By Anne Blythe

Now that many children are back in school, a lot of parents are confused about what to do when they receive a robocall informing them that their child might have been exposed to someone with a lab-confirmed case of COVID-19.

Their questions include:

• Does their child need to get tested?
• How do they find a testing site?
• How long does the child have to stay out of school?
• Who will take care of them if it’s impossible to work from home and a missed paycheck is out of the question?

Those inquiries and more came up during a Zoom session on Wednesday organized by LATIN-19, a group of energetic and problem-solving Duke Health clinicians that meets online weekly to address health disparities in North Carolina’s Latino communities.

The Zoom call, which often draws more than 100 people from across the state, was a listening session to discuss children and COVID-19. 

Though much of Wednesday’s discussion focused on Durham County schools, the questions, problems and ideas for addressing them demonstrated what many parents confront across a state with 115 public school districts governed by individual elected boards, each with different protocols and priorities.

Viviana Martinez-Bianchi, a Duke family health physician and co-founder of LATIN-19, shared a few slides about the state of the state before the conversation about children and COVID started. One graph showed a sharp rise in cases in the 17-and-under category.

“This is why, again, we are concerned about children,” Martinez-Bianchi said. “Young people are some of the highest numbers and increases that we are seeing.”

Boots-on-the-ground report

Gabriela Maradiaga Panayotti, a pediatrician at Duke and a co-founder of LATIN-19, or the Latinx Advocacy Team and Interdisciplinary Network for COVID-19, invited other pediatricians to join as the Delta variant raises new concerns about the availability of testing, contact tracing and strains on health care systems.

On Wednesday, 7,248 new lab-confirmed cases of COVID-19 were reported statewide, and the rate of tests that were positive was 13.8 percent, among the highest of the pandemic.

Hospital beds across the state are filling up with unvaccinated people in their 20s and 30s without underlying health conditions struggling for life, Maradiaga Panayotti said.

“We have not seen ….a big change in serious illness in children,” Maradiaga Panayotti said. “We are certainly seeing infections, but for right now not a huge increase in the serious (cases). It’s happening, I’m not saying it’s not, but it hasn’t necessarily been a change in terms of the hospitalization rates.”

That could change. 

Last year it appeared that young people were less susceptible to the novel coronavirus and seemed to only have mild cases. The Delta variant has changed that calculation, as children’s hospitals across the country are reporting more kids with COVID-19 infections on top of the other respiratory diseases they usually see, a situation that the CEO of the national Children’s Hospital Association recently called “a perfect storm.” 

In North Carolina, nearly 40 percent of children who are 12 to 17 and eligible for COVID vaccines have received a shot, according to Martinez-Bianchi.

The meeting Wednesday, though, was less about parsing the difficult numbers in the state’s fight against COVID-19. Instead, the goal was to hear more from the community health workers and others who routinely have conversations with Latino and other immigrant families who have to make sense of new school policies, safety procedures and health care requirements instituted because of the pandemic.

‘Now it’s about the kids’

Ivan Almonte is a native Spanish speaker who works as a community health worker with La Semilla, a faith-based organization in Durham that reaches out to Latino and larger immigrant communities.

The organization has helped stage vaccination events at Asbury United Methodist Church across the street from the Duke University East Campus. Before the noon Zoom call on Wednesday, Almonte said the organization helped arrange for 25 COVID tests.

Until this stage of the pandemic, much of the work that La Semilla did focused on adults. “Now it’s kids,” Almonte said.

He described the anxiety, confusion and a dearth of easily accessible resources in English or Spanish that parents can quickly turn to for answers about children and COVID.

“Families have to be able to communicate with the pharmacies to get tested and if you don’t speak English then it’s difficult for you to be able to access this information because these are complex topics,” Almonte said in Spanish that an interpreter translated into English. “So the kids have to be taken out of school, and they’re in limbo, and they know they have to get tested. So this is a new era that we’re dealing with right now because we have to deal with the kids.”

Endy Mendez, North Carolina program manager at the Hispanic Federation, a non-profit organization that works to empower the Latino community, described her first-hand experience with that communication gap. She got a message that morning from her 6-year-old’s school, but few details were provided for what she, as a parent, should do next.

“Her class is going to go into quarantine now,” Mendez said. “I did receive this message from the school, but there was no connection to the pediatrician. So now I have to do all that follow-up, that ‘do we get tested or not get tested?’ A lot of things have changed.

“I feel like I have access to the computer, and in a way, I know how to have access,” Mendez added. “But many people in our community do not have that. They have a fear, and they’re in that kind of situation where they’re like ‘Whoa if I said that my kid was exposed, then I won’t be able to go to work, and I can’t miss work. I can’t miss work for two weeks.’”

