Q&A with Dr Jan Fizzell

A Q&A with Dr Jan Fizzell addressing some of the COVID-19 concerns raised by the ECEC sector.

 

MARTIN GRAHAM:

Hello. Welcome to another Q&A session for Early Childhood NSW. Today, we're very fortunate to be joined by Dr Jan Fizzell. She's a public health physician and an international expert in infectious diseases. Dr Jan's known to many people on the internet, and she's been keeping people safe in NSW for more than a decade here.

But, before I begin, I'd like to acknowledge that we meet today on the land of the Wangal people of the Darug Nation, and I pay my respect to Aboriginal Elders past, present and emerging, and also pay my respect to the Traditional Owners of the land that you are on today.

We'd also like to start today by acknowledging the amazing work that's taking place from early childhood educators across NSW. You have more diverse settings than anybody else, and, of all the people, you've really been working throughout this whole crisis, not just helping families by providing care, but providing that important emotional support and stability for children, which, at a very difficult time like this, really is quite remarkable, so the department certainly appreciates all the work you've been doing. We know you've had a lot of questions about this virus, it's something we've all been struggling with, but we hope today to be able to answer your questions so you can practically get on with doing your job.

So, first, Dr Jan, we'd like to ask the most obvious question, but also one that really helps us understand what's going on. How does this virus work? How can you catch this?

DR JAN FIZZELL:

OK, so, COVID-19 is the disease caused by a virus called SARS-CoV-2, and basically, this virus spreads when we interact with each other. So, we get quite a bit of virus growing in the back of our nose and throat, and then, when we talk or when we cough, or when we generally interact, those virus goes out with our tiny, itty bits of spit that happen whenever we talk or yell or cough. So, basically, what we don't want to do is spread the virus to each other because that's how the virus gets legs. When we give it to another person, that person gives it to another three people, and those three people, and it goes on and on and on. So, how we can stop it from spreading is, one, keeping a distance like we are here, so that, when I'm talking, for example, you don't get my bits of spit that come out just generally.

MARTIN:

That's much appreciated.

JAN:

And the other thing is, when I talk, little droplets are falling onto the table in front of us here, so, when I touch that surface, and then touch my mouth, my nose or my eyes, it can get into me. Now, it won't get into my general skin because it just isn't quite that clever, but it will get into the mucus membrane, so that's, like, the inside of my cheek, inside of my nose or my eyes, and so that's why we're particularly careful to keep our hands clean, and also to try and keep that physical distance, particularly between adults 'cause adults are very good at giving this virus to each other.

MARTIN:

We hear a lot about social distancing. That seems to be the key to keeping this under control, like we are here. What does that look like at an early childhood setting?

JAN:

So, I think it's a particularly challenging setting because you've got adults who are used to working quite closely together, as well as all the children, and trying to get children to do social distancing is nearly impossible. The good news about this virus is that kids don't seem to be particularly good at giving it to each other, and they don't seem to be particularly good at giving it to adults. So, that's not to say it can never happen but it's very rare. Now, compared to other diseases that you may have seen in the early childhood sector like gastro or flu, where the kids are good at giving it to each other as well as the adults, this is quite different, and we don't exactly know why, but, one, kids seem to get a much milder disease than adults, which doesn't mean every child who gets it has a mild disease, but generally speaking it's a very mild disease in children, and, two, they don't seem to be giving it to the adults, it's more likely that they're going to get it from an adult giving it to them. So, that's why we're particularly careful about asking people to stay home if they're not well, and, why, when we find a case in a centre, we also ask everyone to stay home for those two weeks, and that's just because that's about how long it takes for us to be sure that everyone who was gonna get symptoms and get sick has been, you know, looked after, and they're either gonna get sick or not. But, generally speaking, kids are not good at doing this one.

MARTIN:

So, we don't have to keep them a particular distance apart, or, you know, how do we manage it with a group of children?

JAN:

I think, where we can, a lot of the visual cues are going to be for the adults, and so it's going to be about, say, there's a change area, only having one more adult there at a time where that's safe to do so. It's about adults changing how they behave, as far as drop-offs and pick-ups, cause I know, when my child was younger, I really liked to talk to the people about how my child's day had gone. We need to do that differently now, and it may be about, instead of having a physical book, or pictures about having things done electronically, and I know, for a lot of centres, that's a big piece of work to change all of that, and many of them have already done this. I think it's about encouraging adults to not stand around talking as they pick up and drop off their kids because that's another good way for adults to give it to each other. We know that that's a really part of an adult's social interaction as well, though, because sometimes that's the only time you get to talk to another parent of a child the same age and to work things out. At the moment, we're asking adults to keep their distance particularly. It may be about thinking about how adults sit and have their lunch, even, so people who'd normally share lunch in a room together, trying to make sure that we've got some distancing between adults. So, it may even be about staggering lunchtimes, which, again, it's something so many childhood centres already do as a matter of course, but all of those sorts of things. But, for the kids, we don't have to worry quite so much. If there's things that we can do to reduce interaction, fabulous, but, if a child comes to hug you or a child's hugging each other...

