Masks, Mental Health and Missed Appointments: AAP President Lee Beers on Pandemic’s Impact on Childhood Health

Lee Beers

Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter. A show where we speak to the top thought leaders
in health innovation, health policy, care delivery and a great minds
who are shaping the health care of the future.

T his week Mark and Margaret speak with Dr. Lee Beers, President of
the American Academy of Pediatrics and the organization’s newly
released guidelines for sending kids back safely to school. They’re
recommending all kids be masked in school and that childre n 12 and
older should be vaccinated as soon as possible to protect them
against the more contagious Delta Variant which is impacting and
sickening more young people. She also talks about the need to
address mental health of Americas children in a more embe dded way
within pediatric care.

Lori Robertson also checks in the Managing Editor of FactCheck.org
looks at misstatements spoken about health policy in the public
domain , separating the fake from the facts. We end with a bright idea
that’s improving healt h and wellbeing in everyday lives. If you have
comments please email us at [email protected] or find us on
Facebook, Twitter , Spotify or wherever you listen to podcast. You can also hear us by asking Alexa to play t he program. Now, stay tuned for
our interview with Dr. Le e Beers here on Conversations on Health
Care.

Mark Masselli : We’re speaking today with Dr. Lee B eers, president of the American
Academy of Pediatrics, representing 67,000 pediatric medical profession als. The a cademy just released its guidelines for safely
returning children to the classroom during the COVID - 19 pandemic.

Margaret Flinter: Dr. Beers is the Medical Director for Community Health and A dvocacy
a t Children's National Hospital and she's the f ounding director of the
DC Mental Health Access and P ediatrics P rogram. She's also the co -
director of the Early Childhood Innovation Network. Dr. Beers, we welcome you to Conversations on Health Care .

Dr. Lee Beers: Thank you so much for having me, I reall y appreciate it.

Mark Masselli: Y eah , what a difficult time for families with school aged children. But
the nation is really reeling in from another surge in COVID - 19. I t really
fueled by the Delta V ariant and we're seeing disjointed approach to
back to sc hool protocols as the virus surges across the country. I'm
wondering how your organization is offering guidance to families and to clinicians and educators , a nd particularly focusing on children and
young people who are now getting sick b ecause I think tha t's a worry
that families have.

Dr. Lee Beers: It's a challenge for a lot of families. I think there's a couple of things, you mentioned as we started that the A A P American Academy of

Lee Beers

Pediatrics has guidance around safe return to schools a nd I think
that's actually guidance we've had throughout the pandemic. J ust like
all of our guidance around COVID, we review and update it really
regularly actually about once a month we take a look at it and make
sure there's nothing that's changed , nothing that needs to be
updated. T he real key sort of behind our guidance is , one, that it's
incredibly important for children to be i n in - person school for all sorts
of reasons, which we can talk about . But, two, that we can do that
safely with good layered precautions. I thi nk it's those two things
together that are so important to talk about, both the importance of
return to school, but also the fact that to do that safely, we really
have to layer precautions to help keep our children safe. Certainly just
even by putting out the guidance , we have seen that be helpful for
communities and pediatricians.

We also have information on our website for parents, we have a great
parent facing website called Healthy Children . org. It’s a place where
parents can find answers to a lot of t hose questions or things that are
worrying them as we get back into school. W e've also had some great
partnerships with teachers and we're actually getting ready to launch
a partnership with the PTA, the Parent Teacher Association where
we'll match up pedi atricians and school districts so that they can work
together to help answer families questions about anything related to
safe return to school.

Margaret Flinter: Well, Dr. Beers, I want to start with your most basic recommendation,
that's a ll children age d two and older should be masked in school and
daycare settings across the country. I'm kind of amazed that I'm
presenting this one as an issue for which we are now seeing protest.
This , what would seem like most basic public health intervention has
become a very charged politically, it's turning out to be quite a
divisive issue. Talk about the science that drives the American
Academy of Pediatrics recommendation, masking and if you'd like to
share w here you think this resistance is coming from.

Dr. Lee Bee rs: Yeah, absolutely. I think like you, gosh, sometimes you do feel
frustrated and concerned about the division around this issue. I think
our recommendations about this really start from the place of
remembering how important it is for our kids to be safe ly in in - person
school. We know over the past year, we've seen school districts be
able to do that safely when they layered precautions, and we've seen
school districts where it didn't go as well, because they didn't have
those layered precautions.

