National Pediatric Leader Talks About Returning To School In Pandemic

Dr. Sara Goza – American Academy of Pediatrics

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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 the great minds
who are shaping the hea lth care of the future.

This week Mark and Margaret speak with Dr. Sa lly Goza , President of
the American Academy of Pediatrics. Dr. Goza talks about A AP ’ s
recommendations for keeping kids safe during the COVID - 19
pandemic . Protocols for ensuring that safety as kids go ba ck into
classrooms, daycare and college campuses, including mas k , social
distancing, reduced contacts, and being aware of the infection rates in
your area. She examines the threat to public health a s millions of kids
had fallen behind in well visits, and v accinations.

Lori Robertson also checks in, Managing Editor of F act Check.org, and
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 health and wellbeing in everyday lives. If you have
comments, please e - mail us at [email protected] or find us on
Facebook, Twitter, or wherever you listen to podcast. You can also
hear us by asking Alexa to play the program. Now stay tu ned for our
interview with Dr. Sa lly Goza here on Conversations on Health Care.

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Mark Masselli: We're speaking today with Dr. Sara Goza, President of the American
Academy of Pediatrics an organization of 67,000 clinicians committed
to the optimal , p hysical, mental and social health of the nation's
infants, children and young adults. Dr. Goza is also a fellow of the
American Academy of Pediatrics.

Margaret Flinter: She earned her medical degree at the Medical College of Georgia in
Augusta and complete d her internship and residency at Cincinnati
Children's Hospital and Medical Center, after which she returned to
her hometown of Fayetteville, Georgia, eventually joining her uncle's
pediatric practice there. Dr. Goza welcome to Conversations on
Health Car e .

Dr. Sara Goza: Thank you for having me today.

Mark Masselli: You know what , it goes without saying we're in the midst of this
incredible public health crisis , and yet like so many things associated
with the pandemic, our knowledge of COVID - 19 seems to g row with
time . F irst data point suggested that children weren't as affected a s
older adults. But now we know children are very efficient carriers ,
spreaders of the virus . I t can also have devastating health impact on
them. I'm wondering as the nation is ab out to send its children back
to daycare and schools and universities , I know parents and caregivers

Dr. Sara Goza – American Academy of Pediatrics

are quite anxious . I'm wondering what advice is the American
Academy of Pediatrics offering to its own member clinicians , but also
to families across the c ountry on what may be the best and safest way
to navigate a school year .

Dr. Sara Goza: I think every family is different , and so my message to every family is
call your pediatrician , call your family practice doctor , call someone
who knows you, your famil y, and your child to discuss what's going to
be in the best interest of your family, especially if you have childre n
with special health care needs, or you have parents in your home or
grandparents who might be living there, who may be at higher risk for
C OVID - 19. We know that public health measures work too. We know
that we have to get the rate of community spread down , and we can
do that. We can have everyone wear a mask, physical distancing,
hand washing, and avoiding large gatherings and really staying home
if you can . I mean, really not going out and doing a lot of the things
that we normally would do to try to get that rate of spread down
because if we can get that rate of spread down in communities, our
children can go back to school, they can go back to their sports, they
will be able to do the things that they're used to doing. But if we don't
get that number down , then children w ill continue to get this virus.

Margaret Flinter: Well , Dr. Goza, getting consistent information about the c oronavirus
for all of us who are trying to follow that all the time has been
challenging. We really appreciate the work of the American Academy
of Pediatrics has been gathering child infection data in recent months.
That's so important. This summer we certainly saw a sp ike among
children and young adults , we saw some schools , summer camps and
now college campuses. I know here in our own state, some opened
th a n closed. What are your data revealing about childhood infection
rates and the risk to children and teens and youn g adults as well as
their families as they spread the virus, which they seem quite capable
of doing ?

Dr. Sara Goza: The rising number of cases in children really corresponds with the
overall rise of COVID - 19. But we did see a big spike in the summer ,
and I think that's because children were getting back out and getting
around other people again . But also the parents were getting the
disease, or getting COVID - 19 because they were back at work and
getting it , and so they were spreading it as well to their chi ldren. We
know there's been substantial spread and that children are going to
get it. The one thing we do know is that children are not immune to
this disease. Children can get COVID. They can get very sick with
COVID, and they can be hospitalized with COV ID . We know that that is
less than with the adult populations, but it’s still there , and we have
seen those numbers. We think more widespread testing also was
part ly to account for those increases in numbers, but we also saw
rises on hospitalizations and d eaths. W e know that it was a true

Dr. Sara Goza – American Academy of Pediatrics

increase in the numbers of children becoming infected . W hat we have
to do is we have to still , just like we said, wear your mask, wash your
hands , physical distance, and really, really try to get those numbers
down.

