Kids & Covid: Pediatrician & Covid-19 Expert Dr. Cara Natterson Answers Your Questions

Ask Lisa Podcast, Ep. 20: Kids & Covid: Pediatrician Dr. Cara Natterson Answers your Questions

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

REENA: So, you know when you have a question about your kid medically and then you start to Google and all these crazy things come up? You don’t have to Google today because we have got the expert, an amazing pediatrician Dr. Cara Natterson, who’s actually helping schools with kids and COVID and creating health and safety plans, she’s also a New York times bestselling author. Her books on puberty and parenting and she’s got this incredible newsletter. It’s about science, parenting, COVID. We’re gonna tell you all about tha,  how to subscribe later, but Kara, welcome.

CARA: Thank you.

LISA: This is Lisa here. We’re thrilled to have you.

CARA: I’m thrilled to be here.

LISA: All right we’ve got so many questions. Why don’t we just get down to business. All right vaccine is out. What do we need to know about kids and the kind of coronavirus vaccine?

CARA: A few things. The first is just a little bit of a reality check. Vaccine is out for very few people. So the very first folks to get vaccinated are health care workers, and then people who live in residential care settings. I will say my own husband who works in the hospital in the ICU is getting his vaccine tomorrow. So very excited, but that being said I’m not, and you’re not and it’s going to be a little while before the vaccine is rolled out. For our kids it’s going to be longer than a little while because they’re not being studied and this is a really important thing. There are a couple of studies that have begun. Pfizer has included kids between the ages of 12 and 15 and they were authorized to give their vaccine to kids ages 16 and up, so that’s pretty significant, and Moderna has just announced that they will be studying kids, but the American Academy of Pediatrics is doing a full court press on all the vaccine developers, trying to get all of them to include kids because it takes time between studying them, analyzing the data and then rolling out the vaccine for them. The answer to the question every parent has for me, when can my kids get vaccinated, is let’s cross our fingers and toes. I hope this summer or early this fall, and how does that impact my kids going back to school? Tremendously.

LISA: What about, Kara, if many, many of the adults around kids are vaccinated, what does that mean for kids’ safety?

CARA: Well let’s start with what it means for adult safety because it’s adults who get sicker with coronavirus, so there is a reason for the priority in terms of who is being studied and who is getting the vaccine first. It makes a big difference if we protect our most vulnerable populations, and so rolling out vaccine for adults is critical and it does protect our entire community the more people who get vaccinated, the more protection we have until we reach this point called herd immunity, and herd immunity is a concept that means enough of the people in the herd, in the group that live in a community, have protection against a virus that the virus can’t really penetrate that community, it can’t infect that community very effectively. No one has agreed at what the human at what the herd immunity level is for current affairs. We don’t know how many people have to either have had coronavirus or been vaccinated in order to get herd immunity, but if every adult who can get a vaccine does get a vaccine, we will get there much faster and that will protect our kids.

REENA: And we know that at this point right now we’re not there yet with herd immunity and obviously back and you’re just rolling out. We know that Mr. Biden, Joe Biden, has said that in his first 100 days, he wants to get kids back to school. You look at some of these European countries where elementary schools actually had better success in staying open in let’s say the middle or high schools. Why do you think that is, Dr. Kara? And I keep hearing people say that younger kids, they’re not spreaders, they’re not spreaders. Is that really true?

CARA: I work a lot with schoolS. I am a huge advocate of getting kids back to schools. The reason why kids can do that safely is that if you look at how the virus actually gets into the body, go with me here, just close your eyes for a second, go on this science ride, okay? Virus comes into your respiratory tract through your nose or mouth, and it has to get inside your cells in order to multiply and then to spread not only inside your body, but also for you to pass it back to other people. In order for the virus to get into cells, it has to attach onto a receptor. Think of it like a lock and a key in a door. The receptor that is responsible for allowing coronavirus, this strain of coronavirus, into cells is called an ace two receptor. The younger you are, the fewer you have, which means that viruses have less likelihood of getting into cells where they then multiply if you’re young. So younger kids, and we’re talking about preschoolers, kindergarten, first, second, third grade, these kids actually produce less virus because less virus is able to get into their cells, into the machines that then turn them over. So that’s one fact.