W hen it comes to masks, they really are a safe and effective way to
decrease the spread of COVID. They do really dramatically when used
consistently and when used by everybody decrease the spread of
COVID w ithin school settings . F or example, there was a study loo king

Lee Beers

at school districts in Georgia, were comparing some which had
universal mass mandates, and some which made it optional in the
schools where there was universal mask wearing had significantly
decreased spread of COVID w ithin those school settings . W e'v e
known that masks can prevent the spread of viruses for a long time ,
a nd it's just a slightly different setting that we're putting them in .

I think some of the other questions that come up are, how can our
kids do this? Is this okay for our kids ? I think also, what we've seen is
that kids really adapt very well to wearing masks, especially if the
adults around them just approach it calmly a nd just help them to
know , you know what, this is something we're doing, it helps keep
you safe and healthy. But it al so helps keep your friends , it helps keep
your teachers , it helps keep your neighbor safe.

M y son is a 13 year old, a young teenager, and we were ta lking about
this a little bit a nd he said, y ou know what , he's like I have friends at
school who have things that might make them more sick with COVID,
why wouldn't I wear a mask ? K ids really do understand that. T hey
really do understand the importance of keeping each other safe.
We've seen a lot of different ways that's a safe and effective way to
decrease the spread of COVID. T he more divisive it gets, the more it
takes away from our ability to really focus in on all the other things we
really need to be doing to o to get the pandemic under control, from
educating people about the safety and efficacy of vaccines , it takes
away from our focus on making sure that kids have a good transition
to school. I'm hopeful that as we start to see that those schools where
they're not mandating mass, they're having a harder time . I hope that
we can kind of come back together o n this.

Mark Masselli: What’s the timeline you expect for younger children to be approved
for the vaccine? Right now i t's 12 a nd over and what's your sense ? W e
still have a majority of our American parents who are reluctant to
vaccinate their children, wha t is the academy doing around
empowering pediatric practitioners to carry the importance of that
message to their patients?

Dr. Lee Beers: I don't think it'll be too long , sometime in the fall. I t's a decision by the
FDA, and also depends on what the FDA, with the decision that they
make when they review the data . T his is a really important part of our
vaccine monitoring system is to trust the folks at the FDA to do their
jobs . W hat we're hearing is that the next group that's likely to be
authorized is 5 to 11 a nd then shortly thereafter younger than that, so
I think it will come in phases . T hough, I would say at the AAP, you
know, we've been really pretty public about saying we do think that
we need to be approaching the authorization of vaccines for younge r
kids with the same urgency that we did for older adults, because they
still can get very sick and any preventable illness is one that we want

Lee Beers

to prevent.

This is probably the only time in our history where most of the general
public has really a good ide a about what the vaccine development
process i s . This isn’t something that most people thought a whole lot
about before recently, so of course, folks are going to have questions.
I had questions before I got the vaccine . Both of my teenagers are
vaccinated . I made sure I have my questions answered.

P art of what we're doing for pediatricians is just making sure that they
have the resources to share information with their patients. We've
got, again, soon actually getting ready to launch some videos that we
ca ll them science explainer videos where they kind of talk through the
science of the vaccine. We also have a lot of resources for the
pediatricians about how to get the COVID vaccine into their own
practices like our patients. P hysicians and health care pro viders,
they've been working really hard for the past 18 months, so we want
to do everything we can to support them.

Margaret Flinter: Well, Dr. Be ers speaking of vaccines, when the pandemic hit pediatric
visits, just plummeted. We saw instant delays in im munizations and all
the other very important things that happen at well child visits and
now the Delta V ariant is here. I worry that we're going to see yet
another retrenchment from people being, frankly, afraid to go into
another office to get their routi ne care when there's still no vaccine
available for the little ones a nd when D elta V ariant is on the rise .
W hat kind of adjustments or accommodations do we need to protect
children from all the conditions for which they get vaccines, and also
those very im portant screenings?

Dr. Lee Beers: We have s een some pretty dramatic decreases in routine childhood
immunizations over the past year. I think one of the things out of that
is that now our pediatricians offices and all of our doctor's offices
know w hat they need to do to keep families and patients safe while
they're in your office . Particularly, I was so impressed at the very
beginning of the pandemic, when this was all very new and practices
had to really pivot. J ust within very short periods of time how mu ch
creativity and innovation and commitment there was to making the
office safe.

W e've got, you know, pediatricians and offices who are going out to
the parking lot to give vaccines, they've separated out their clinics,
sick and well, they've made changes to their schedule s o maybe you
see all your we ll patients, or first half of the day, your sick patients the
second half of the day, so lots, lots of different accommodations have
been made to make sure that our offices are safe. We've done a lot of
media a bout it, talking about how important it is to get back in . For
some families it's fear for some, it's just -- it’s been a hard year. Now,
it's been a while, we want to make sure that everybody's getting back

Lee Beers

in so we can get kids up - to - date on all their sh ots, but also all those
other things that you mentioned, that are so important, chronic
disease management, s creening for mental health concerns,
developmental issues, all of those things.

