Back to school with Covid

From the CDC

Schools are an important part of the infrastructure of communities and play a critical role in supporting the whole child, not just their academic achievement. This guidance is intended to aid school administrators as they consider how to protect the health, safety, and wellbeing of students, teachers, other school staff, their families, and communities and prepare for educating students this fall.

Critical Role of Schools

This guidance is intended, first and foremost, to protect the health, safety and wellbeing of students, teachers, other school staff, their families, and communities.

Schools provide safe, supportive learning environments for students, employ teachers and other staff, and enable parents, guardians, and caregivers to work. Schools also provide critical services that help to mitigate health disparities, such as school meal programs, and social, physical, behavioral, and mental health services. School closure disrupts the delivery of these critical services to children and families, and places additional economic and psychological stress on families, which can increase the risk for family conflict and violence.

The unique and critical role that schools play makes them a priority for opening and remaining open, enabling students to receive both academic instruction and support as well as critical services. In order to prioritize opening schools safely and helping them to remain open, communities should consider adopting actions to mitigate community transmission. The CDChas strategies for community mitigation to reduce or prevent the spread of COVID-19, which in turn will help schools to open and stay open safely. Recognizing the importance of providing safe, in-person learning, communities may also wish to help schools by examining whether additional public or private space, including outdoor spaces, that is currently underutilized might be safely repurposed for school and instructional purposes.

Returning to school in fall 2020 poses new challenges for schools, including implementing mitigation measures (e.g., social distancing, cleaning and disinfection, hand hygiene, use of cloth face coverings), addressing social, emotional, and mental health needs of students, addressing potential learning loss, and preparing for the probability of COVID-19 cases within the broader school community. This guidance provides information about:

        • what is currently known about COVID-19 among school-aged children;

        • the importance of going back to school safely;

    • what is currently known about SARS-CoV-2 (the virus that causes COVID-19) transmission in schools and its impact on community transmission; and

        • the ways administrators for kindergarten through grade 12 (K-12) schools can plan and prepare for in-person instruction and minimize the impact of potential closures.

What is known about the signs and symptoms, burden, and transmission of SARS-CoV-2 among children?

Signs and Symptoms

Common COVID-19 symptom among children.include fever, headache, sore throat, cough, fatigue, nausea/vomiting, and diarrhea.However, many children and adults infected with the virus that causes COVID-19 are asymptomatic (meaning they have no signs or symptoms of illness).

Impact of COVID-19 on Children

Early reports suggest children are less likely to get COVID-19 than adults, and when they do get COVID-19, they generally have a less serious illness. As of July, 2020, 6.6% of reported COVID-19 cases and less than 0.1% of COVID-19-related deaths are among children and adolescents less than 18 years of age in the United States.

Early reports suggest the number of COVID-19 cases among children may vary by age and other factors. Adolescents aged 10-17 may be more likely to become infected with SARS-CoV-2 than children younger than age 10, but adolescents do not appear to be at higher risk of requiring hospitalization.. There are currently a higher proportion of COVID-19 cases among Hispanic/Latino children as compared to non-Hispanic white children. Children with underlying medical conditions are at increased risk of hospitalization..

What is known about how schools have reopened and the impact on Covid transmission?

Internationally, schools have responded to COVID-19 using a variety of approaches.For example, China, Denmark, Norway, Singapore, and Taiwan all required temperature checks at school entry.Most countries have changed the way they operate to reduce class sizes, increase physical distance between students, and keeping students in defined groups to reduce contacts. Furthermore, many countries have staggered attendance, start and stop times, and created alternating shifts to enable social distancing. In some places this means that only certain students have returned to schools, either by grade range or need. For example, Denmark was the first European country to reopen schools. Denmark staggered students’ reentry in waves (e.g., one group started school first, followed by another group at a later date), with limited class sizes and using other social distancing measures. Younger students (under age 12) returned first based on their lower health risk and need for more supervision than older students. Class sizes were reduced to allow physical distancing. In Taiwan, students returned to school with mandatory temperature checks and use of face masks. Rather than national school closures, Taiwan relied on local decision-making to determine if classroom or school closures were needed, based on infection rates.