Not enough testing sites

Though much of the recent political debate has focused on whether school boards should require masks and whether the governor should issue a statewide mandate, many parents of school children have hit on a larger issue.

As the state’s 1.5 million kindergarten through high school students return to classrooms and the Delta variant rages, finding COVID testing sites has become more difficult than earlier in the pandemic.

“One of the things that I am hearing, that we all know, is that we need to have better access to testing,” Maradiaga Panayotti said. “This system that we have now is not easy, it’s not fast, and it’s very delayed. I had a virtual clinic yesterday with about 15 patients and all they needed was a test. So I think there’s better systems and we have to find a way, a way to improve the access to testing in the community. …The worst place to get testing is in the emergency (department.) We have to look for different ways so we can ask Duke and UNC and different systems to look for a way to improve access to testing.”

Martinez-Bianchi voiced her frustration.

“For me, this is a deja-vu,” Martinez Bianchi said in English to stress the point. “A year ago we were begging for, asking for testing, and a year later with similar numbers, with kids coming from school. I mean for my own colleagues, I am hearing, ‘I cannot access testing.’ You know, ‘I just got a call. My kid was exposed again. We are needing to get tests.’ If our own, highly educated colleagues are having trouble finding a test site for their children, what’s left to the community that doesn’t have the privilege of the access and the ability to be going and looking? But often we don’t have the ability of the time to be able to go and get a test. So drive-throughs are gone or almost all gone.”

Eleanor Wertman, a community health program manager at UNC Health Alliance attending the Zoom meeting, acknowledged that UNC had closed down some of its testing sites.

“One thing we are really struggling with at UNC is: How do we reserve capacity to do everything else?” Wertman said.

The same, she said, is happening at county and local health departments, as well as rural hospitals.

“Everyone is struggling,” Wertman said. “No one has enough people. So the decision was made a little while back, really before Delta hit, to shut down many, if not all of our drive-through COVID testing centers because there was this need to redeploy those people back to providing primary care services which had been neglected for months.”

Health care workers are being shifted again, Wertman added. 

“We are finding ourselves in this difficult position of cases rising — predicted to reach levels that we saw at the peak in January, if not higher than that. So there are people actively being deployed from primary care into the hospitals to prepare for that surge.”

Voices of change?

Hearing from community health workers and parents participating in the LATIN-19 meeting could help spur change, Wertman said.

“I think it’s important to hear this community feedback because I can then go back to the folks focused on health equity and say, ‘Look, there is a desperate need for this and I agree,’” Wertman told the participants. “People that have money, resources, connections to the health care system cannot figure this out. 

“People that don’t have those connections and don’t speak English definitely cannot figure this out, and those are the people that are getting sick with COVID.”

County and regional health departments are starting to ramp up contact tracing again, too, because of the Delta variant.

“We are behind, basically, in terms of where we were three and four weeks ago so we have returned to a six-day-a-week staffing schedule to be able to try to catch ourselves up,” said Lindsey Bickers Bock, a public health practitioner at Durham County Public Health. “We just have done that in the last two weeks, so it is the case that we are not as quick as we were before.“

Help wanted

School systems are dealing with staffing issues, too.

In Durham County, there is such a large shortage of school bus drivers that Durham Public Schools has increased the hourly wage to $16.25. Wake County also has increased pay for drivers.

One of the community health workers recounted stories he has heard from parents about children taking their masks off on buses, in part, because of the heat and reports that children are not allowed to open the windows even when there is no air-conditioning.

“The person that is in charge of operations told me that they are all supposed to have their windows open,” said Alexandra Valladares, a Durham County school board member participating in the meeting. “Some buses have AC and some do not. But even with the AC, because the AC is not that strong, we are asking all the buses, they should have the windows down. So if parents are seeing that all the windows are not down in the buses, they need to communicate that to us.”

The Durham school board also is talking about requiring vaccination for those who are eligible for the COVID vaccines.

“We want everybody at DPS to get vaccinated,” Valladares said. “So we have the willingness, but we have to be very careful because we are in a very important moment at DPS, where we don’t have enough employees. We don’t have enough staff members, really. We have a lot of vacancies.”

Valladares took in all the information from the meeting, acknowledging the confusion and frustration of parents.

The schools hope to prevent the transmission of COVID while also giving students every opportunity to be in the classroom this year instead of taking the online and remote classes offered most of the past year.

“But transmission can happen in many different ways so you have to analyze every situation carefully,” Valladares said.

So for example, if a student or staff member tests positive for COVID, but had very limited, or no close contact with others, “we’re not going to shut down a school because of that.”

“What you want is being able to navigate this complexity, that children have access to education because children have a right to an education and we don’t want to deprive them of that right,” Valladares added. “But at the same time, we need to manage it so that we don’t have the spreading of COVID cases.”

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