REENA: I have never heard that explanation before.

CARA: Yeah. It’s a really big contributor to why we are able to keep daycares, preschools and the youngest grammar school kids in their school communities. The other thing is, think about your littlest kids. When they cough, their force of cough is much less than yours or mine, right? So this whole six-foot rule that we’ve been hearing for months and months and months, that’s predicated on me being able to cough or yell out my respiratory droplets far enough that I can reach you from six feet away. No 4-year-old can do that. They might be able to pass their viral droplets one or two or three feet but a large number are not going six feet, and so they’re not great transmitters.

REENA: You know when you talk about spreaders and spreading, you know we’ve had these holiday gatherings over the past month and into the new year. Some people are just not staying at home, right? How do you know when it’s really safe for your child to go to school?

CARA: So, great question because you’re letting me distinguish between what you’re doing at home and what you’re doing at school. Schools are really really good about enforcing mitigations. Mitigations are the safety measures we take to prevent the spread of coronavirus, so when you walk into schools, by and large, you’re seeing kids in masks and teachers in masks. You’re seeing people separated by at least six feet, you’re seeing activities outside as much as possible, you’re seeing a huge emphasis on hand hygiene, washing your hands, and no one is stepping foot on a school campus if they’ve got a symptom of coronavirus or frankly any other illness. If we all ran our private lives that way, we’d have different rules around gathering, but we don’t. When we gather in private, we all take our masks off, we hang out close together, we gather, we share food, we don’t wash our hands. I wish the messaging was, you want to gather, gather like you gather at a school. Think about managing the number of people and the interactions people have, and I guarantee your transmission rate would be lower, but human nature just doesn’t work that way. So we are stuck with saying, don’t gather.

LISA: Wow that’s so helpful. And this is actually my question, Kara, and then I’ve got questions more from our listeners, so what I think I hear you saying is given how good schools are at enforcing the rules, even if there’s a child with COVID in the classroom, it’s still pretty hard to get it from them. Is that an accurate characterization of what you’re saying?

CARA: Well certainly if it’s a really young child. I have two teenagers at home and they’re going to be really efficient spreaders if they go to school with their coronavirus. Yes wearing a mask minimizes the risk, yes keeping distance minimizes the risk, but my 15-year-old son can cough virus much further than I can. His lung capacity is bigger and his force of exhalation is actually better than mine. So for the youngest kids, the risk of transmission, very very small, but your going to start to see differences between school policies for grammar school kids, middle school kids, and upper school kids, simply based on the fact that their physiology is different.

LISA: Okay that is so interesting and actually the idea of like your son having more power to transmit out of sheer, you know, the machinery of his body is so fascinating

CARA: Well you should see him. The guy is huge.

LISA: Okay here’s a question from a listener. Once your child has COVID and recovers, how long does the immunity last?

CARA: Nobody knows. Anyone who tells you they do is lying to you. I mean this is a virus that’s been around for a year. I think it’s safe to say a year. There’s a lot of data coming out now that shows cities, Los Angeles where I live,  we’re looking at old banked blood from November and December of last year, and we’re starting to find evidence of coronavirus in that banked blood, which is very interesting, but that’s probably as old as the virus is in terms of community viral load. So we don’t have any sense of longevity of immunity since this virus is so new. That said, if you start reading some of the vaccine data, I think it’s very interesting the recommendations as vaccine rolls out is that if you’re actively infected with coronavirus, don’t get the vaccine, and in fact, in the first 60 to 90 days after active infection you probably don’t want to get the vaccine because remember vaccine turns your immune system up. It upregulates your immune system. Well so does the virus. You don’t want to give someone who’s already got an immune system that’s revved up a vaccine that will further rev it up. So there will absolutely be a large group of people who have had coronavirus who get vaccinated, but by and large, I think the recommendation is going to wait two or three months after because you’ve got enough protection from your infection and you don’t want to overdo it with the immune system.