There is mixed evidence about whether returning to school results in increased transmission or outbreaks. For example, Denmark initially reported a slight increase in cases in the community after reopening schools and child care centers for students aged 2-12 years, followed by steady declines in cases among children between ages 1 and 19 years. In contrast, Israel experienced a surge of new cases and outbreaks in schools after reopening and relaxing social distancing measures; it is unclear what caused the increase in cases and what other mitigation measures the schools had implemented. In summer 2020, Texas reported more than 1,300 COVID-19 cases in childcare centers; however, twice as many staff members had been diagnosed as children, suggesting that children may be at lower risk of getting COVID-19 than adults.

It is important to consider community transmission risk as schools reopen. Evidence from schools internationally suggests that school re-openings are safe in communities with low Covid transmission rates. More research and evaluation is needed on the implementation of mitigation strategies (e.g., social distancing, cloth face coverings, hand hygiene, and use of cohosting) used in schools to determine which strategies are the most effective.

Why is it Important to open Schools for in-person instruction?

While opening schools – like opening any building or facility—does pose a risk for the spread of COVID-19, there are many reasons why opening schools in the fall of 2020 for in-person instruction is important.

    • Schools play a critical role in the wellbeing of communities.Schools are a fundamental part of the infrastructure of communities. Schools provide safe and supportive environments, structure, and routines for children, as well as other needed support services to children and families. Schools play a vital role in the economic health of communities by employing teachers and other staff and helping parents, guardians, and caregivers work.

    • Schools provide critical instruction and academic support that benefit students and communities in both the short- and long-term. The main role and priorities of K-12 educational institutions are to provide age-appropriate instruction and support students’ academic development. Reopening schools will provide in-person instruction for students, facilitate increased communication between teachers and students, and provide students with critical academic services, including school-based tutoring, special education, and other specialized learning supports.

    • Studies show that students have experienced learning loss during the period of school closure and summer months. In-person instruction for students has advantages over virtual learning, particularly when virtual learning was not the planned format for instruction, and schools may not have the resources or capability to transition fully to virtual learning. In-person classroom instruction has the added benefit for many students of interpersonal interaction between the student and the teacher and the student and peers. Teachers are able to more actively participate in student learning, provide feedback as students encounter challenges, and promote active learning among students.

    • In-person instruction may be particularly beneficial for students with additional learning needs. Children with disabilities may not have access through virtual means to the specialized instruction, related services or additional supports required by their Individualized Education Programs (IEPs) or 504 Plans.

    • When schools are closed to in-person instruction, disparities in educational outcomes could become wider, as some families may not have capacity to fully participate in distance learning (e.g., computer and internet access issues, lack of parent, guardian, or caregiver support because of work schedules) and may rely on school-based services that support their child’s academic success. The persistent achievement gaps that already existed prior to COVID-19 closures, such as disparities across income levels and racial and ethnic groups, could worsen and cause long-term effects on children’s educational outcomes, health, and the economic wellbeing of families and communities. While concern over higher rates of COVID-19 among certain racial/ethnic groups may amplify consideration of closing a school that educates primarily racial minority students, there should also be consideration that these may also be the schools most heavily relied upon for students to receive other services and support, like nutrition and support services.

    • Schools play a critical role in supporting the whole child, not just the academic achievement of students. Social and emotional health of students can be enhanced through schools.Social interaction among children in grades K-12 is important not only for emotional wellbeing, but also for children’s language, communication, social, and interpersonal skills. Some students may have experienced social isolation and increased anxiety while not physically being in school due to COVID-19. Resuming in-person instruction can support students’ social and emotional wellbeing. Schools can provide a foundation for socialization among children. When children are out of school, they may be separated from their social network and peer-to-peer social support. Schools can facilitate the social and emotional health of children through curricular lessons that develop students’ skills to recognize and manage emotions, set and achieve positive goals, appreciate others’ perspectives, establish and maintain positive relationships, and make responsible decisions. 

    • Continuity of other special services is important for student success.Students who rely on key services, such as school food programs, special education and related services (e.g., speech and social work services, occupational therapy), and after school programs are put at greater risk for poor health and educational outcomes when school buildings are closed and they are unable to access such school health programs and services. During periods of school building closures, students had limited access to many of these critical services, potentially widening educational and health disparities and inequities.

How can K-12 schools prepare for going back to in-person instruction?

Expect cases of COVID-19 in communities.International experiences have demonstrated that even when a school carefully coordinates, plans, and prepares, cases may still occur within the community and schools. Expecting and planning for the occurrence of cases of COVID-19 in communities can help everyone be prepared for when a case or multiple cases are identified.

