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Brian Lehrer: Brian Lehrer on WNYC. We're about five weeks away from the reopening of public schools here in New York City. That means five weeks away from September 13th, the day the classes are scheduled to begin. We know school starts earlier in many other districts, but in the city, that September 13th date makes today the very last day the children 12 and up can get fully vaccinated with a 2-shot vaccine by the start of school. This year's back-to-school season has, of course, coincided with a surge in serious COVID cases among children. Kids now make up one-fifth of all new coronavirus cases in America.

More children are being hospitalized right now than at any other point during the pandemic. This uptake in COVID cases and hospitalizations is being driven primarily by the spread of the Delta variant, as we all know. Where does this leave children and their parents, looking ahead to the reopening of schools and just living life in mixed families, some vaccinated, some not if there are any vaccinated members at all. With me now is Dr. Judith Flores, pediatrician, fellow at the American Academy of Pediatrics, former chief of ambulatory care at several Brooklyn hospitals, and community vaccine outreach worker with the city's Test and Trace Corps. Dr. Flores, a pleasure. Welcome to WNYC.

Dr. Judith Flores: Good morning and thank you for having me on this very important issue today.

Brian Lehrer: Listeners, we'll invite your calls right away on this. Parents, do you have questions for Dr. Flores about vaccinating your younger kids and teens, or anything about COVID and children as the school year approaches? 646-435-7280. 646-435-7280, or tweet your question @Brian Lehrer. Dr. Flores, as we wait for those calls to come in, we've heard it reported that the Delta variant poses a greater risk for younger people than other known variants. Why is that in the case of children, if it's easy enough to say?

Dr. Judith Flores: For what I know and for what we know today, the Delta variant is extremely infectious, and that is to everyone, including children. Children really are carriers and are as exposed as adults are. They do not have the same hospitalization rates and they traditionally haven't gotten as sick, but we're seeing more and more hospitalizations as you mentioned. The Delta variant is extremely, extremely infectious. You can liken it and it's been likened to chickenpox. If you sit in a room with someone who has chickenpox, 90% of people will be infected. That is what's going on with the variant.

There's a lot of virus being carried around. It's carried in our noses, whether we're vaccinated or unvaccinated, but the advantage of being vaccinated is that we protect ourselves from serious illness and those around us in addition. That's why it's affecting children. Children, as we know, are going back to school. It's hard to limit a child's physical contact with other children. The more people that surround a child that are vaccinated in an environment, be it home, be it at school, or in the community, the better protected that child is.

Brian Lehrer: There was a story over the weekend in the New York Times, maybe you saw it, about children struggling with long COVID, even children who had very mild COVID cases initially. What can you tell us about that from whatever you know about it?

Dr. Judith Flores: Sure. It's very interesting because more and more the workaround long COVID in children has really been more focused on adults, but now we're seeing that children do and can get consequences from COVID that are long-term. What we're seeing more is children that will have problems with learning, with cognition. That's really important because that's pretty much their principal job in school is to learn. Also, we're seeing children having problems with sleep, with behavioral issues, chronic tiredness.

The data isn't fully in, but more peer-reviewed articles are coming out now. I'm actually one that's very interested in looking at that because one of the arguments for making sure that children get vaccinated is that we don't know long-term consequences of COVID. Many parents are worried about the long consequences of children being vaccinated and even adults being vaccinated. They're worried about the side effects and the long-term consequences. It's always very important to remember that the long-term consequences of COVID are much more predictable and documented and are evident as opposed to any long-term consequences of the vaccine.

Brian Lehrer: Vaccination rates in some parts of the city are lagging behind. Other parts of the city, in Far Rockaway, I read only 34% of residents are fully vaccinated, citywide, it's 56%. What's the push to get children vaccinated look like? What's worked for you as someone who's actively doing vaccine outreach with Test and Trace?

Dr. Judith Flores: Thank you. Thank you for that. My work is really working with communities that have been mostly affected that have been affected by the inequities, and that have been really hit hard by this pandemic. We talk about children. These are children that have a lot of loss, that had the grief of losing a parent or a caregiver. I work a lot with those communities. We started really working in the North Queens area. If you look at the current map today, it's happily a lot darker. That means more and more people are being vaccinated.