MARTIN:

That's still OK?

JAN:

It's still OK. They can play in the same sandpit together, they can play on the same toys together. Wherever we can, we're keeping our cleaning of high-touch surfaces going on, but early childhood's been one of those sectors which has often had really good infection control because you have had all those other viruses, and you know what to do and you know how to do it, so it's about keeping on doing the things you already do well.

MARTIN:

What about using outside spaces?

JAN:

So, outside spaces are fabulous because, again, the kids have got a bit more time to room, and, again, it's that thing about those virus particles I was talking about. If anyone does have the virus, instead of it falling into an internal surface where everyone's going, you know, it's got a lot more area to dissipate, so it's not just about having the virus on the surface, it's about how much virus you have on a particular surface, cause, if you've only got one or two particles, chances are you're not gonna be able to infect anyone else, so, if you're outdoors and playing, and also we know sunlight's also quite good at killing off this virus, so it's not like... You know, otherwise we'd just put everyone out in the sun, but unfortunately it's not quite that good, but it's better than nothing. But, if you don't have an outside space, it's just about keeping the kids playing, and thinking about, you know, spacing activities around the room, as well.

MARTIN:

What about babies? If you're changing a nappy, are there any particular precautions or are standard precautions enough?

JAN:

Standard precautions are enough. So, basically, you've all got the Staying Healthy in Childcare, the NHMRC publication, so that's from the highest medical experts signing off on that, and that's got really good infection control advice, and if you're doing the same things as you would normally do to protect yourself, you're doing fine.

MARTIN:

So as you said, the sector tends to have, kind of, really good practice, and it's probably taught...children were the ones teaching their parents how to wash their hands.

JAN:

Absolutely, yes.

MARTIN:

So, if you followed the general advice, you're probably getting most of the way there.

JAN:

Absolutely, absolutely. So, you've got a lot of practices already there, but a lot of our practices are usually about how do we stop children giving it to each other or children giving it to adults? This is a new way of thinking about - how do we reduce the interaction between the adults?

MARTIN:

The adults, so it's the lunchroom, it's the parents coming to the service.

JAN:

Yes.

MARTIN:

So, I'm assuming it's not the time to be having grandparents and parents coming in and helping out?

JAN:

No, no.

MARTIN:

At the moment, I think, if you can reduce the number of people who attend your service as far as possible, that's great. Gotta keep our safe ratios to look after the young people. And I know, for some centres, you know, that means bringing in a casual occasionally to make sure that those ratios are kept up to date, but as far as possible keeping the same staffing structure, keeping the same educator looking after the same group of kids, that's fine. At the end of the day, we've gotta deliver the service safely, so, if that means that we do need to bring in a casual staff member, then that's what we need to do to keep the kids safe. What about prac students? I mean, it's an incredibly important part of, you know, joining the profession is actually having that practical experience, so what should we be thinking about having prac students in?

JAN:

So again, if that prac student is going to be part of that particular early childhood community for a period of time, then that's fine. I'd probably recommend against having a rotation of people through where they're only there for one session a week. I don't know how much extra that's adding to their learning compared to having the same student come to the same group each time, so I think, depending on what the prac is like, probably not work experience students from the local school, for example, that's a very different situation. But if it's a prac student actually building up some hours on a regular day each week, and you and they have been able to negotiate that they're gonna behave in a certain way at the service, i.e. keep their physical distance, and you can supervise them whilst keeping their physical distance, then that's fine.

MARTIN:

What about excursions from the service?

JAN:

So, at the moment, we're really trying to just, sort of, keep that early childhood community together, so, rather than leaving the service, probably not at the moment, and also a lot of the places that you might've taken them to are also going to be closed at the moment. So, I think, at the moment, try and keep things in there. I also know that incursions are often quite popular. Again, probably just try to keep that early childhood community together without having people who don't need to be there entering, so probably not incursions, or I'm sure there's a nicer name for them, is there?

MARTIN:

No, you've nailed it.

JAN:

You know, the visiting farm, the visit from the fire service, all of those things that add so much to our children's, you know, excitement about the world around us. We'll just have to find different ways of doing it. Maybe it's a virtual visit to the fire station, rather than the excitement of having the fire engine there.

MARTIN:

So, it's not the time to have people come around and do fitness for different groups, not the time to have them coming between centres?

JAN:

Correct, absolutely correct. What we want to do is try and keep that early childhood centre community together, few as people in and out as possible, just so we've got that stability, and that gives safety to the educators, as well as some comfort to the parents, I think.

MARTIN:

That's great.

JAN:

And carers. If a child comes to a service, and I've noticed they've got a runny nose, what should I do? You know, often kids have a bit of a sniffle, winter's coming on.