    • Coordinate, plan, and prepare. Administrators should coordinate with local public health officials to stay informed about the status of COVID-19 transmission in their community. Additionally, planning and preparing are essential steps administrators can take to safely reopen schools:

    • One important strategy that administrators can consider is cohorting (or “pods”), where a group of students (and sometimes teachers) stay together throughout the school day to minimize exposure for students, teachers, and staff across the school environment. At the elementary school level, it may be easier to keep the same class together for most of the school day. In middle and high school settings, cohorting of students and teachers may be more challenging. However, strategies such as creating block schedules or keeping students separated by grade can help to keep smaller groups of students together and limit mixing. Strategies that keep smaller groups of students together can also help limit the impact of COVID-19 cases when they do occur in a school. If a student, teacher, or staff member tests positive for SARS-CoV-2, those in the same cohort/group should also be tested and remain at home until receiving a negative test result or quarantine. This helps prevent a disruption to the rest of the school and community by limiting the exposure. Schools should have systems in place to support continuity or learning for students who need to stay home for either isolation or quarantine. This includes access to online learning, school meals, and other services. The same holds for students with additional needs, including children with a disability, that makes it difficult to adhere to mitigation strategies.

    • Prepare for potential COVID-19 cases and increased school community transmission.Schools should be prepared for COVID-19 cases and exposure to occur in their facilities.  Having a plan in place for maintaining academic instruction and ensuring students have access to special services is also critical.

    • Assess the level of community transmission. There are specific strategies schools can implement based on the level of community transmission reported by local health officials:

        If there is no or minimal community transmission: Reinforce everyday preventive actions, ensuring proper ventilationwithin school facilities, including buses, and maintaining cleaning and disinfection practices remain important. These actions can help minimize potential exposure. Schools should also monitor absenteeism among teachers, staff, and students to identify trends and determine if absences are due to COVID-19, symptoms that led to quarantine, concerns about being in the school environment and personal health and safety, or positive test results. Anyone who tests positive for COVID-19 shouldstay home and self-isolate for the timeframe recommended by public health officials. Anyone who has had close contact with someone who has tested positive or is symptomatic for COVID-19 should be tested and stay home until receiving a negative result, or stay at home and monitor for symptoms.

        If there is minimal to moderate community transmission: Schools should follow the actions listed above, and continue implementing mitigation strategies such as social distancing, masks, reinforcing everyday preventive actions, and maintaining cleaning and disinfection. This also can include ensuring that student and staff groupings/cohorts are as static as possible and that mixing groups of students and staff is limited.

        If there is substantial controlled transmission: Significant mitigation strategies are necessary. These include following all the actions listed above and also ensuring that student and staff groupings/cohorts are as static as possible with limited mixing of student and staff groups, field trips and large gatherings and events are canceled, and communal spaces (e.g., cafeterias, media centers) are closed.

        If there is substantial uncontrolled transmission: Schools should work closely with local health officials to make decisions on whether to maintain school operations. The health, safety, and wellbeing of students, teachers, staff and their families is the most important consideration in determining whether school closure is a necessary step.Communities can support schools staying open by implementing strategies that decrease a community’s level of transmission. However, if community transmission levels cannot be decreased, school closure is an important consideration. Plans for virtual learning should be in place in the event of a school closure.

Masks help. Wear them!

From the Mayo Clinic

Can face masks help slow the spread of the coronavirus (SARS-CoV-2) that causes COVID-19? Yes, face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the virus.

So why weren't face masks recommended at the start of the pandemic? At that time, experts didn't know the extent to which people with COVID-19could spread the virus before symptoms appeared. Nor was it known that some people have COVID-19 but don't have any symptoms. Both groups can unknowingly spread the virus to others.

These discoveries led public health groups to do an about-face on face masks. The World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC) now include face masks in their recommendations for slowing the spread of the virus. 

How do the different types of masks work?

Surgical masks

Also called a medical mask, a surgical mask is a loose-fitting disposable mask that protects the wearer's nose and mouth from contact with droplets, splashes and sprays that may contain germs. A surgical mask also filters out large particles in the air. Surgical masks may protect others by reducing exposure to the saliva and respiratory secretions of the mask wearer.

At this time, the U.S. Food and Drug Administration has not approved any type of surgical mask specifically for protection against the coronavirus, but these masks may provide some protection when N95 masks are not available.

