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COPING WITH CHILDHOOD ANXIETY AMID RETURNING TO THE CLASSROOM
After a year of virtual learning, many kids are beginning to return to the classroom in-person. Johns Hopkins Medicine experts say this new adjustment may prove to be challenging for many children and parents alike, bringing along some worries.
Carisa Parrish, Ph.D., co-director of pediatric medical psychology at Johns Hopkins Children’s Center and associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, has seen a mix of emotions from parents and children when it comes to going back to in-person learning. While the idea of returning to class may excite some children, it may bring feelings of anxiety for others.
According to the Centers for Disease Control and Prevention, about 4.4 million or 7.1% of children and adolescents in the U.S. between the ages of 3 and 17 have been diagnosed with anxiety. Anxiety can be triggered for a number of reasons, including potentially, for some, the idea of being in the same room as their teacher and peers and losing the anonymity of being in class virtually or ensuring they or their classmates adhere to new safety guidelines like wearing masks and washing hands regularly.
Parrish advises parents to be mindful of their children’s feelings, emphasizing that there is no correct way to feel about returning to school. If these worries occur, Parrish recommends “turning each worry into an action plan,” to help combat concerns, especially those surrounding unknowns. For example, if a child is worried about not knowing what to talk about with his or her friends, you can brainstorm conversation topics the night before. It is also important to validate your child’s worries, without ruminating on them, Parrish adds.
She advises parents to set positive expectations for the transition to in-person learning to inspire an optimistic mindset for the child. Parrish also reminds parents to prepare for changes in the evening and morning routine to avoid feeling rushed or stressed in the morning. Simple steps like making lunch or selecting an outfit the night before can alleviate unnecessary extra stress in the morning. Kids may need to roll bedtimes up slightly to allow for earlier wake-up times.
“An overly grumpy or tearful reaction may simply signal lack of rest, as returning to school in person takes longer than waking up and logging into remote school,” Parrish says.
If feelings of anxiety persist for longer than a few weeks, Parrish recommends speaking to your child’s school counselor, pediatrician, or another medical professional.
Parrish is available for media interviews on potential anxiety relating to the transition to in-person learning.
Rachel Hackam contributed to this content.
NEW GLOBAL TRACKER MEASURES PANDEMIC’S IMPACT ON EDUCATION WORLDWIDE
The COVID-19 pandemic has disrupted education for 1.6 billion children worldwide over the past year. To help measure the ongoing global response, researchers at Johns Hopkins Medicine and Johns Hopkins University are collaborating with the World Bank and UNICEF to create a COVID-19 Global Education Recovery Tracker.
The tracker is intended to make data available to help decision-makers in more than 200 countries make informed decisions around their COVID-19 responses. The tool is built to have the flexibility to incorporate emerging issues while offering a time trend of actions in the past months.
The effort captures and showcases information across four key areas:
- Status of schooling
- Kinds of learning (remote, in-person or hybrid)
- Availability of remedial educational support
- Status of vaccine availability for teachers
Data collected by the tracker through early March 2021 shows that 51 countries have fully returned to in-person education. In more than 90 countries, students are being instructed in multiple ways, with some schools open, others closed and many offering hybrid learning options. The team will continue analyzing these trends on a global and regional level.
In addition to recording the operational status of schools, the tracker will monitor how students are being supported. This includes changes to the school year schedule as well as tutoring, especially for the primary school grades. These interventions will be a critical component of the education recovery process after a year that has affected the learning and well-being of 95% of school children across the globe.
In countries where the COVID-19 vaccine is available, the tool is tracking whether teachers are currently being vaccinated as a priority group. Of the 130 countries where vaccine information is available, more than two-thirds are not currently vaccinating teachers as a priority group, according to the tracker.
The tracker is supported by the Johns Hopkins University eSchool+ Initiative, which is a collaboration between the Consortium for School-Based Health Solutions, the Berman Institute of Bioethics, and the Johns Hopkins schools of education, medicine, and public health. The eSchool+ Initiative focuses on child well-being from an equity lens, developing tools and resources for K-12 schools to help policymakers and educators support students during the COVID-19 pandemic.
Megan Collins, M.D., M.P.H., assistant professor of ophthalmology at the Johns Hopkins University School of Medicine, associate faculty at the Berman Institute of Bioethics, and co-director of the eSchool+ Initiative, is available for interviews.
COVID-19 DRIVES INNOVATION AND EVOLUTION IN PATIENT CARE
In March 2020, Johns Hopkins Medicine admitted its first patient with a confirmed case of COVID-19, just the beginning point of a pandemic that would change medicine and the world in ways we couldn’t have imagined. To help reduce the spread of COVID-19, and accommodate patients who did not want to travel for care due to exposure risk, it was essential to create flexible and innovative alternatives to traditional care models.