Mark M asselli: Dr. Goza, the American Academy of Pediatrics had recommended a
couple of months ago that kids be sent back to school , citing the
potential of long term impact on mental health educational track and
social development . Y ou recommended educators sho uld do their
best to ensure that children can come back , but they also needed to
keep kids safe with mask, social distancing and other measures that
you just walked us through . But it doesn't seem that the nation or
parts of the nation have been able to fo llow those recommendations
control the virus to make it safe for children to return to school safely.
I'm wondering if you have changed any of your recommendations as ,
again, I think we're all learning as more data comes in . I t sounds like
you initially su ggested that some of this is hyper local response, call
your local pediatrician or family practitioner to get some advice , but
how about for the academy itself? Has there been any shift in its
position on this ?

Dr. Sara Goza: We still believe that the goal should be for children to be in school in -
person , and you know the reasons , the mental health , the social
emotional developmental issues, our children are losing. We have an
education gap already , and just the children having to do online
schooling, there is internet gap where some people have internet and
computers and others don't , s o that's going to increase that education
gap. We have children losing social skills that autism children, some of
my patients in my practice of parents call me and say they' re losing
their ground , and so the goal is still to get children back into in - person
school. We have not changed our guidance on that . B ut we know that
you have to look at what's ha ppening in your local communities what
your spread is. If the spread is hig h, you're s urging with numbers of
COVID - 19, it is probably not very safe to open y our schools , and public
health has to be involved in that decision making process along with
the school systems.

We also have some school systems who are not able to do the
m itigation that we recommend . T hey're just not able to do that. There
needs to be funding for that from the federal government. We have
to have funding, we have to have public health and the school
systems working together , and the communities working toget her to
get the community spread down , to do the mitigation that they need
to do in the schools because it is so critical for our children, we have
food insecurity as well. C hildren who don't have access to food who
are hungry, you can't learn when you're h ungry . W e know that it's
critical to get those goals in sight and to really work towards making
th at so that children can get back into school. But we have to make

Dr. Sara Goza – American Academy of Pediatrics

sure it's safe not only for the children , but for the faculty and staff.

Margaret Flinter: Y ou know, Dr. Goza , it wasn't just the sc hools that were closed ,
practices were closed across the country . When we look back at the
early weeks in March and April and May and with it just a vast
reduction in well child routine , health maintenance checkups f or
children along with that the decrease in vaccinations . I think people
have been so creative and so disciplined about bringing up t elehealth ,
coming up with clinics to just do the vaccinations and catch people up.
But now we head into flu season. How is the American of Pediatrics
addressing this consequence of the pandemic? What are your
recommendations to your pediatric community in the field about ho w
to make this catch up happen?

Dr. Sara Goza: I've been very proud of the American Academy of Pediatrics in this
time . We have moved very nimbly and very quickly to put out
guidance. Our first guidance was to clinics , to practices , to say,
prioritize to young children, make sure we're getting those vaccines
in. If that's all you can do, do that. Try to rearr ange your office so you
can have an area where it's only well visits , area that's only sick visits
or different times of the day. Moving into t elehealth , we had
webinars about how to do t elehealth , how to get paid for it. We
advocated for payment for t eleh ealth through Medicai d and through
the other payers.

We started a campaign called # CallYourPediatrician on social media to
try to get parents to realize that pediatricians were still open. T hen we
just recently came out with a guidance on caring for ill ch ildren in your
practice , and it talks about some of the things you can do to try to
make your practice safe, not having a waiting room , bringing people
in one at a time , seeing children outside if you think the y’ re truly
contagious, doing testing outside i n the parking lot or somewhere ,
and still trying to keep those children up - to - date on their vaccines, get
those checkups and get them in -- getting a list of your patients so
that are not up - to - date and calling them and getting them to make
appointments , c ontinuing to do t elehealth as we've talked about .

We also put out guidance on testing with that about what children
should be tested . Then it talks about the different tests that are out
there when they should be used, what they're good for , what they're
n ot good for. Also , which children you really -- children that are sick,
that have been exposed to definitely be tested . C hildren that you're
not sure what's going on , probably should be tested that are
symptomatic , and then when to test asymptomatic childr en if they've
had an exposure, so you can do contact tracing.