Mark Masselli: We're speaking today with Dr. Lee B eers, P resident o f the American
Academy of Pediatrics . Dr. Beers, you've been a longtime advocate of
advancing c ommunity h ealth, with a really particular focus in social
determinants of health. Also, how might some of the interventions
such as school based health centers, where children spend most of
their days offer a more efficient, effective, hopefully elegant approach
to assessing and addressing child's needs, especially our most
vulnerable children ?

Dr. Lee Beers: T here are so many different influences on the health of the child and
family. I think, you know, in many ways, one of the things that
underlies a lot of the work that I do is, is really the belief that we want
to meet families where they are and provide care and services in the
most accessible place. S ometimes that that means where patients
live , go to school and play . S chools are a perfect example of a place
where we can provide support school based health centers are a
tremendous part of our medical community. We can make the care
really accessible. The stude nts in the school and the families in the
school really get to know the school based health center staff, so they
feel really comfortable with them. T hey can ask them questions that
they might be embarrassed to ask someone they don't know, as well.

Our sc hool nurses are also really tremendous partners. We've got
some great examples across the country of school nurses really
partnering with their communities and with their school systems to
give information about COVID - 19, or partner for immunization
delive ry, things like that. I think that's been a really important piece.
But ultimately, we want to try to find the places where patients and
families and kids feel comfortable and safe, and able to have their
questions and concerns answered.

Margaret Flinter: Dr. Beers, there's also have been a movement in the country for
several years now towards pediatric practices , embedding behavioral
health specialists , interventionists, right within the pediatric practice
as well . I'm wonder if you could both speak to is that a trend that is
growing, that we're going to see more of the parents might expect
that there would be a child clinician or psychologist available to see
their child . B ut also maybe comment on what are your colleagues
seeing in terms of behavioral heal th disruption or symptoms, because
my guess is it's going to call for some new strategies based on what
people have been through in this past year.

Dr. Lee Beers: I mean, anyone listening knows that we have actually really been in a
mental health crisis fo r young people for a long time n ow . T his even --

Lee Beers

t his predated the pandemic and the pandemic has really accelerated
that it's made it much more acute. I t's also just -- it's harder to access
mental health services which were already really hard to access. It's
sort of burned in my memory a comment from a pediatrician who
said, I have treated more kids in my office for mental health concerns
this month than I have for ear infections. I think that speaks to the
scope of what we're seeing .

W e're sort of the fi rst ones many times to see when an issue is
starting to bubble up, because we're hearing about it from patients
one at a time, but we're really start -- you really -- you start to get a
sense, like, why everybody's calling me about this, what's going on
wi th that. The next thing you know, it's showing up in the data. I think
mental health is very much like that, and there's a lot of reasons for it.
I mean, you know, of course, the disruption to school and the social
isolation plays a role in that. But many families have also experienced
grief and loss in their family. They've had economic disruptions that
are very stressful for their family. W e have a lot of concern about
increased violence or abuse in the homes during this period of time ,
so a ny one of thos e things could be contributing.

W e know there just aren't enough child psychiatrists across the
country to meet this whole need. W e do have to think about how we
do things a little bit differently. I think just like with the school based
health centers, ha ving mental health care in a place where families
feel comfortable, where it feels less stigmatizing is a really important
strategy. W hen you see mental health concerns early, and you can
address them early, they often are less acute in the long run and we
can really help make sure that kids are healthy and thriving. I think
those are things we really can do in the pediatrician ’ s office.

Now, sometimes concerns are more acute or severe. And they really
do need much more specialized in - hospital mental health treatment,
or day treatment or things like that. W e can help make sure that kids
get connected to that. As we move forward and come out of this
pandemic, I do think we're going have to really look critically at our
mental health system of care across the country, because it's just not
designed to do all the things we need it to do right now. W e are going
to have to think differently about how we do that.

Mark Masselli: I do want to pull the thread on Margaret's question about strategies.
T hank you for talk ing very frankly about the behavioral health issue
that children have, and the role that pediatricians , pediatric practice s
play t o have that communication . There were going to be changes to
the way we approach health care. I think telehealth has been a fo rce
multiplier. I'm wondering, are there other innovative approaches, as
we think about this new model of delivery, we're still in the midst of
the pandemic, we are going to get out of it. But it's going to have a

Lee Beers

profound impact on practices. What are you seeing out there?