N95 masks

Actually a type of respirator, an N95 mask offers more protection than a surgical mask does because it can filter out both large and small particles when the wearer inhales. As the name indicates, the mask is designed to block 95% of very small particles. Some N95 masks have valves that make them easier to breathe through. With this type of mask, unfiltered air is released when the wearer exhales.

Cloth masks

A cloth mask is intended to trap droplets that are released when the wearer talks, coughs or sneezes. Asking everyone to wear cloth masks can help reduce the spread of the virus by people who have COVID-19 but don't realize it. Cloth face coverings are most likely to reduce the spread of the COVID-19 virus when they are widely used by people in public settings. And countries that required face masks, testing, isolation and social distancing early in the pandemic have successfully slowed the spread of the virus.

While surgical and N95 masks may be in short supply and should be reserved for health care providers, cloth face coverings and masks are easy to find or make, and can be washed and reused.

Masks can be made from common materials, such as sheets made of tightly woven cotton. Instructions are easy to find online. Cloth masks should include multiple layers of fabric. The CDC website even includes directions for no-sew masks made from bandannas and T-shirts.

How to wear a cloth face mask

The CDC recommends that you wear a cloth face mask when you're around people who don't live with you and in public settings when social distancing is difficult. 

Here are a few pointers for putting on and taking off a cloth mask:

•    Wash or sanitize your hands before and after putting on and taking off your mask.

•    Place your mask over your mouth and nose.

•    Tie it behind your head or use ear loops and make sure it's snug.

•    Don't touch your mask while wearing it.

•    If you accidentally touch your mask, wash or sanitize your hands.

•    If your mask becomes wet or dirty, switch to a clean one. Put the used mask in a sealable bag until you can wash it.

•    Remove the mask by untying it or lifting off the ear loops without touching the front of the mask or your face.

•    Wash your hands immediately after removing your mask.

•    Regularly wash your mask with soap and water by hand or in the washing machine. It's fine to launder it with other clothes.

And, here are a few face mask precautions:

•    Don't put masks on anyone who has trouble breathing, or is unconscious or otherwise unable to remove the mask without help.

•    Don't put masks on children under 2 years of age.

•    Don't use face masks as a substitute for social distancing.

Tips for adjusting to a face mask

It can be challenging to get used to wearing a face mask. Here are some tips for making the transition:

•    Start slow.Wear your mask at home for a short time, such as while watching television. Then wear it during a short walk. Slowly increase the time until you feel more comfortable.

•    Find your fit. If your mask isn't comfortable or is too difficult to breathe through, consider other options. Masks come in a variety of styles and sizes.

One more reason to wear a mask: You’ll get less sick from COVID-19!

From the University of California

It’s likely that face masks, by blocking even some of the virus-carrying droplets you inhale, can reduce your risk of falling seriously ill from COVID-19, according to Monica Gandhi, M.D., an infectious disease specialist at UC San Francisco.

“The more virus you get into your body, the more sick you are likely to get,” she said.

In the latest wave of infections in the U.S., the wider use of masks may be one factor for the lower death rates — along with more testing, younger patients and better treatments — said Gandhi. A greater proportion of these new cases have been mild or asymptomatic, though more data is needed to see if they track geographically with higher rates of mask-wearing.

Worldwide, epidemiological patterns seem to provide a clue. In countries where mask wearing was already commonplace, such as Japan, Taiwan, Thailand, South Korea, and Singapore, and in countries where mask wearing was quickly embraced, such as the Czech Republic, rates of severe illness and death have remained comparatively low.

These epidemiological observations are among the evidence that Gandhi and colleagues cite in a paper in the Journal of General Internal Medicine, in which they propose that masks can lead to milder or asymptomatic infections by cutting down on the dose of virus people take in.

“Masks can prevent many infections altogether, as was seen in healthcare workers when we moved to universal masking. We’re also saying that masks, which filter out a majority of viral particles, can lead to a less severe infection if you do get one,” said Gandhi. “If you get infected, but have no symptoms — that’s the best way you can ever get a virus.”

Not a new idea.

The idea that viral dose, also known as viral inoculum, determines the degree of illness is not new, said Gandhi. Descriptions of a dose-mortality curve — how much of a virus is needed to cause death in an animal — were first published in 1938. And after all, the earliest vaccines, which were documented in 16th century China, involved exposing someone to a small amount of smallpox virus to induce mild illness and subsequent immunity. A small number viral particles is more likely to be quelled by the immune system before they can proliferate, said Gandhi.