Our outreach work really is very community-centered. Our presentations are very appropriate in terms of language access. We want to make sure that people are reached in their communities in their own language to the point that we've done a lot of work with indigenous populations also through translators to make sure that people are reached. I think the city is doing a marvelous job actually with getting kids back in school and getting them vaccinated. As you mentioned, we are really down to the wire. If you get your vaccine today, you get the second dose in about three weeks, and then you've got about two weeks to really be fully vaccinated.

Getting these children vaccinated 12 and over is extremely, extremely important. I think the schools are doing and the city is doing a great job in terms of reaching out to families on the phone. They are also being incentivized. I think that what's going to work really well is that interaction and that partnership between parents, school boards, and the department of health and other regulatory bodies, to make sure that we understand what is needed to make it safe for children to be in school and to communicate back to our local school when things are not working and parents getting involved is extremely important now.

Brian Lehrer: Tom in Manhattan, you're on WNYC with Dr. Judith Flores, pediatrician. Hi, Tom.

Tom: Hi. My son is a student at a public high school and he is vaccinated. Our biggest concern is probably the commute to and from school. He commutes on the subway. I feel fairly confident that he'll be safe while he's in school with other mostly vaccinated high school students. I'm interested in your perspective on safety during the commute on public transportation.

Dr. Judith Flores: I'm so happy you brought that up because not only for your son but also for children that travel in buses and maybe are younger and do not have the opportunity to be vaccinated. I think we have to make sure that we make a plan with our kids, that we have them understand that wearing a mask on the subway on the bus when they eat lunch with other children is extremely important. That is the most protection that we can offer them in a public setting. Masking does work. It's proven to be a measure that has reduced a lot of the infection rate in schools and in other settings. I would sit down with him, make a plan, and make sure that he understands the importance of wearing his mask.

Brian Lehrer: Are you for the in-school mask mandate for kids? I know a lot of pediatricians are. What I hear as an argument on the other side sometimes is, if this goes on and on and on where students, little kids included, keep having to wear masks in school that it starts to damage their mental health after a certain point or contributes to them checking out while they're in class and not absorbing the material as well because they're behind a mask and feeling a little isolated.

Dr. Judith Flores: Yes. That's very understandable. Dealing with the behavioral issues or emotional issues, it's pretty much my job as a pediatrician and as a parent and working with parents. We have to be cognizant of how we have to make sure we communicate these things very clearly to children. That this is not forever, that this is something that if we do well, we can get out of this pandemic, that we want them to go back to school. The worst thing was this year that we had kids that definitely checked out that were even absent to their virtual classes, especially children that had any kind of special accommodation or needed special therapies.

Those children really have a lost year. We don't want that to happen again. In order to do that, we really have to get a handle on giving the most protection to those that are unvaccinated. We're really talking about younger children especially, but the older, the 12 and over is the most important to get, of course, the only ones that are available to be vaccinated. Giving that circle of vaccination around these children and the mask mandate is very, very important. We just have to look at other places in the country right now that have not enforced the mask mandate.

I will tell you, I belong to a circle of physicians and we do a lot of COVID vaccination engagement throughout the country. My friends in Arizona and Florida are constantly on the line telling me on how each district has to struggle to make sure that they preserve that mask mandate. It is extremely important. We want to get out of this. This is not forever, but if we don't do this, we're allowing this virus to mutate again and again. We are the hosts. We are the feeders for this virus. If we don't stop it in some way now, the Delta will be followed by many other variants that may be able to break through our current vaccines. It's very, very important. Yes, I am very supportive of mask mandates.

Brian Lehrer: This is WNYC FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We're a New York and New Jersey public radio with pediatrician, Dr. Judith Flores. Troy in Brooklyn, you're on WNYC. Hi, Troy. Thanks for calling in.