Dr. Lee Beers: Yeah, I would echo your observations about telehealth , it is -- this is
one of these things that in medicine for a long time we've been
talking about how great it would be to do more telehealth and boy,
we -- that accelera ted really quickly over a very short period of time ,
a nd that's good. I think there are some really good things about that ,
a nd that's going to be part of improving the mental health system of
care is more accessibility to telehealth, because that's been r eally
powerful thing that that's come out of it . W e are going to have to
start thinking innovativ ely .

I mean, one of the things that we have been thinking a lot about in
pediatrics is what kind of things do we do in our well child visit , a nd
how is that se t up? H ow do we really better focus on the preventative
and family support things that come up in as w ell, because I mean
pediatricians do a great job of this, no doubt. But I think at the end of
the day sometimes our financing systems aren't set up to rea lly
support all those things that we do at those visits. I think that will be
one thing that we're thinking about .

I think that what we'll probably think about in the future is what do
those visits look like? There's an increasing discussion and
understand ing of the importance of , sometimes we call it relational
health, sometimes we call it two generation approach , b ut essentially
the b ottom line is that the family health and mental health so
integrally impacts the ch ild's health and mental health, a nd so h ow is
pediatricians can we best support that ? W e're not adult doctors, but
we do know that the family -- the family is an important part of the
child's health into how can we as pediatricians best support the
families. So I think that is one thing we're re ally, really thinking about .

I think another piece that's been so important and that I think we are
actually seeing some good awareness and innovations on is around
immunization delivery and vaccine hesitancy . As a nation, we're
talking abo ut this more tha n we ever have. As pediatricians we've
faced vaccine hesitancy for a long time, that there is, I think, a much
greater understanding and public will to be thinking about how do we
combat misinformation? How do we promote confidence in vaccines?
I think the re's a lot of opportunities for partnership and innovation
there as well.

Mark Masselli: Tw o questions. One we're seeing in our pediatric residency programs,
real concerned about the exposure that the pediatricians have had
either coming into the program, right, less clinical engagement . I'm
wondering what you're seeing . The second thing, what are we seeing
happen with pediatric practices across the country , a re they rolling up
less single shingles more consolidation happenings?

Lee Beers

Dr. Lee Beers: Yeah. I think the challenge with the residents has been tough. I mean,
and what I've been hearing is that they are -- they're getting caught
up, basically. I mean, what I'm hearing from a lot of folks is that the
interns maybe are a little rust ier right at the beginnin g than they
typically are , but that they're picking up speed pretty quickly .
E specially as -- sometimes for the medical students they were doing a
lot more telemedicine or not in person stuff and so they are picking
up . W e are also talking a lot about resi dent education around in
pediatrics around things like mental health, racism as it impact on
child health, all those different pieces that we haven't done as good a
job on educating with .

I think with pediatric practices w e were, I mean, particularly the
b eginning of the pandemic, we had a lot of practices that really
struggled . V ery senior leaders and the AAP talking about how they
were deferring their salaries so that they could pay their staff,
furloughing staff , that is, for most practices I think picki ng up now,
particularly as kids are going back to school without masks , b ut also
families are coming back for their well visits and practice are having
the flip side. I mean I saw a note from a pediatrician in Alabama the
other day that they have sort of s hort hours on the weekends fo u r
hours a day, and they saw over 200 patients over the weekend ---
[Crosstalk]

Mark Masselli: Are you saying a --- any disproportionate retiring going on at this
point, or is it sort of the normal?

Dr. Lee Beers: Yeah, it's a good question. I anecdotally, I would say yes. But we don't
quite -- we do have a regular survey of our members, but it's not quite
caught up to be able to tell us that. I mean, anecdotally, yes w e are
hearing that. We're also hearing on the flip side some of our younger
members having to take -- leave their jobs or go part time or just quit
because they're having to take care of their kids at home b ecause
there have young kids and the y are virtual schooling and the kid ---
they just they can't do it all.

M argaret Flinter: W e didn't -- w e've talked mostly about primary care today. We didn't
talk about our colleagues who are caring for kids in ICU and i n patient .
B ut I will tell you, those are some of the voices I'd like to hear at the
public hearings about ma sks and these demonstrations. I just don't
think people got the idea early on, that children did not get that sick
with COVID, which seems to be true early on. But we are seeing such
a reversal in that now. I f ever there was a compelling reason for the
adu lts to go get vaccinated is to try and protect the kids , s o thank you
so much for all of your words today. We really appreciate it.

Mark Masselli: Absolutely.