Margaret Flinter: Right.

Mark Masselli: We're speaking today with Dr. Sa lly Goza, President of the American

Dr. Sara Goza – American Academy of Pediatrics

Academy of Pediatrics, an organization of 67,000 members . Dr. Goza,
I want to pull the thread on the conversation you’re just having with
Margaret around t elehealth , and I think it's fair to say it's one of those
silver linings in this crisis that it allowed providers and patients to
really connect with each other pretty much was a fairly s wift
transition , not so much for the smaller in it, maybe independent
practices had a little more difficulty. I'm wondering as you sort of
think about it and we know it's complimentary to in - person, you
obviously can't give a flu shot over the phone. But i t's a hand in glove
relationship between telemedicine and in - person visits. As you look
forward , how's the association dealing with CMS on the regulatory
side? What are you looking for from the government in terms of
guidance , b ecause I would imagine for a lot of practices, if this is going
to be a long term permission , there are additional investments that
are going to need to make. Tell us about advocacy that you're doing
on behalf of t elehealth and what are the other is sues that you're
focused in on?

Dr. Sara Goza: We came out with guidance on t elehealth very quickly. We had
webinars for practices and pediatricians to watch. We will continue .
W e know t elehealth is here to stay and we've been very excited about
some of the uses it's had. Our subspecialist and our surgical specialists
were really quick to pick up on using t elehealth . I mean they had
webinars on their own sections about how to use t elehealth . Th is has
really been helpful for especially our rural communities where
children have to travel two a nd three hours to get to sub specialist , to
be able to see their subspecialist on a t elehealth visit.

I had a patient yesterday who would have waited months to get a
genetics appointment , because of t elehealth was able to get it right
away . I think that the re are a lot of good reasons to have t elehealth .
We're going to be advocating to continue the parody and payment , to
continue some of the regulations that have been relaxed about
whether it can be the origin of it and those kind of things where you
can do t elehealth from , all of those things we're go ing to continue to
advocate for. Also talking about what does it mean about cross state
lines . I f you have a patient who's in college in another state, and you
see them for something, will it be still okay to se e that patient even
across state lines without having licens or issues ? I think we will
continue to look at this as we go forward as to whether the best
practice i s. We have a section on t elehealth who is looking at this very
seriously and coming up with re commendation s that I haven't seen
yet , but that are coming up about how do we move forward as the
pandemic goes away , what do we want t elehealth to l ook like going
into the future.

Margaret Flinter: Dr. Goza, I wonder if I could talk about something other than COVID,
which is hard to find these days. We're all very concerned with

Dr. Sara Goza – American Academy of Pediatrics

workforce issues and workforce in primary care . In our organization ,
we're very proud to be home to training for a large group of pediatric
residents. We host a postgraduate nurse practitioner residency
program. We have postdoctoral clinical psychologists . S till we know
we have a distribution problem , and we actually have a pipeline
problem as well . P rimary care struggles as people are pulled to some
of the specialties. I wonder fro m your vantage point at the American
Academy of Pediatrics, if you would speak a little bit to how you are
inspiring the next generation of medical students , or just children
coming up in the pipeline to thin k about pediatric primary care.

Dr. Sara Goza: I just like to say first in my own practice, when I have children tell me
they're interested in medicine, I'm always talking to them about
pediatrics when they're there . I was like pediatrics is the best thing.
Well, I’ll come back and work with you Dr. Goz a , I'm like fine you just -
- do it. I also try to encourage patients when they're talking about
going into medicine, not to get discouraged in those first years in
college . S ometimes you stumble when you first go to college, there
are other things that ent ice you to do, and to continue to be
committed to it and t o realize that th ey can make it.

The A AP is very interested in the pipeline . We are starting to look at
ways that we can address pre - college even , if there's a place to do
that. But also we now have a medical student section on trainees , and
the medical students can join that . I s aw that one of our fastest
growing sections is because of the medical students have been joining
and joining in , and they can come to our meetings, they can be
involved in a ctivities at the academy . I think once they see what the
academy does, and what pediatricians do that pediatricians aren’t,
especially primary care , pediatricians aren't just in an office seeing
patients that we work outside the office , that our goal is to work on
everything that affects children. W e know what happens to children is
very little of what happens in the exam rooms. It's really what's
happening to them outside in the world . A ddressing those social
determinants of health, those public health iss ues, and things like
that .

