Four Seasons Pediatrics

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In-Classroom vs Remote Learning

Back to School

Many of you have been asking our opinion regarding sending your child back to school this fall.  Let us start by stating that this is a personal decision for each of you.  You may have other considerations that we may not have listed here.  Consider all these options and make the decision for you, your child and your family.   

We agree with the American Academy of Pediatrics that children learn best when they are in the classroom.    Evidence so far suggests that children and adolescents are less likely to have symptoms or severe disease from infection. They also appear less likely to become infected or spread the virus.

Schools provide more than just academics to children and adolescents. In addition to reading, writing and math, children learn social and emotional skills, get exercise and access to mental health support and other things that cannot be provided with online learning. For many families, school is where kids get healthy meals, access to the internet, and other vital services.  So what should be considered in sending them back to school?  Is it safe to do so?

Australian Study

First, let’s look at a study just released from Australia.  Australia has given us their early experience, as they did not close schools when the virus began there.  The Australian schools represent an infection rate more like the Capital District than in NYC,   Their experience is based on 15 schools and 10 preschools.  They carefully followed infection by doing a combination of symptom surveys, antibody testing and diagnostic testing (nasal).  Here is what they found for transmission rates: 

• The rate of transmission from one child to another child – 0.3% of the time

• The rate of transmission from one child to a staff – 1% of the time

• The rate of transmission from staff to another child – 1.5% of the time

• The rate of transmission from staff to another staff – 4.4% of the time 

This is another study that has added to what we have suspected – children are not getting this infection nor sharing this infection at a high rate, nor at a higher rate than adult to adult transmission.

Considerations of In-Classroom Learning

Benefits of in-classroom learning

• The Capital Area is not a population dense area

• Learning in a classroom is superior to remote learning (almost all students and parents we have surveyed agree with the American Academy of Pediatrics)

• Social and emotional adaptability improves with peer interaction

• Children have a low risk of severe disease 

• We have better testing availability

• We have better tracking of infection rates (NYS has the best in the country)

• We have better contact tracing

• We can pivot to remote learning if the infection rates go up (hopefully based more on  evidence vs emotion)

• Children have had a loss of skills (reading, math, writing) attributed to remote learning

• Some children need the structure and goal setting of in-classroom learning

Benefits of remote learning

• Infection rates will increase as schools re-open

• Your child may have a medical condition that puts them at high risk (NYS has been tracking the top 10 medical conditions that lead to poor outcomes – Click here .  Hypertension and Diabetes are #1 and #2.  We also have learned that a BMI over 30 is an important risk factor)

• A parent may have a high risk medical condition

• A teacher may have a high risk medical condition

• You may be living with a family member at high risk

• Remote learning quality is quickly improving with experience

• Some of the teachers who most respect the virus and are the best at cleaning surfaces and washing hands may decide to do remote learning due to their own worries about the virus

• We are potentially months away from a vaccine which may largely eliminate the need for remote learning

• Some children are self motivated to maintain the discipline of remote learning

Of the 25,000 New York State Fatalities –  The top 10 risk factors for poor outcomes in New York State (from highest to lowest) are:

1) Hypertension (13,442)

2) Diabetes (8,886)

3) Hyperlipidemia (5,245)

4) Dementia (3,421)

5) Coronary Artery Disease (2,953)

6) Kidney Disease (2,632)

7) Chronic Obstructive Pulmonary Disease (COPD of the elderly) (2,375)

8) Atrial Fibrillation (1,979)

9) Cancer (1.926)

10) Stroke (1,651)

There may be other risk factors, but they are much less common.  We frequently have been asked about asthma as a risk factor.  This is reasonable, given that asthma affects the lungs and we hear about severe Covid Disease needing lung support on a ventilator.   About 8% of the population has asthma (children and adults).  About the same percent of the elderly have atrial fibrillation, yet asthma was not among the top 10 medical conditions with fatalities in New York State, but atrial fibrillation was number 8.  Compare this to hypertension.  Almost 50% of the adult population has hypertension and only 1 in 4 (24%) have their hypertension in control.   We also are learning that lack of control of these medical conditions (hypertension, diabetes control) leads to poorer outcomes.  

In summary, more of the infections for COVID-19 are in adults.  Most severe infections occur in adults.  90% of the fatal outcomes have an underlying disease and most of these are not in control.   Children are less likely to get the infection, less likely to spread the infection and much less likely to have a bad outcome from it.  

Let’s compare influenza.  It is my belief that influenza continues to represent a greater concern to children.  Tragically, for the 2019-2020 flu season, 184 children died from influenza.  As is true for most years, about 50% of children have no underlying high risk medical condition.  90 children have succumbed to the COVID-19 virus thus far.   Each year 100-200 children die from influenza (85-90% of which are not immunized).  In 2009, 477 children died from the H1N1 pandemic flu.  All of this occurs with the flu, despite having a fairly effective vaccine in the face of a constantly changing flu virus, and having effective anti-viral medications to use on the flu, as well as a very accurate PCR test.  It is hard to imagine that we will see this kind of outcome from COVID-19 in children.    This is not to downplay the virus, but rather to give perspective to consider its impact to children as you consider the school year.  Consider these statistics, your child’s medical conditions, the impact on learning, but most importantly consider what high risk elderly relatives come in frequent contact with a child who is going to school.  

Illness in the Office

As previously stated, children with potential COVID-19 symptoms are seen in their cars.  We examine them and do testing outside in full PPE.  This is to protect families and children of the practice.  This also protects our staff by limiting exposure only to Dr. Miller, Dr. Elmer, Dr. Lange, Dr. Apruzzese and our Physician Assistant Joyce Gillespie.  We have completed construction of our temporary vinyl structure and will open it soon.   Rapid molecular testing for the COVID-19 virus is weeks away for Four Seasons Pediatrics.  We also want you to know that we have no hesitation to test for the virus at this time.  Below are the most common symptoms of COVID-19 in children :

Cough (49-54%)

Fever (42-56%)

Sore throat (35-46%)

Muscle aches (23%)

Shortness of breath (13%)

We do ask you to consider the following – if your child is doing well (drinking, comfortable, responds to acetaminophen), we ask that you wait 48 hours before coming in to be evaluated and tested.  In that 48 hours, there are some children who will declare what illness is going on. (e.g. the rash of hand, foot and mouth disease a.k.a. Coxsackie virus).  We can make that diagnosis over the phone or video in most cases and it prevents un-necessary testing.  If symptoms are persisting after 48 hours, we are happy to evaluate and test (testing supplies permitting).   We are unable to do COVID testing on the weekend at this time. 

Well Visits in the Office

We want to make a plea that you cancel your well visit for anyone with the symptoms above, along with any other potential viral symptoms, including but not limited to runny nose, diarrhea, vomiting.   Even if you think your child is having allergy symptoms, let us evaluate by phone before coming in.  We are committed to keeping patients, families and our staff as safe as possible.  Please help us in doing so.  

Dawne Salazar-Moore, LMHC

Dawne, our Pediatric Therapist has been working hard to assist patients and families with the stress, anxiety and other mental health needs associated with our current times.  She is now accepting patients with:


Empire Blue Cross/Anthem




Thank you

Lastly, Dr. Elmer and I want to thank all of you (including the anonymous individual(s) who recognized our office by “Flocking” us).    Thank you all for your well wishes to us.  Dr. Elmer and I want to especially recognize our staff for all their hard work.   They have taken on the task and effort in sanitizing every surface, after every patient, every day.  They are keeping us safe with all of their hard work.  They have energized us.  We are so proud of them.    

Warm regards,

Dr. Miller and Dr. Elmer

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