Dr. Lee Beers: I think you're right, like even if it is like a couple percent of a whole lot

Lee Beers

of k ids is a whole lot of kids.

Mark Masselli: A whole lot , it’s a whole lot of kids.

Margaret Flinter: W e've been speaking today with Dr. L ee Beers, P resident of the
American Academy of Pediatrics, which represents 67,000 pediatric
medical professionals in No rth America . A ccess their latest
recommendations for sending children back to school amid a
resurgence of COVID - 19 and all of their important work by going to
Healthy Children .org or you can follow them on Twitter
@ Amer AcadPeds. Dr. Beers, thank you for yo ur lifelong dedication to
the health of children for addressing health inequality in children and
in pediatrics a nd for joining us today on conversations on health care.

Dr. Lee Beers: Thank you so much for having me. It was such a pleasure.

[ Music ]

Mark M asselli: At C onversations in H ealth C are, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy . Lori Robertson is an award winning journalist and Managing
Editor of F act C heck.org, a nonpartisan, nonpro fit consumer advocate
for voters that aim to reduce the level of deception in US politics. L ori
, what if you got for us this week,

Lori Robertson: Falsehood about the COVID - 19 vaccines have been widely
disseminated on social media. Two recent claims conce rned the
airline industry. Airlines which suffered a steep decline in air travel
last year due to the COVID - 19 pandemic are encouraging people who
have received a COVID - 19 vaccine to fly once again. Yet, social media
posts falsely claim that airline execut ives around the world are
discussing banning vaccinated passengers due to a risk of blood
clotting at high altitudes. Medical expert say there is no evidence of
an added risk of blood clots for vaccinated air travelers.

A spokesperson for the International Air Transport Association told us
the organization is not aware of any airlines considering a ban on
vaccinated passengers due to a blood clot risk, this long distance
travelers can develop a type of blood clot known as deep vein
thrombosis or DVT after e xtended periods of immobility. A DVT
typically forms in the leg and is a different disorder from these rare
blood clot cases in the United States that have been associated with
the Johnson & Johnson COVID - 19 vaccine. The individuals in those
rare cases suf fered from a combination of a type of blood clot called
cerebral venous sinus thrombosis and low levels of blood platelets.

Other viral claims said without any evidence that the deaths of four
British Airways pilots and five Air India pilots were a result of receiving
COVID - 19 vaccines. British Airways said, “There is no truth
whatsoever in the claims on social media speculating that the four

Lee Beers

deaths are linked. None of the deaths were linked to vaccines.” That’s
my fact check for this week. I’m Lori Roberts on, Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact t hat you’d
like checked, email us at chcradio.com, we’ll have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health Care.

Mark Masselli: Each week C onversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Anxiety
disorders are on the rise among the nation's youth and experts in the
field of child psychology f eel the condition starts much earlier in
childhood, and it's far more common than previously thought . W ith
an estimated one in five children being affected, but too often these
so called internalizing disorders go undiagnosed.

Unlike children with more expressive conditions, such as ADHD or
Autism Spectrum Disorder , young kids struggling with anxiety or
depression often in ternalize their symptoms, and may just seem like
an introvert to the casual observer. University of Vermont Child
Psychologist Ellen Mc g innis says the process of diagnosis for younger
children is often painstaking and can take months to confirm.

Dr. Mc g inn is says the traditional method of diagnosis involves
creating scenarios that induce anxiety followed by behavioral
observation by clinicians, and the results can be inexact. She teamed
up with her husband and fellow researcher, Biomedical Engineer Ryan
Mc g innis to create a wearable sensor that can pick up on physical
cues that suggest the presence of anxiety, using accelerometers to
compare normal stress responses .

Ellen Mcginnis: The device i t's about the size of a business card. W e've strapped that
to bel t on each child. W hen they did the mood induction test, it has
an accelerometer in it , a nd so we're able to pick up angular velocity
speed, how much the child is turning side to side, and it actually picks
up 100 samples per second. W e were able to see if kids with anxiety
and depression move differently in response to a potential
threatening information , a nd they do.

Mark Masselli: The ir research paper shows the device was nearly 85% accurate in
making a correct diagnosis. S he says early diagnosis is the k ey to
avoiding more damaging manifestations of anxiety disorder later on .
A simple wearable tool that can assist parents and clinicians in
determining if a child is suffering from anxiety disorder, leading to
more rapid diagnosis and treatment , n ow, that's a bright idea.

[ Music ]

Lee Beers
Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and Health .
[Music]
Female : Conversations on Health Care is recorded at WESU a t Wesleyan
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