LISA: That’s really interesting. Okay here’s another one, might be in the we don’t know category. I know it’s still early, but can we tell anything about the long term effects of COVID on kids and teens?

CARA: No.

LISA: Okay.

CARA: We have a lot of stories. We have no data. I mean we have a lot of stories about adult symptoms and long haulers, which is very interesting, these people who have symptoms that are going on and on for not just weeks but months after their affection. But remember very few kids relative to adults get sick, so we don’t have a huge crowd of people who were symptomatic with COVID that we then follow for long term symptoms. We will though. MIllions of millions of people Infected, we will.

LISA: Okay, so then related. Is it safer for my kids to run errands for me so that I am not exposed to COVID? I know they are less likely to get sick from it than I am but they can still pick it up.

CARA: It depends what kind of kid you have.

LISA: Okay.

CARA: Okay so if you have a kid who’s gonna go run an errand with a mask on, keeping six feet of distance from people who are in the store, coming home and washing hands, well then yes 100 percent go send your kid, because the chance that he or she gets sick with it is lower. Now they can get it up and their nose. They can get it on their hands and then touch their eyes, they can get virus and if they pick up virus then they can multiply that virus in their body and pass it to you. If you have a kid who will not keep their mask on, who will not wash their hands, they might try but you just know it’s all the execution and the execution is not there, go do the errand yourself. Just be protected.

LISA: Love that.

REENA: That’s good advice, very good advice. You know there was news out of England that they’ve started inoculating people and there were two people that had severe allergies to the Pfizer BioNTech vaccine. A question here from a mom is if your child has allergies, how can you tell if the vaccine is really safe?

CARA: We’re going to hear a lot more about side effects. The studies that have been done so far on the leading vaccine contenders, Pfizer, Moderna, but they’re not also AstraZeneca and Johnson, these are studies of 30 and 40,000 people. We’re talking about giving vaccine to billions of people. So the one in a million side effect is going to happen often. Okay? And it’s important to put it into perspective. We’ve been expecting to see side effects once we give vaccine that we didn’t see in the study. I think was a little surprising that you know on day one or day two in the UK we saw these two episodes of anaphylaxis, anaphylaxis for people who have allergies or if kids have allergies you already know this, it’s an overwhelming inflammatory immune response to an allergen. What the recommendation, where the recommendation is landing now, is that people who have allergies to foods or to the environment or to pet dander, do not need to worry. That is not a contraindication to vaccine. You can get the vaccine safely. It’s people who have a documented reaction to components of the vaccine who need to be concerned. Now that’s logical, but what are the components of the vaccine and how are you going to know that you are allergic to that? Right? That’s a whole different question and no one really has the answer, I mean we we know what’s in the vaccine, but in terms of figuring out if you’re allergic to a component or not, I don’t know how people are going to figure that out but I will tell you no latex allergy people until we know that the vaccine is given without a latex stopper, that’s import.

REENA: Oh interesting. But if my son has, let’s say, a nut allergy?

CARA: Totally fine.

REENA: I shouldn’t be concerned?

CARA: Totally fine. The group that’s going to be confusing, as far as I’m concerned when I put on my pediatrician hat and I think, who do I, or don’t I want to vaccinate? It’s the people who have had reactions to other vaccines.

LISA: That makes sense.

CARA: And where this gets confusing is often the reaction to other vaccines are related to the component parts of those vaccines. For instance, a vaccine that’s made using egg might cause someone who has an egg allergy to have a reaction. Well there’s no egg in the coronavirus vaccine, so people who have had a reaction to a vaccine with a component of egg in it might say, but I’ve had a vaccine reaction, and you really need to be able to walk them through what it is they’ve reacted to, so that you can reassure them that the coronavirus vaccine’s going to be safe.