Troy: Thank you for having me. I'm just wondering if this process of isolation that people had been home and not going out interacted, then all of a sudden, the city opening up, people's immune systems probably were not prepared to handle that, being so isolated and over sanitized because I'm sure it was this radio station that I heard a doctor on maybe prior to COVID saying that all the antibacterial stuff was no good for our immune systems. Then we went heavily into antibacterial everything.

Now we're having situations with people that are getting sick, people vaccinated are getting sick. I don't think I've heard anything about-- I'm not accusing you, but a lot of doctors aren't saying anything about bolstering up people's immune system prior to going back into the environment, maybe [crosstalk]--

Dr. Judith Flores: I thank you for that question because it does bring up a lot of issues and you're right. When you're isolated and you go out again, that's when you start getting-- We've seen a lot of summer colds. We're going to see flu if people don't get their vaccinations because we haven't been around each other, so we haven't had our immune system exposed to other things. You're absolutely right. The way around that, first of all, and foremost, is making sure we're vaccinated against COVID. That's number one. That will bolster our protection.

It looks like vaccines are probably going to last much more than we think, because now that we're really looking at the details of our immune system, I don't want to spend too much time on it, but the B cells and the T cells and all that armamentarium and army that we have to protect ourselves, these vaccines are working and can give us long-term duration. I also want to mention that with children, in particular, remember, there are a multitude of childhood diseases. We get kids with all sorts of things for which we vaccinate. Many of those kids have not made it back into seeing their doctors or getting vaccinated.

Your point is well-taken, it's time for us to make sure those kids get vaccinated and get the care that they have been missing for a year. The good news is the COVID vaccine available for children, or Pfizer, can be given along with the others. Making that appointment, going back, getting back on your health plan, getting back on your nutritional schedule, getting kids back on their sleep schedule, especially as they're going back to school, is extremely important. Your point is very well taken.

Brian Lehrer: The issue of isolation also brings up remote learning. When you're not exposed to other kids versus in-person where you are exposed to other kids, maybe you're not going to get as many germs as a kid as you would have without masking in the past. Mayor de Blasio has been adamant that the New York City public schools be open only for in-person instruction starting in September, no remote option. I'm curious if you have an opinion on that.

Dr. Judith Flores: Yes, actually. As it was mentioned, I'm a member of the American Academy of Pediatrics. Myself and our colleagues, and those of us who care for children and families know the importance of in-person learning. I think aside from the fact that we know that the school environment can be safe, that we can make it safe for our children, especially by vaccinating those that can be vaccinated, including school staff. Right now, we have about 60% of our school staff that's been documented as having at least one dose. We want to do a better job with that.

We're about 43% of our kids that have been vaccinated. That's extremely important. Aside from that, we want to make sure that we bring them back for all the things that school offer, including the learning experience, the emotional and mental health support. We need to be able to address the inequities. Kids that didn't have opportunity to learn well in the remote setting have to get back. They have a lost year and we have to be able to recoup. I think that a lot of that work started over the summer when we had kids in summer school with both academic and recreational activities.

The loss has been academic, social, and remember, we have children with very serious emotional issues that are grieving, that have had depressions, and a lot of anxiety. We do have good services in the city, but we have to, as parents and as caregivers, make sure we pay attention to that. Those red flags are going to come up and the sooner we address them the better. I and many of us that care for children are very supportive of making sure they come back, that the environment is safe, that we have them vaccinated, that we use our mask mandates, that we use good ventilation in our classrooms.

I think the recommendation is two air purifiers per classroom at this point. That's all very, very important, but it's important to know that your children are probably safer in a classroom setting than they are in the open community. We see much more infection in the community than in classrooms.

Brian Lehrer: Do they have two air purifiers per classroom in every New York City public school? Do you know, do they have it ready to go for September, or will they have it by September 13th?

Dr. Judith Flores: I think what I know is that that is a recommendation. I also know that by the time school opens, there's going to be much more information on what is being done to monitor, to test, and to make sure the environment is well ventilated. I know that those are plans. I do know that, again, the mantra is the important things are masking, making sure there's good ventilation, and in terms of social distancing, because that'll be the next question, the recommendation is wherever possible, we give kids a good 3 feet between children. To be honest with you, more importantly is the masking, ventilation, and vaccination.