Researchers have studied dose dependency experimentally with other viral infections, like the flu. In a study with healthy volunteers, those who received a higher dose of the influenza A virus developed more severe symptoms.

Because the new coronavirus, SARS-CoV-2, is potentially lethal, experiments on masking and disease severity have been necessarily limited to animals. In a hamster study, a surgical mask partition between the cages of infected and uninfected hamsters significantly cut COVID-19 transmission. Fewer hamsters caught the virus and those that did showed milder symptoms.

Tale of two cruise ships

Gandhi believes the viral inoculum theory helps explain an unusual feature of the new coronavirus — what Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Disease, has called its “protean” manifestations.

Early in the year, as COVID-19 spread around the world, infectious disease experts began to notice this strange aspect of the new virus — the extreme variation in its symptoms and severity. Some who tested positive didn’t seem sick at all, some had symptoms of a cold, others lost their sense of taste or developed delirium, and still others suffered severe pneumonia that led to death.

Experts quickly focused on differences among patients, such as age and co-morbidities, that can affect their chances of severe illness. But the details of two outbreaks on cruise ships spurred Gandhi to think that viral dose could be another important determinant of the course of the new illness.

“We’re also saying that masks, which filter out a majority of viral particles, can lead to a less severe infection if you do get one. If you get infected, but have no symptoms — that’s the best way you can ever get a virus.”

In February, one of the first outbreaks of COVID-19 outside of China occurred on the Diamond Princess cruise ship docked in Yokohama, Japan. Of the 634 people on board who tested positive, about 18 percent of infections were asymptomatic. In March, an Argentinian cruise ship found itself in a similar predicament, but of the 128 people on board who eventually tested positive, 81 percent were asymptomatic.

A key difference, Gandhi noted, was that on the Argentinian ship, surgical masks were issued to all passengers and N95 masks to all staff as soon as the first passenger became sick.

More recently, an Oregon seafood processing plant where workers were required to wear face masks reported an outbreak of 124 cases, 95 percent of which were asymptomatic. Similarly, in a Tyson chicken-processing plant outbreak in Arkansas where workers were provided mandatory masks, 455 out of 481, or nearly 95 percent were asymptomatic.

To Gandhi, these case studies suggest that if more people wore masks, we could see less serious illness from COVID-19 and a higher proportion of asymptomatic cases, currently estimated to be around 40 percent of cases by the Centers for Disease Control and Prevention. Milder infections would ease the burden on the health care system, save lives, and even nudge us closer to herd immunity before a vaccine becomes available, said Gandhi.

And it means that the public health message on masks can appeal to more than altruism.

“We messaged that mask wearing will protect other people, and that did not seem to convince our country as much as we would have hoped,” said Gandhi. That’s not surprising given human nature, she said. “If you think something’s going to help you or your family, you are going to do it more than if you think you’re helping others.

Safe outdoor activities during the COVID-19 pandemic

From the Mayo Clinic

For many people, the summer of 2020 has been like no other in recent memory. Public health restrictions caused by the coronavirus disease 2019 (COVID-19) pandemic have led to cancelled festivals, concerts and other events. Many vacations and large celebrations have been limited or put on hold.

Despite the changes caused by the COVID-19 pandemic, there's still plenty of fun to be had. In fact, seeking out fun activities may be even more important now. Doing something you enjoy can distract you from problems and help you cope with life's challenges.

When activities are near where you live and allow plenty of space between you and others, outdoor activities pose a lower risk of spread of the COVID-19 virus than indoor activities do.

Why choose outdoor activities?

The COVID-19 virus is primarily spread from person to person through respiratory droplets released into the air when talking, coughing, or sneezing. When you're indoors, you're more likely to inhale these droplets from an infected person, especially if you're in close contact, because you're sharing more air than you do outdoors. Poor building ventilation can cause droplets to hang in the air for a longer period of time, adding to the potential for infection.

When you're outside, fresh air is constantly moving, dispersing these droplets. So, you're less likely to breathe in enough of the respiratory droplets containing the virus that causes COVID-19 to become infected.

Being outside offers other benefits, too. It offers an emotional boost and can help you feel less tense, stressed, angry or depressed.