The critical flexibilities government granted during the COVID-19 pandemic allowed providers, like those at Johns Hopkins Medicine, to be nimble and rapidly transform how care was delivered. Systems nationwide quickly scaled remote services to maintain vital connections to patients who otherwise would have delayed or skipped needed treatment.
Telemedicine has been an established care option for some time. That said, prior to the pandemic, Johns Hopkins Medicine recorded 86 telemedicine visits for the month of January 2020 at its six hospitals in Maryland, DC and Virginia as well as more than 40 community physician locations. By April 2020, the number of telemedicine appointments exploded to more than 90,000 — accounting for more than half of all outpatient care at Johns Hopkins Medicine at the time.
Since the start of the pandemic, Johns Hopkins Medicine has conducted nearly 850,000 telemedicine visits for patients in Maryland, Washington, DC, Florida and across the country. In a survey of 700 Johns Hopkins Medicine patients, 88% stated they were moderately to extremely likely to use telemedicine after the pandemic. During the last 12 months, telehealth helped reduce the spread of the virus by enabling virtual access to essential care for patients.
For example, one patient story illustrates how people have benefited from telemedicine care. The Florida resident is a patient of Carol Ann Huff, M.D., associate professor of oncology and medicine at the Johns Hopkins University School of Medicine and Medical Director for the Johns Hopkins Kimmel Cancer Center. Although the patient receives her lab work and treatments close to home, due to her cancer and chronic inflammation illness, which has left her immunocompromised, she trusts and relies on Dr. Huff and other Johns Hopkins Medicine experts to coordinate with her local doctors for care guidance.
Virtual access to Johns Hopkins’ experts became crucial when she contracted COVID-19. The patient arranged a virtual visit with Howard Lederman, M.D., Ph.D., director of the Immunodeficiency Clinic at the Johns Hopkins University School of Medicine, to discuss treatment options for coronavirus. Lederman was able to provide her with important information about possible treatments such as monoclonal antibody infusion therapy.
The patient says, “I wouldn’t have gotten treatment without Dr. Lederman’s communication. My doctor [in Florida] is good but wasn’t aware I could get this treatment outside of a clinical trial and wouldn’t have recommended it — I was fortunate to find out about it through my connection with Dr. Lederman, which started with a telemedicine visit. I got to the hospital on the first day they were offering the treatment. It saved my life.”
This story mirrors many patients’ experiences with telemedicine care during the pandemic. Her ability to seek virtual care was due, in part, to federal and state governments granting emergency authorization to temporarily relax restrictive licensing laws that previously limited doctors’ ability to serve patients living across state lines. The benefits of the emergency authorization of state licensing reciprocity to provide this flexibility in care have proven to be undeniable.
However, this is not a permanent solution. Looking ahead, the Bipartisan, Bicameral Temporary Reciprocity to Ensure Access to Treatment Act, or TREAT Act, S. 168/H.R. 708, is a temporary federal solution to address the patchwork of state licensing laws to ensure equitable access to treatment, and a chance to continue to offer care in the ways patients need now.
The reinstatement of regulations generating telemedicine restrictions in certain states has already begun to alter patient care. Due to state restrictions, within the past month, Johns Hopkins Medicine has been forced to cancel hundreds of telemedicine appointments and further restrict the scheduling of established patients who happen to live out of state, sometimes only miles from their provider.
The ongoing COVID-19 pandemic has brought unprecedented demands on the nation’s health care system, and it has changed the way people want to and can receive care. Brian Hasselfeld, M.D., medical director for digital health and telemedicine at Johns Hopkins Medicine is available to further discuss the critical need for continued access to virtual care, as well as the important role the TREAT Act will have in the continued effort to deliver innovative care during and beyond the COVID-19 pandemic.
Hasselfeld is available for interviews. The patient is also open to interviews but wishes to remain anonymous.
STUDY SHOWS PANDEMIC LIMITATIONS ON SURGERIES CAN IMPACT PATIENT CARE
One of the most serious consequences of the current COVID-19 pandemic has been the postponement of non-essential surgeries — defined by the federal government’s Center for Medicare and Medicaid Services (CMS) as “medical procedures that are not necessary to address an emergency or to preserve the health and safety of a patient.”
When the CMS issued guidelines in April 2020 for medical centers nationwide to limit non-essential operations until facilities could be declared free of COVID-19, the American Academy of Otolaryngology — Head and Neck Surgery followed suit, telling its physician members to delay performing non-essential ear, nose and throat surgeries.
What was the impact? That’s the question Johns Hopkins Medicine researchers attempted to answer in a recently published study comparing inpatient and outpatient surgical volumes from March 2020 through September 2020 with data from the same timeframe in 2019. A surgical volume is defined as the number of times a hospital has done a specific surgical procedure during a defined time.