E ncouraging people to understand that going into pediatrics means
that you're really looking at the future of this world because we're
taking care of our future and trying to make sure that they're healthy
and that they grow up t o lead the best lives they can. I think that's
part of it is that motivation that this is really more than just being a
pediatrician in the exam room taking care of sore throats and
[inaudible 00:15:41] , it's really taking care of a child.

We also look at team based care . We have a team based care policy,
and we believe that that's the best way to do it. Everyone should
work up to the top of their license and what they're trying to do

Dr. Sara Goza – American Academy of Pediatrics

because that's how we're going to be able to spread out and do the
work t hat needs to be done. You look at mental health now , I mean,
we need -- that takes up so much time in a primary care office , and
we need to be able to do that it's so critical to do it . We all need to be
working to the top of our licenses. Also, nurse prac titioners and PA s
can also be members o f the National Academy as well. We have area
for them to o.

Mark Masselli: Well, I'd like so much your thought that health care is not only what's
inside the four walls, but it's outside . I know the AAP has really a
ro bust policy agenda, really thinking about the social determinants of
health, which in many ways I think this younger generation is very
focused in on as well , animated about it. You talked earlier about food
insecurity, maybe walkthrough the work in policy and advocacy
around social determinants, whether it's gun violence or substance
use disorder, or as we've discussed earlier, the impact that poverty
has on adverse child hood events on health outcomes. What's driving
your policy initiatives right now? How does the public get engaged
with the work that you're doing and better understand t he work that
you're doing?

Dr. Sara Goza: You know right now, our major focus is actually on health equity and
the disparities that exist in this world, and that includes al l of those
things , that includes poverty, food insecurity, racism, gun violence .
You name the disparity that's out there , and we know that a lot of it is
based on racism and poverty. I mean, our black children and our
American Indian, Alaskan natives, and our Hispanic children are much
more disparate, just proportionately affected by all of these things. It
is a broad umbrella to look at all of that, and I think racism has kind of
risen to the top this year, is one of the things that because we know
that bl ack and Hispanic children are more likely to get COVID and
more likely to be sick with it. We know that they are the number one
group of children that are being admitted to the hospital with a multi
inflammatory system disorder . W e are really trying to loo k at how can
we affect change in the health equity and the disparities , and we
know that we have to address racism a s one of the top things .

Poverty is still there. We've been trying to address poverty for years,
and we're going to continue to address the issues with poverty . We're
still working on gun violence . We're still working on substance use
disorder. All of those things are still being worked. Mental health is
another one. I t's really a village , I mean, one thing is not disconnected
from the other , and so it's all just this big thing of how do we make
sure and decrease those disparities and have health equity and have
children have the equal chances in this world, have the same ability to
succeed in this world because we know right now they do not.

M argaret Flinter: But I'll tell you, I really respect the chapter levels of A AP and I know

Dr. Sara Goza – American Academy of Pediatrics

here in Connecticut, I don't know if you've met up with any of
Connecticut people Dr. Dudley and others who works for us . They are
in the legislature every year, ever y year advocating on behalf of
children there in the schools. They really are, as you say, very
seriously engaged in the environment and the community in which
children's health takes place , s o thank you so much to the academy
for really being out there. W e've had a lot of great projects through
H ealthy T omorrows .

I think we have all counted on them for their leadership during the
COVID pandemic. They were right there recognizing that offices
probably needed to close for a period of time and right the re rea lly
helping offices open up again in pediatrics to make sure that those
very important well child visits, vaccinations, immunization
screenings, what could be done online would be done online via
t elehealth or what had to be done in - person would happen in
t elehealth . I think the health care commu nity is really counted on
them.

We've been speaking today with Dr. Sa lly Goza , President of the
Am erican Academy of Pediatrics, an organization of 67,000 members.
You can learn more about their work by going to www.aap.org or
follow them on Twitter @AmerAcadPeds, and you can follow Dr. Go z a
on twitter @AAPPres. Dr. Goza, we want to thank you for your tireless
advocacy for America's children , for the frontline clinicians who are
ded icated to protecting and safeguarding their health and their future
and for joining us today on Conversations on Health Care .

Dr. Sara Goza: Well, thank you for all you do and thank you for having me today.

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Mark Masselli: At Conversations on Health Care 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 FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters tha t aim to reduce the level of deception in US politics. Lori,
what have you got for us this week?