Low-risk ways to move more

Coming into close contact with people who don't live with you increases your risk of being exposed to someone infected with the virus that causes COVID-19. That's why, in general, any activity that allows you to keep a social distance of at least 6 feet (2 meters) from others is lower-risk.

There are many activities you can enjoy close to home, whether you're visiting your favorite public park or even spending time in your neighborhood. Get moving with these low-risk outdoor activities during the pandemic:

•    Walking, running and hiking

•    Rollerblading and biking

•    Fishing and hunting

•    Golfing

•    Kayaking, boating and sailing

•    Fitness classes, held outside, that allow distance

Avoid crowded sidewalks and narrow paths and choose routes that make it easy to keep your distance. Wear a mask when you can't maintain at least 6 feet (2 meters) from people you don't live with. Don't wear a mask during activities in which it might get wet, such as swimming.

Low-risk social activities

Many other outdoor activities can be good choices, too:

•    Picnics. Pack food from home or pick up takeout from your favorite restaurant or food truck and take it to enjoy at your favorite public park.

•    Farmers markets.Wear a mask and maintain a social distance of at least 6 feet (2 meters) from others.

•    Gathering with friends. Allow for social distancing between people from different households and skip the hugs and handshakes. Plan activities that don't require close contact, such as sidewalk chalk for kids and games like Frisbee. And offer hand sanitizer. Remember that just getting together for a chat at a safe distance can offer a valuable opportunity to be with people you care about — and boost your mood at the same time.

•    Drive-in movies.The COVID-19 pandemic has launched a drive-in movie theater comeback in the U.S. It's something many people can enjoy together with plenty of physical distance.

Moderate-risk outdoor activities

Depending on how they're done, many popular outdoor activities can also be done safely, including:

•    Restaurant patio dining. Outdoor patio dining at uncrowded restaurants where patio tables are spaced appropriately is safer than indoor dining. Wear a mask when not eating or drinking.

•    Camping. If you only have close contact with people you live with, camping is low-risk. If you camp with people outside your household, camp in separate tents spaced at least 6 feet (2 meters) apart and avoid sharing camping supplies, including food and drinks. Pack hand soap, hand sanitizer and supplies to clean and disinfect commonly-touched surfaces.

•    Swimming pools and beaches. Close contact (closer than 6 feet, or 2 meters) with others — not water itself — can make these activities risky. If you go to the beach and come into close contact with others, your risk is higher. Water itself doesn't seem to spread the COVID-19 virus to people.

•    BBQs and outdoor potlucks.Keep your gathering small, maintaining social distance from others. Plan activities that don't require close contact. You may even choose to have everyone bring their own food and drinks to enjoy the togetherness with less chance of virus spread. Wear a mask when not eating or drinking.

•    Sports and sporting events. Contact sports, such as wrestling and basketball, carry more COVID-19 risk than others. Team sports such as tennis, baseball, softball and soccer, pose less risk because players can maintain physical distance. It's important for spectators, players and coaches to keep social distance. Wear a mask, use hand sanitizer and ensure you have enough social distance — at least 6 feet (2 meters) — between you and other spectators, whether you're standing, sitting in chairs or sharing bleachers.

High-risk outdoor activities

Bringing many people together in close contact for a longer period of time poses the highest risk ofCOVID-19spread.

Examples include:

•    Large gatherings.Being in large crowds of people where it's difficult to stay spaced at least 6 feet (2 meters) apart poses the highest risk. The longer people are together in these situations, the higher the risk. Weddings, festivals and parades are examples.

•    Summer camp activities. Camps are generally high-risk because campers come from different locations and spend a lot of time together indoors, in close contact. Camps can pose less risk if campers are from the same area, don't share objects, wear masks, and spend time outdoors with at least 6 feet (2 meters) between them.

•    Playgrounds.The many frequently-touched surfaces of playground equipment make it easier to transmit the virus that causesCOVID-19. However, in many areas, parks and playgrounds are open. Children who use playground equipment should maintain distance from others and wash their hands afterwards to help prevent the spread of the COVID-19 virus.

Think safety and enjoyment

As the COVID-19 pandemic continues, it's important to take care of yourself and those around you. Practicing good hand hygiene such as washing your hands, not touching your face with unwashed hands, social distancing from others, and wearing a mask when you can't avoid being near other people are all good steps to take. These steps are especially important for those with a higher risk of serious illness from COVID-19.