A report on the findings appeared February 2020 in JAMA Otolaryngology-Head & Neck Surgery.
To conduct their study, the researchers used the healthcare performance improvement tool called Vizient. Researchers used data from 609 hospitals across the United States. Data were collected for the period March 1, 2019, through Sept. 30, 2020. Hospitals were included if they had a minimum of 20 otolaryngology cases per month pre-COVID and had reported volumes for all months in the study period.
Data came from 174 inpatient and 295 outpatient community facilities. The researchers found that in April 2020, outpatient surgical case volumes dropped to 18% compared to April 2019. Inpatient volumes dropped as well, especially in the Middle Atlantic and parts of the southern US, where volumes fell to 40% of the level in the previous year. Areas most affected corresponded with regions where the pandemic initially hit hardest. These data, the researchers say, might be used to determine how quickly institutions can resume surgeries following a future crisis.
By September 2020, the data showed that outpatient volumes climbed back to 97% and inpatient volumes improved to 99% of pre-pandemic levels. These recoveries over such a short period of time, the researchers say, indicate that providers were diligent about meeting patient care needs even when the country was still at the height of the pandemic.
“As the pandemic continues, we’ve noted that otolaryngology surgeries are still backlogged and this impacts the health and wellbeing of patients,” says C. Matthew Stewart, M.D., Ph.D., associate professor of otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine and senior author of the study. “To address this, we plan to keep monitoring trends in surgical volumes to develop helpful strategies for reducing or eliminating such backlogs during future pandemics or other crises.”
Stewart is available for interviews.
PROFILES OF IMMUNE CELLS SHOW DEFENSE AGAINST COVID-19 MUTANTS SIMILAR TO ORIGINAL VIRUS
In January, an international research team — led by Johns Hopkins Medicine and in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID) and ImmunoScape, a U.S.-Singapore biotechnology company — published one of the most comprehensive profiles to date of T lymphocytes (more commonly known as T cells), the immune system cells that help protect us against SARS-CoV-2, the virus that causes COVID-19. The researchers felt that better defining which T cells interact with which specific portions of the virus could help accelerate the development of next-generation, more effective vaccines.
New variants of SARS-CoV-2 continue to spring up around the world, raising concerns that current vaccines — designed to induce an immune response by recognizing spike proteins of the pandemic’s original virus — might not provide sufficient defense against a mutated strain. This could potentially make COVID-19 re-infection more likely or vaccination less effective.
To address these concerns, the same researchers who profiled the T cells responding to the original SARS-CoV-2 have done a second study, this time characterizing whether the immune cells also respond to three variant virus strains.
The latest research used data generated from samples collected for the first study — blood cells taken from 30 convalescent patients who had recovered from mild to moderate cases of COVID-19. The researchers used the data to assess how likely a specific type of T cell — known as a CD8+ T cell (commonly called a “killer T cell” for its ability to eliminate cells that are infected with viruses) would recognize the three main SARS-CoV-2 variants that emerged in the past year in the United Kingdom (B.1.1.7), South Africa (B.1.351) and Brazil (B.1.1.248).
CD8+ T cells are covered in protein complexes called T cell receptors (TCRs) that bind to a specific protein fragment, known as an antigen, derived from a foreign body such as a virus. When this binding occurs, the T cell becomes activated and triggers an immune response against the invader. The ability of a specific TCR to recognize its target antigen defines that response.
In the earlier study assessing T cell response to the original SARS-CoV-2 in convalescent patients, the researchers tagged and identified the various types of CD8+ T cells specific for different parts of SARS-CoV-2. This enabled them to determine which of the viral antigens were targeted by the T cells.
Identifying those targeted antigens told the researchers which of the three SARS-CoV-2 variants to examine in the latest study. This time, they wanted to assess whether the genetic mutations associated with the variant strains might affect T cell recognition of the targets.
What they discovered was that the specific CD8+ T cells targets from the original SARS-CoV-2 remained virtually unchanged for all three mutant strains.
This finding is good news, the researchers say, because it suggests that T cell response to these viral targets in the convalescent patients studied — and most likely, in people who have been fully vaccinated — will not be greatly affected by the mutations found in the variants.
“Therefore, the vaccines currently being distributed worldwide should offer a reasonable measure of protection from either infection or serious disease caused by the three variant viruses and hopefully, any others that may emerge,” says study lead author Andrew Redd, Ph.D., assistant professor of medicine at the Johns Hopkins University School of Medicine and staff scientist at NIAID.
Redd is available for interviews.
For information from Johns Hopkins Medicine about the coronavirus pandemic, visit hopkinsmedicine.org/coronavirus. For information on the coronavirus from throughout the Johns Hopkins enterprise, including the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University, visit coronavirus.jhu.edu.