Lori Robertson: In his speech at the Republican National Convention , President
Donald Trump claimed that his administration will “ f urther reduce the
cost of pr escription drugs and health insurance premiums. ” He added
“ they're coming way down. ” But insurance premiums for those with
employer based plans where nearly half of Americans get their coverage have gone up as they normally do . While there's not one
standa rd measure of prescription drug cost, the metric Trump has
used in the past of evidence of a decrease now shows a year over year
increase.

Dr. Sara Goza – American Academy of Pediatrics

The Kaiser Family Foundation's latest annual survey found premiums
in the employer market for single coverage went up 4% from 2018 to
2019 , and family coverage premiums rose 5%. Employer sponsored
insurance premiums have risen each year, dating back to at least
1999. For those who buy their own coverage on what's called the
individual market , that's 6% of the US populati on , t he story in the pas t
few years has been different.

On the Affordable Care Act exchanges, premiums on average have
gone down in 2020 by 3.5%, for the lowest cost silver level plan, and
in 2019 by 0.4%, but that was after a double digit increase for 201 8
plans, which rose by nearly 30% on average , t hat hike was driven by
the Trump Administration's elimination of cost sharing subsidies and
ensure uncertainty over the ACA ’s future. The Urban Institute says
that many insurers have overreacted to that uncert ainty pricing 2018
plans higher than necessary. As for prescription drugs, Trump has
been using the Bureau of Labor Statistics , Consumer Price Index for
prescription drugs to claim drug prices decreased last year. But that
talking point is now outdated. Th e measure of drug price inflation
aims to capture what consumers a long with their insurance
companies or other payers are paying for a basket of retail
prescriptions. It now shows a year over year i ncrease for 10 months
straight.

The President also touted recent executive orders he signed
concerning drug prices, saying they “ will massively lower the cost of
your prescription drugs ” . But it's uncertain what the impact of those
orders will be. They largely revived past administration proposals and
require mov ing through the federal rulemaking process. That's my
fact check for this week. I'm Lori Robertson, Managing Editor of
FactCheck.org.

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Margaret Flinter: F act C heck.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 that you'd
like checked, e - mail us at www.chcradio.com w e'll have
FactCheck.org’s Lori Robertson check it out fo r you here on
Conversations on Health Care.

[Music]

Mark Masselli: Each week Conversation highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Over the past
few decades, kids have been getting less and less phys ical activity
throughout the school day. Phys Ed has become less prevalent in
many schools . The University of Michigan Researchers wanted to find
a creative and effective solution that would increase kids ’ movement

Dr. Sara Goza – American Academy of Pediatrics

wit hout disrupting the school day.

Dr. Re becca Hasson: We looked at the scientific literature in terms of prolong ed sitting, if
you just does two minutes of activity, a small burst get up do some
movements , activity in that small of a dose can have dramatic
improvements on health on cognition , on learning. W e decided to
develop an intervention , a program , that would allow children to get
these small burst of activity throughout the day.

Mark Masselli: Dr. Rebecca Hasson is Principal Investigator for Impact , interruption of
prolonged sitting with a ctivity .

Dr. Rebecca Hasson: We typically see in PE or recess lower participation in girls compared
to boys. But in classroom activity breaks, you actually see similar rates
of participation, if not higher rates of participation in girls. We also
saw that for children who are carrying few extra pounds , if those
children also were exercising at a high intensity, even children with
asthma .

Mark Masselli: They wanted to design the intervention that would be easy for
teachers to adopt and manage. T hey created v ideos designed to get
kids moving quickly .

Dr. Rebecca Hasson: We created a compendium of 200 activity breaks that are just three
minutes long , s o the teachers had a variety of different types of
activities whether it was jumping jacks, leap frogs, somethi ng that will
get their heart rate in a target heart zones .

Mark Masselli: Kids burned on average about 150 more calories per day, and at the
end of the week, had accrued a significant amount of physical activity.

Dr. Rebecca Hasson: We had these little acc elerometers. They measure movement at the
hip , and so it tells us how many calories were they kids burning away
from the laboratory , and how much physical activity were they
getting .

Mark Masselli: A low cost easily adoptable fitness intervention for kids, allowing
short burst of physical activity throughout the school day , enhancing
fitness positively impacting the learning experience. Now that's a
bright idea.

[ Music ]

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.

Female : Conversations on Health Care is recorded at WESU at Wesleyan

Dr. Sara Goza – American Academy of Pediatrics

University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcast. If you have comments, please e - mail us at
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