At the same time, well-being also includes doing things that make life worth living. With the right information, you can make thoughtful choices about ways to bring a sense of normalcy and joy to your life during the COVID-19 pandemic.

Amp up your diet with these plant proteins

From the Tufts Nutrition Newsletter

Plant Proteins Legumes, pulses, or beans— whatever you call them, these nutritious, versatile, under-consumed plant foods are an easy way to improve diet quality. Replacing some (or all) animal protein with plant protein; eating more vegetables; and choosing naturally fiber-rich foods in place of refined carbohydrates are all excellent ways to improve the healthfulness of your dietary pattern. Eating more legumes helps you do all three! Legumes are inexpensive, versatile, tasty… and underutilized. The many shapes, colors, and sizes can add variety to everyday meals. 

What is a Legume? 

Legumes are plants from the Fabaceae or Leguminosae family. Beans, peas, and lentils are all seeds of legume plants. When these are dried, they are sometimes referred to as pulses. “Many people do not realize that green peas and green beans are, botanically speaking, legumes,” says Nicola M. McKeown, PhD, an associate professor at Tufts Friedman School of Nutrition Science and Policy. “Peanuts are legumes as well.” The latest Dietary Guidelines for Americans (DGA) suggest U.S. adults eat at least three cups of legumes per week (or about one half-cup per day) as part of a healthy dietary pattern. According to population surveys, adults are consuming a third less than the recommended value. 


Legumes have a unique nutrient profile that fits them neatly into both the protein and the vegetable food groups. They are an excellent source of plant protein, not only because they are a sustainable protein source compared to animal-based foods, but also because they have a high content of the essential amino acid lysine compared to other plant foods. “Soybeans stand out,” says McKeown, “because they are one of the few plant foods that provide all the essential amino acids in the amounts your body needs.” Most plant foods are low in at least one essential amino acid. Although it used to be thought that vegetarians and vegans had to pair legumes with grains (as in rice and beans) at every meal to get all the necessary amino acids, it is now understood that a variety of plant foods eaten throughout the day works just as well. 

“Legumes are high in dietary fiber and rich in micronutrients, specifically B-vitamins, selenium, potassium, zinc, and vitamins E and A,” says McKeown. “A half cup of legumes delivers, on average, seven grams of dietary fiber, which is a third of the recommended daily value. Importantly, they contain both insoluble and soluble fiber.” Soluble fiber helps decrease blood cholesterol levels and controls blood sugar, and insoluble fiber helps digestion and regularity. 

Make the Switch 

One of the world’s most commonly consumed foods, legumes have been a staple in many traditional cuisines for over 1,000 years. Because legumes are both a vegetable and a protein, they are easy to include in any type of meal, from the traditional (like rice and beans) to the trendy (think brownies) for a quick boost of protein, fiber, and nutrients. They are also extremely cost-effective, dried or canned. Here are some simple ways to add beans to every meal: 

Appetizers: hummus or other bean dips; salsa with black beans 

Legume-based main dishes: Bean and egg breakfast wrap; rice and beans; edamame or tofu stir fry; sautéed beans and greens; pasta with bean puree or whole beans and veggies (try Italian pasta fagioli); bean chili or soup; bean burritos; bean-based burgers; Indian dal (lentils); French cassoulet; falafel; hummus wraps or sandwiches; or substitute legumes for some or all of the meat in burgers, chili, and stews 

Sides and salads: three bean salad; other bean- or lentil-based salads (with or without whole grains); green salad with beans; pasta salads with beans; baked beans; refried beans The benefits of legumes extend beyond their positive impact on human health. As crops, these nitrogen-fixing plants have been used for centuries to improve the quality of soil. They also adapt well to adverse environments, are highly resistant to disease and pests, and need less water than grains. All-in-all, choosing legumes in place of less healthful foods is a great way to improve your diet quality—and your health.

Yes, we ARE seeing sick kids …

And yes, we do Covid swabs!

Contrary to some recent Facebook posts, we are seeing sick children in our office, including those with fever. We do this in separate rooms from those we use for well-care visits and vaccines, and we do it with safety in mind - both patient safety and our safety. Certain high-risk patients, such as those with severe cough and high fever, are sent to urgicenters, but these are the exceptions, rather than the rules. Again, we are seeing sick kids in our office.

We also can do Covid swab testing in our office. We will do this for any sick child whose symptoms require it. 

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The Kidfixer Newsletter            Autumn, 2020