers got infected, it was what they call break room breakouts, where they sat, they had coffee together, they relax. So that this is something we learned from our direct observation. And the other point is we’re sort of losing on the other pandemic of obesity and physical inactivity. And there is no reason not to do physical activity. There’s no reason not to have PE. We saw with our studies that we could maintain physical distancing within PE, we could maintain high activity. And we do not want to see these kids who — particularly lower socioeconomic kids who are already at risk for weight gain and physical inactivity — we don’t want to see that worsen because the health consequences of that are very serious as well.

ORLOWSKI

And presumably for PE class, they can usually do that outside.

COOPER

Right. And we’re very fortunate, obviously, in Southern California unlike other parts of the country where winter is very cold and you just can’t be outside. We have the distinct advantage of, for most of the year, we can do PE outside.

ORLOWSKI

Well, so as we’re looking at this issue of how susceptible children are to SARS-CoV-2 and how much schools can contribute to the spread of the disease, a big issue right now is when teachers might be able to get vaccinated. And the state and local authorities are trying to figure out how to prioritize who gets the vaccine first and whether teachers should be closer to the top of the line. Based on the evidence that you’ve seen. Dr. Ulloa, do you think that all teachers need to be vaccinated before we can open schools? Or do you think there’s a safe way to do it before every teacher has been vaccinated?

ULLOA

I agree with both of those statements. I think that there are safe ways to reopen. I mean, certainly we have reopened society and restaurants and everything, and we’ve tried to implement these opening strategies and safe ways by wearing masks and having distance between people, etc. So there are ways. However, I do believe strongly that our teachers should be prioritized and that they should be included. And it is my impression that they will be included in the next phase 1-B of the state’s vaccination priority list. And so I’m hopeful that we will stick to that and that they will be included in the next group and be eligible. I think we’ve talked today and said, “Hey, we don’t think it’s a — you know, schools don’t seem to be hotspots for disease spread, but there have been cases of staff members being infected and becoming very, very ill. You know, there are always exceptions, but one sick person or one dying person is one too many.

ORLOWSKI

Dr. Cooper?

COOPER

I agree. And there’s no zero risk. Even before the pandemic, there were diseases like flu, influenza that kids could get and transmit to teachers and a tiny, tiny percentage of people would get very, very sick from those diseases. I really agree with Dr. Ulloa. I’m on one of the Orange County advisory committees and have urged, to the extent that we can, that the teachers really get high priority. And I would also suggest that, you don’t want to put people at risk. So teachers who are in a high risk group should probably be doing more distance teaching. But I think that as a society, we would have done much better had we looked at the problem of opening schools logistically and opened them earlier with really good plans to maintain safety at the schools.

ORLOWSKI

Well, and Dr. Cooper, I want to go back to something that you’ve mentioned a couple times now, which is the different levels of impact on different socioeconomic groups for school closures and how that impacts different families differently. What is that disparity for how a wealthier family in a wealthier school district might be affected by a school closure and how a lower income family in a lower income school district might be affected?

COOPER

Well, this is a great question, and it really gets to the heart of the matter. So just consider square footage and who’s living in a home and the ability of a child in a lower socioeconomic neighborhood, perhaps for example, in Santa Ana, compared to a neighborhood in Newport Beach, or even Irvine. In the former neighborhood, in the lower socioeconomic, you often have multi-generational families under one roof. Tragically, even things like the bandwidth of the internet connection is not as good, so it makes the ability to do distance learning that much less. More often than not, both parents may be working and don’t have a lot of time to spend with their kids to ensure that they are following their lessons. And so what we’ve seen is the rate of kids either just dropping out of internet learning from lower income homes is higher than it is in a place like Newport Beach. And the inability for the kids to have a place to play because many times in those neighborhoods parents don’t feel that it’s safe for their kids to just go out and play. So in so many ways, this school shutdown has conspired against the wellbeing and health of lower socioeconomic kids.

ULLOA

And I just want to piggyback and say one more thing is that schools provide a benefit to families beyond providing education, right? So they also provide childcare, a lot of school services, meals. So that’s a place where a lot of kids from lower income families, that’s where they eat. And they provide other family support systems. Certainly going to school actually contributes to their mental wellbeing, mental health. So without in-person instruction, children are at increased risk of falling behind academically, but also exacerbating a lot of these educational inequalities and these other inequalities.

COOPER

Chulie’s absolutely right. But remember, all kids have generally suffered. And even if you look at a school like Irvine, the Irvine Police tell me that incidents of suicide, attempted suicide, among school-aged kids is up by about 20 percent.

ORLOWSKI

Wow. That’s incredibly tragic. Dr. Cooper, is there anything that we can do as a society to address that, beyond just getting back into the classroom?

COOPER

Well, I think that we need to put politics aside and everybody work together to understand that it is in the best interest of our society to have our kids at school. That’s number one. Number two, and I think Dr. Ulloa would agree with me, we looked at schools, private schools that have large campuses and were able to invest in putting mitigation into place, and we looked at schools in lower income that had wonderful teachers and wonderful principals who worked their hearts out to make sure that their kids were kept safe. We, as a society need to say two things. One, schools have to be healthy places. And number two, there should be no difference between the quality of education and facility at a private school in Newport Beach and an inner city school in the middle of Santa Ana.

ORLOWSKI

As we look at the coming months and what we need to do in the coming months as we try and really end the pandemic, Dr. Ulloa, do you see that there’s some light at the end of this tunnel for children in school and for getting schools open? And how do we get there?

ULLOA

Yeah, absolutely. So I do see some light at the end of the tunnel, and I think that we’ve learned a lot, I think over the past several months, almost a year. And so I’m hopeful. I’m hopeful that we’ll move forward and have our teachers vaccinated. And then everyone’s going to feel a little bit more comfortable reopening schools. And I think that we can do so in a gradual way and get everyone back in the school because otherwise this is just going to drag on forever. And the folks that are suffering the most are our children, unfortunately, right now. So I am hopeful that we will be able to reopen schools and that teachers will also get vaccinated and facilitate that process.

ULLOA

But just a cautionary note. And I don’t mean to be the Debbie Downer, but we do, we do have obstacles ahead. You know, there are emerging variants of this virus. We don’t precisely know whether children will be more affected. Dr. Ulloa pointed out that right now, fortunately, most kids are either asymptomatic or minimally symptomatic. Will that be true for the viral variants? Will the vaccine work? So I think we have to (be) cautious, cautiously optimistic, but we can’t forget that we may have to continue a mitigation procedure, and understanding that we cannot eliminate the risk, but we can minimize it and we can deal with it.

ULLOA

Yes, reopening is going to be with still strict mitigation procedures. And even if you’re vaccinated, we still need to learn more about how vaccines actually affect the transmission of the virus, etc, etc.

COOPER

And, Aaron, remember as we were saying, so far, very few kids between the age of 12 and 16 have really been in any kind of clinical trial with a vaccine and no children between the ages of zero and 12 have even been entered in a safety or early phase clinical trial. So there’s a lot of work to do in the months ahead.

ORLOWSKI

To make sure that the vaccine is effective for children and safe.

COOPER

Correct.

ORLOWSKI

Dr. Cooper and Dr. Ulloa, Thank you for joining me today on the UCI Podcast.

COOPER

Thank you.

ULLOA

Thank you.