Weekly COVID update with Dr. Bunio – “Back to School”

by Aug 14, 2020Health, NEWS ka-no-he-da




Each week, Chris McCoy, director of EBCI Communications, interviews Dr. Richard A. Bunio from the Cherokee Indian Hospital Authority (CIHA). It is aired via Cherokee Cablevision Channel 28 and livestreamed by Communications. Dr. Bunio is the executive clinical director at Cherokee Indian Hospital and has been in practice for more than 20 years.  The updates are currently being broadcast live on Wednesdays at noon. 

Here is an edited transcript of the Q&A session from Wednesday, Aug. 12.

This week, McCoy and Dr. Bunio are joined by Dr. Linda Givens, pediatrician at CIHA, and Kayla Grzech, licensed clinical social worker at Analenisgi.

Dr. Bunio announced that the EBCI tribal community is at COVID threat level yellow. For the previous two weeks, the Tribe had been at threat level red. 

How do I explain to my kid. He is curious about why everyone is wearing a mask and why he has to wear one? I feel like he is too young to really understand what COVID is.

Dr. Givens: The best thing to do is be honest with your child. First of all, parents need to educate themselves about what COVID is so that they can sit down and talk to their kids about it. Find a time when you are not pushed, you are not rushed…dinner time is a good time or go to the park, take a walk. And we don’t want to create fear in our kids. We want them to be educated correctly about coronavirus. One way to start out is to start talking about germs. There are good germs and there are not-so-good germs. And so that can lead into about why we have to wear a mask, because the mask keeps us from getting germs from other people. Then we can talk about washing our hands, why we wash our hands, then you can teach them things about social distancing. Take a tape measure out six feet and show them what six feet is. If you take them in the grocery store, explain to them that this grocery cart keeps us six feet away. By doing that, that child will understand COVID a lot better. If all else fails, Sesame Street has done a great video on COVID-19 that you can pull up on Youtube.

My daughter does not understand why she can’t hang with her friends as long as they stay six feet away and do not touch each other and I’m having the worst time really trying to explain this as a measure to keep her safe, as well as her father and I. What do I do?

Ms. Grzech: I think one of the hardest parts of this pandemic for all of us is having to stay away from our friends and our loved ones. What I might talk to her about is that even though social distancing and wearing masks are things we can do to stay safer but the safest option is to limit our interaction with people outside the household. You are doing your job as a parent by not only keeping your daughter safe but also keeping her friends and family safe, as well as the rest of the community. 

Dr. Bunio: You can be carrying the virus and spreading it and not even know it; people who are asymptomatic. Children tend to have fewer symptoms. A lot of the concern is that they are going to go and spread the virus in the community or when they are visiting their grandparents or somebody else whose immune system is maybe not as hardy. It is better to know where your teenagers are than for them to do things in secret. Try to be open and honest with your kids. If they are going to hang with that friend that they just can’t be away from, it is better to know than to do that in secret. As we have discussed before, you want to know your quarantine bubble. If one person in that family is positive, you want to know that because your child may bring it home to you. But you want to be able to tell that other family if you get a positive in your household. 

Ms. Grzech: It is tough, especially for our older teens, who are used to having some level of freedom and some level of independent responsibility. Make sure parents are in agreement about what the rules are and just acknowledge that this is a really hard time for them. It’s ok that they are feeling sad or even frustrated by what’s going on. Give them some space to communicate that.

What signs or symptoms should I look for if I am worried that my child has COVID-19?

Dr. Givens: The signs and symptoms you see with COVID-19 are the signs and symptoms you will see with a cold or with the flu. So, fever, runny nose, cough, congestion, can be diarrhea, could be vomiting, all of those are signs and symptoms of COVID also. A typical, ordinary cold is probably going to be pretty much a runny nose, a cough, maybe a fever and it will probably go away within three to five days. But remember someone may be totally asymptomatic with COVID. And kids are a little bit different because they don’t get as sick. If your child is sicker than usual, or if your kid is not a complainer and they are not usually complaining about being sick, call your primary care provider. 

How do I help my kids cope with stress? What signs do I look for?