LISA: All right let’s talk about romance and high schoolers. My teenager is in a new relationship and wants to spend more time unmasked, not distanced for sure, with his girlfriend, asks one of our listeners. How do I handle this from a safety standpoint, especially since I told my elementary school kids no playdates.

CARA: The special playdate. I get this call all the time and I will tell you that the answer is half medicine and really it’s half psychology. So, Lisa, you, I’m sure, have a lot to say about this and I bet I’m going to agree with you. From the medical standpoint,  we know that close contact unmasked is a risk factor for coronavirus. We also know, though, that if you’re not with anyone else and if you essentially create a germ family and that is generally speaking it’s the people who live under your roof, but let’s define a little more broadly, it might be the people you live under your roof and one or two other people who don’t, so long as you are swapping germs only with these people, and these people are swapping germs only with you. You now understand your risk, and so here’s the advice I give from a medical standpoint to people who call me with this question. I say, well it’s a little fast for the relationship but here’s what you should suggest to your child. He or she is now in a germ family with the person who they are dating. Loosely dating, seriously dating, doesn’t matter.

LISA: But at least smooching.

CARA: Smooching, and so you need to ask that person and their family to respect the boundaries of the germ family, meaning if the kids can be together then the two families agree that they’re not exposing themselves to other people. It falls apart if in one family the parents are working off, you know, on the front line somewhere are getting exposed and in another family they’re having playdates or hanging out or inviting families over because that’s not a contained germ family, but if you can commit to contain germ family then you can think about letting the kids have the relationship.

REENA: That’s so hard, though, right? You’re essentially quarantining with your child’s girlfriend or boyfriend’s family, right?

CARA: And let me tell you, I am not the psychologist on on the line

REENA: We know one.

CARA: We do know one. My two cents, and Lisa I want to know your two cents, but my two cents is the social and emotional benefits of relationship development are so profound that this is one that I have told parents, especially of older teens and young twenty somethings, get over it and make the germ family work because to ask our kids to stunt their physical, emotional and social development because of virus, when know there are things we can do to contain it, to be safe, I just think parents should get over it. I don’t know, Lisa, what do you think?

LISA: I agree completely. No surprise, and especially when I think from the standpoint of romance and also having something wonderful in your life in the context of an otherwise very depressing time for a lot of young people, and the only thing I would add is that as the pandemic tracks on, I worry that we can some help accommodate to this idea or adapt to this idea the kids can’t see their friends and kids can’t have romances, and just try to treat it as as annoying when kids are pushing against that, and so I think I love what you said about like, get over it. It may be a little fast for the relationship but I think the first framing is just to say to the kiddo, I can’t believe you even have to ask me for permission to have a crush or a date or a, you know, that that the idea that we have to even roll up our sleeves on this, this is so wrong and so unfair to you, so yes let’s do everything in our power to make this possible, and just acknowledge that this is so unfair, that is even on the table for, you know, weird phone calls and tough negotiations.

CARA: Right?

LISA: And then hope that you can trust the other family, right? That’s what it comes down to is  a trust issue.

CARA: And I would just add for the 8-year-old who’s like, well why don’t I get a playdate with my friend? Well, you know, life is hard for that 8-year-old too, and I think we have to make choices, and we can explain to our kids as best as possible but I do think there’s a point at which we can say to our kids, different stages in life, different rules, and that’s appropriate, right? We wouldn’t give an 8-year-old car keys, so it’s okay to treat them a little bit differently.

REENA: Mmhm. That’s good advice because that happens in a lot of families where they’ve got older kids and younger kids and how do you bridge the divide.

LISA: All right, one more question about schools. So we hear you on mitigation and all of the things schools can do. What about dates in January? I’ve heard a few different things, you know, some schools pushing it,  just to give families more time from when they might have traveled, some starting January 4th, January 11th. What do you think on that?