Brian Lehrer: Mark in Parsippany, you are on WNYC with Dr. Flores. Hi, Mark.

Mark: Good morning, Brian. Good morning, doctor. Thank you for this [crosstalk]--

Dr. Judith Flores: Good morning.

Mark: [chuckles] Good morning. I'm calling because my wife is a teacher here in New Jersey. My understanding is, governor Murphy is implementing a masking mandate, but we have a 14-month-old, obviously can't be vaccinated at this time. We're a little concerned about the risk of her spreading to him. Do you have any recommendations beyond what you were talking about just now with schools about how she as a teacher in a schoolroom can take precautionary measures to reduce the risk of spreading? My follow-up question is, do you have any sense of when children, possibly as young as 14 months, 18 months, will be eligible to be vaccinated?

Dr. Judith Flores: Those are all very, very good questions and questions that I ask myself actually every day, when is the next vaccine coming and what do we do for the preschool-age children? Pre-school regulations are still, I think, being formulated for the 14-month-old, but your 14-months-old is home. The very best thing you did or can do is to round them by vaccinated people because even though when we're vaccinated, we can spread some virus because the viral load is so high with Delta. I think with her precautions of masking at the school environment, coming home, good handwashing around your baby is probably going to be the best thing you can do right now.

As far as vaccination for children, it looks like the 5 to 11-year-old group will probably be the next group rolled out and probably sometime in early to mid-fall. As far as the youngest group is concerned, I think there's going to be a wait for the five and under. That's as far as I know right now, but I'd say keep looking at the guidance and something is going to hit. The other thing that's very important is to know that probably FDA full approval of our current vaccines will be coming by Labor Day, we're hoping by Labor Day. That moves the needle on a lot of this other work.

Brian Lehrer: We're almost out of time. Again, the news hook for this segment is that today is the last day, if your child is going to be a student in the New York City public school system, that you can get a first vaccination dose and have the child have both their doses plus two weeks by the start of school on September 13. That doesn't mean don't do it if you can't get it done by today. For those of you who have that flexibility who want to get in under the deadline, that would be today. That's really only for the Pfizer vaccine, right?

Dr. Judith Flores: Yes, that's the only one that's eligible so far.

Brian Lehrer: Three weeks plus another two weeks from today for the second shot and then plus the two weeks. Do you think we're headed for a big mess, with Delta being as contagious as it is, of schools or individual classrooms opening and closing and opening and closing? Last year, I was just talking to a New Jersey public school teacher who told me of being quarantined five different times last year during the school year, though this teacher never got COVID themselves, but because the school kept being open and closed and open and closed. In one group that this teacher was involved in, 10 of 12 students who were doing something all got COVID. With Delta, is it going to be even more of that this year?

Dr. Judith Flores: I think that we have this year which we didn't have last year is we have a vaccine. We have some power on our side against the variance. The more people get vaccinated, the less this is going to be in the community. The other thing is talking about school closures is in order to close the school, the current standard, to my understanding, by the DOE is that four classrooms have to be impacted. Four classrooms have to be affected with identified infected individuals in order to close the entire school. Four. An individual classroom will be closed if there is one case identified. Closure is very different from last summer because we do have the vaccine.

Remember, at least in New York, and I'm speaking mostly for New York City. In New York, we have a wonderful Test and Trace Corps out there. We'll be testing any adult that works in a school setting that has not been vaccinated will be tested every week. Then there'll be some further testing among children. The testing patterns have changed, the closure regulations have changed, and by all means, get your children vaccinated. This is a critical tool. It avoids so much illness, the children can get sick, can get very sick, maybe don't get as sick as adults do, but they can also bring it back to your home and make your little one sick and your vulnerable adult sick. That's my take-home message.

Brian Lehrer: Dr. Judith Flores, pediatrician, fellow at the American Academy of Pediatrics, former chief of ambulatory care at several Brooklyn hospitals, and community vaccine outreach worker with Test and Trace. Dr. Flores, thanks so much for being here.

Dr. Judith Flores: You're welcome. Have a great day. Bye-bye.

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