Ms. Grzech: Signs of stress in kids can look a little different than adults. They might have similar physical symptoms. They might complain of headaches, stomachache, even like chest pain, or unexplained aches or pains. They might be more clingy. The might be more irritable. They might have more angry outbursts. They could be sad or worried or spend time alone in their room more so than usual. Take some time to check in with your kids, especially if you are noticing some of those signs. Find a good time to do that, making sure it is a quiet time, it’s a calm time, when you can put 100 percent of your focus with you and your child. And it can be just, “Hey, I noticed you are having a hard time sleeping lately. Do you want to talk about that?”, “I wonder if you are missing your friends or worried about getting sick?”. And just giving that space. Sometimes kids would rather draw than talk about their feelings. 

Should kids be tested?

Dr. Givens: This is something that should be left up to the primary care provider. If you know for sure that a child has had a contact, within a household, I do recommend that they be tested. We live in a community where we have a lot of our elders raising younger kids and it is important that we think about our elder community because they are more at risk. Again children can be asymptomatic carriers and so if one person in that household is infected, I think they should be because they are coming in contact with those elders. 

I’m scared about the coronavirus and want my family to be safe and healthy, but I am pretty sure I’m annoying them more than anything but it’s so stressful to see them not do everything that they should. What do I do?

Ms. Grzech: I think for kids what might be helpful, I notice we have the great signs, the 3 W’s, having that visual reminder is very helpful. That is absolutely something that you can have in your household. Maybe put a sign up by the door that says don’t forget your mask. Get the kids involved, maybe they can help draw or color them and put them up on the wall. That way you might not feel as much pressure to be constantly on the lookout if they’ve got some other reminders there. 

Can the virus affect any other part of the body besides your lungs?

Dr. Givens: It can. It was initially the cough, the lungs. But what we have found in children is that it can cause rashes, it can cause diarrhea, it can cause any of the symptoms I mentioned previously. So that involves all organs of the body. For adults, I have heard of some problems with return of taste, and some memory problems. 

My child thrives on routines. The last few months have been anything but routine and now with school starting back virtually, it’s only added to the stress for my child and me both. How do I help adjust? 

Ms. Grzech: We can’t change what’s going on in the outside world unfortunately it’s just something that is not in our control. They’re right. Routines help kids and adults feel safe and to know what to expect. Create your own routine at home. I know that it is easier when we know we don’t have to go to school that “maybe they don’t need to get dressed today” or that we can just do things as we feel, but kids respond really well if you sit down and set up a time of this is wake up, this is bedtime, this is when we’ll eat breakfast, this is playtime, and this is school time. Maybe working with them to write that schedule down and post it up somewhere so that they can see it so they know what to expect. You know what to expect. 

What do I do after my kid returns home from school? Do they need to immediately change clothes, wash their masks, or what?

Dr. Givens: I would recommend that they take their clothes off and take a shower. I would also recommend that you have enough masks to use a clean mask every day. If they wear a cloth mask and they are only going to school two days, then have two masks and then you can wash them. 

Will talking about COVID-19 increase my child’s anxiety? I’m worried that they’ll worry themselves crazy over every little cough or runny nose.

 Ms. Grzech: It is important to be honest with our kids. Do it in an age appropriate way. It is important for them to know what is going on and why they have to wear a mask so that they can follow guidelines. But they don’t necessarily need to know every statistic and every update that’s coming through. I think that is up to you as a parent to decide what is appropriate for their age. Make sure that you are staying calm when you are speaking to them about this. Make sure that you are in the right frame of mind. Our kids are really looking to the parents and adults to give them cues for how they should respond. If you are calm and let them know they are safe, then they are going to feel like it is okay to feel calm and safe themselves. 

How likely is it that my child will get Coronavirus? What age group is more at risk for COVID-19?

Dr. Givens: It is probably not likely that they will. The group that is at the highest risk are children or babies that are 12 months and younger. That is probably because of their immature development, their immune systems. So if there are moms out their who are breastfeeding, please continue to breastfeed because that will help those babies’ immune systems. The other group that is probably more likely to be infected is our teenage group. And that goes back to them not wanting to social distance and wanting to be around friends. So they are more at risk. 