CARA: I think that the rule in January will be nimbleness.I think parents will need to be flexible and schools will need their parents to be flexible because it all depends upon how traveling, gathering over the holidays translates into case counts. In my hometown of Los Angeles I am very very loud about the following fact: if our government worked to prioritize school reopening instead of retail, our kids would be in school. Independent of the horrible numbers that we’re seeing right now, what’s stopping schools from opening, what’s stopping teachers in teachers unions from being comfortable is the fact that we are being asked to stay at home, and yet the mall is open. This makes no sense there’s no consistency. So in order for schools to open in January, I believe local and state governments and, by late January I hope the federal government will have consistent rules that prioritize how we are allowing people to engage. To minimize the spread of virus and since schools do this best, let’s prioritize schools. Since getting kids to school means parents can work, let’s prioritize schools. But things need to change in terms of local rules and regulations and they are a patchwork from city to city and state to state.

REENA: I wish you had a hotline so I don’t have to Google these crazy questions and I could just call you. This is so fantastic. We’re going to have to have you back very very soon.

LISA: Thank you so much. And just clinician to clinician, I have so much respect for you and especially when you say, I don’t know. This is so hard, I think, for well-trained people to do, and I just I so appreciate it because it just it’s the truth. It means that you when you tell us you do know something we can just lean into that. I have so much respect for your clarity on all things COVID.

CARA: Well thank you. I always tell people when you choose a doctor, choose a doctor who knows those three words. I don’t know. They’re really powerful.

REENA: So Lisa keeps telling me about these incredible books that you have, not just for parents, but for kids she says, you’ve got to get these books for your kids. Tell us about these books. Tell us about those books. Where can we get them? And what’s your website and the newsletter as well.

CARA: Well there’s a book series called ‘The Care and Keeping of You,’ which is directed at girls and girl body development, although I think we should read it. There’s a series called Guy Stuff, which is about boys and boy body development. I think girls should read it and they’re everywhere and my website is called worryproofmd(dot)(com).

LISA: Thank you so so much for taking our questions and our listeners’ questions. We are really grateful.

CARA: You’re so welcome. Thank you for having me.

REENA: Lisa, what do you have for us For Children Everywhere?

LISA: So today I want to actually point our attention to the American Lung Association, which is a nonprofit organization that supports lung health. I had the honor of working with them earlier this year on a campaign to help parents talk with their tweens and teens about vaping. The campaign was called Get Your Head out of the Cloud, which is basically, uh your kid might be vaping. You need to be having this conversation, and we’ll put a link to the campaign in the show notes, but we have never cared more about lung health than we do right now. We have a long disease, you know we’ve got COVID that’s topping the world with its impact on our lungs, and so this is a good time to think about donating to the American Lung Association at lung(dot) (org).

REENA: An important reminder. I love that. So what about parenting to go?

LISA: Well one of the things that I think is important as we think about kids and because and COVID and the medical implications for them, is that always in parenting, we are helping young children and then older children, to take over the work of caring for themselves. It’s something that happens gradually, you know first we bathe them, them then they bathe themselves, you know first we drive them places, then they drive themselves to places, and I think that should be our posture with regard to COVID safety, that we don’t see it as something we always make happen for our kids, It’s something we help kids to gradually take more and more ownership of, especially as, I think what’s becoming clear, is even as things get better and better we may still be wearing masks for a long time. So things like not always saying, hey remember your mask. And treating that like it’s our job as a parent, but increasingly working to help kids see that remembering their mask is a lot like remembering their water bottle when they go to sports, and it’s just part of what they take over and do.

REENA: That’s great. Sometimes you want to do everything for them and we need to give some space to learn how to do it themselves.

LISA: Yep and to see it as a developmental trajectory. First we do it for them, then we do it with them then we help them do it themselves.

REENA: That is a great reminder and we want to thank all of our listeners out there. We’re going to take a little holiday break next week but we’re going to be back at the start of the new year.

LISA: Yes thank you to our incredible community of listeners. We are so grateful for you, and yes, we will see you first Tuesday in January for a hopeful and happy start to 2021.

REENA: I love that. Happy holidays.

LISA: Happy holidays.