My kid keeps asking me “When will this be over?” What do I tell them?

Ms. Grzech: Unfortunately, I don’t think this is going to be a situation where we can say we are going to wake up tomorrow morning and everything is going to be back to normal. And we have been through a lot of changes and transitions. Just like we are now in our “yellow phase” that is going to change and transition. And we are going to listen to our experts and our guides and we are going to slowly transition back to normal activities. It is important to focus on the fact that their may be some more changes to come. We may get back to a point where we are doing school face-to-face or in-person but it might look a little different. Instead of helping them focus on this unknown time in the future for when it’s over, really working to help be there for them in all these changes and transitions. 

Whatever happened to this “Kawasaki-like” illness? Is that still something I should worry about?

Dr. Givens: The Kawasaki type illness is something that we have seen in pediatrics for years and it is related to children being infected with a virus. It is termed multi-system inflammatory syndrome in childhood. The virus causes different organs and blood vessels of the body to become inflamed. It can cause some severe problems where you get organ shutdown. So, it is still there. There has been some data that suggests that some children are more susceptible to that; children who have problems with their immune systems. What I recommend to parents if your child is really, really sick-you can’t get them to wake up, they are in bed, they are not eating, they are not drinking, then that makes me think more about this multi-system inflammatory disease. Or if their eyes are really red or their skin has a bright red rash to it, that is outside of the usual symptoms of COVID. It’s still there, but we don’t see it as frequently in kids.

So how do you maintain normalcy in your home when nothing is normal these days? There’s murder hornets one day, explosions the next, virtual school, the constant threat of getting sick. I am exhausted myself.

Ms. Grzech: It has been a really wild year. We can’t control what is going on in the outside world. Try to have a routine in your household. Create a new sense of normalcy, at least within your household or within your family. Have a game night or go for a walk after dinner, things that you can really look forward to spending some positive time together. Take a break from the news and social media. It is important to stay informed and know what is going on, but you do not need to be plugged in 24/7. It would exhaust anyone. So take a break. Spend some time with your family. Do some art or listen to music. 

My daughter has asthma, is she more at risk?

Dr. Givens: Individuals who have chronic diseases such as asthma, diabetes, they are more at risk for COVID-19. But just because your daughter has asthma doesn’t mean that she will get COVID. For anyone who has asthma-children, adults-you want your asthma well controlled. So you want to see your PCP, make sure you have your inhalers, make sure you are taking your medicines because we know asthma is connected to allergies. Take your allergy medicine. We live in the mountains, so we have a lot of allergies. As we go into flu season, it will be important for anyone who has a chronic illness to get their flu shot and also for anyone in the community, because the flu is a virus like COVID, the two will probably come together. If we can keep our flu numbers down, it is going to help the whole situation. 

Dr. Bunio: (Concerning flu shot availability) I was just talking to Public Health about scheduling some community, mass immunizations. We want to get as many people to get the flu shots this year as possible because the symptoms of COVID and the symptoms of the flu and other viruses are very similar. Better to just not get the flu than to have to put yourself or your child through the worry that it might be COVID.

What do I do if I think my child has COVID?

Dr. Givens: Call your primary care provider. We can give you some direction on what we are going to do and what we need to do. 

Will my child be behind in their social development skills due to social distancing?

Dr. Givens: When a child is born, you are their introduction to socialization. For children from birth to age four, that is where that they get most of that from. It is from the family. I do not think they are going to be behind. I do think this is a great time for us to get back to being families. Our daily lives-school, working-take us in so many directions, they really fragment the family. My family committed that we had to reconnect at least once a day and we did that at dinner time. So just think of this as a time of reconnection. 

Ms. Grzech: I just want to remind families that kids are really resilient. You’re worried education, social skills and developmental skills and, they are going to bounce back okay. And you have got a whole community here to support your family and support your kids. Lots of people who are working very hard to make sure everybody is on track. 

Dr. Bunio: (Updating on testing delays) Right now we are getting our test back, on average, in 1.8 days. We are looking for all kinds of other options just in case it gets back to what it was. That was unacceptable. Before it was taking a couple of weeks. It’s looking good right now.