JAN:

And we're coming into winter and, as soon as somebody gets out of a... Particularly, some parts of NSW, the cold weather's enough to give every child a runny nose. So, I think that's a really tough question, to be perfectly honest. I think, if... We're asking parents and carers, particularly, if you're feeling unwell, if your child is even slightly off-colour, do not leave the house, and that's just a message to our whole community. If you are feeling even slightly under the weather this winter, do not leave the house. If you're fairly confident that this is a runny nose and not just a bit of cold coming into the centre, you should ask the parents and carers to come and collect that child, and they need to go home. As soon as you're worried that a child's off-colour, not quite themselves, picking at their food, if you're worried about that child, really low threshold for sending them home, and for the parents and carers, again, we want them to be understanding that there's going to be a very low threshold, and so, when the childhood centre says, Please, come and pick them up, come and pick them up. If there's the idea that, Oh, I'm gonna give them a go today, cause I know we've all done that at some point or other.

MARTIN:

I've heard it happens.

JAN:

You've heard it happens?

MARTIN:

I've heard it happens. You know, because we're all concerned that, you know, we need to be at work, and we're really important, therefore they must have me there, but, at the moment, out of concern for our childhood educators, we're really asking parents and carers, if you are even slightly concerned about your child's health, to keep them home. So, it's a two-way street. We really want parents and carers to be responsible and to be really aware that we're privileged to have early childhood educators who are going to work each day, and to have that trust maintained we need to make sure that we're being responsible, and not sending our children, and, at the same time, as an early childhood educator, we're being responsible, understanding that a child may come in cold, but, if you're concerned after half an hour, you should send that child home.

MARTIN:

Yeah, no, that's fantastic. And staff, often, as you've said, early childhood staff are exposed to everything, so they come to work through all kinds of circumstances. They really, you know...

JAN:

Oh, absolutely. MARTIN: So, what should they be doing? So, basically, for themselves, it's about keeping their hands clean, being really aware of the high-touch surfaces, and trying to maybe use wipes that you may find. Trying to make sure that, when a parent comes to you, that you're assertive in saying, "I need to step away from you, you're too close." Making sure that the kids understand why they're washing their hands, and what's going on, and also taking some time for yourself 'cause I know it's a worrying and difficult time. Sometimes, we just need to switch off the COVID stuff, and just go about and do some other things, making sure that we're getting out to exercise, making sure that we're going out and not just thinking about "COVID at my workplace". You can see that I've got that challenge behind us, that, if I go home and I turn on the news, then all I do for 24 hours a day is COVID. So, I really urge people to find, you know, an escapist show on the television, go out for your walk, I know the gyms aren't open but, you know, go for a run, go for a bike ride, do what you can to get out and about so that you're not feeling like you're enclosed in COVID world with the kids. You're all in it together, we're all in it together, but finding something else to do, as well, is really important.

MARTIN:

Yeah, in terms of that personal safety, should people be wearing personal protective equipment, or, I mean, we're not wearing anything here, but what's the kind of general advice?

JAN:

So, the biggest weapon we've got against COVID is distance and handwashing, and, really, that's really important. If, however, you find that a child is really unwell, and children, we do, do not wear masks well, they just don't, but, you know, you might put on a mask if you're looking after a child whilst you're waiting for the parents to come and pick them up, and you're also probably gonna take that child to a space where they're isolated and not infecting other kids, if they are unwell. Most childhood centres will have a protocol for this, and, if you're concerned, put on a mask, but, otherwise, no. It's your gloves when you're changing nappies like you always use. You do your hand hygiene, put your gloves on, change the nappy, take them off from the inside. So, making sure that you're trying not to touch the outside of the gloves when you're taking them off, and then you do your hand hygiene again. So, it's the same things as you normally do, but the key thing is to make sure that you are keeping your hands clean, and the mask, again, it's just a little bit of an extra precaution. You don't need to have it. You absolutely do not need to have it. So, if you don't have one at work, don't worry, you're gonna be fine. As I say, chances that the kid's gonna give you anything, really, really small.

MARTIN:

In terms of temperature, so we talk about children having a temperature, you know, is there a temperature that...you know? Do the thermometers, are they that accurate, or do you look for something else? What would you advise?

JAN:

I generally advise to look at the kids. You'll know the kids, you know when they're off-colour, you know when they're not well. A temperature's just something else that tells us, yes, the child's unwell. But I think, this winter coming, use your Spidey senses, and you'll know when the kids are not good and you'll know when they're not right, and that should be enough for you to be able to say, really, I need you to take this person home. You know, because whether the temperature's 36, 37.5, 38, doesn't matter if you think that child's not quite right. We know, in COVID, that up to 40% of people in our first 200 didn't actually run a temperature when they had COVID-19, so it's not the only marker. If you normally have the practice of taking temperatures, fine, but having a low temperature with a child who's unwell, you still need to send them home. Yeah?

MARTIN:

That makes sense. So, at this time, is it advisable that children continue to have vaccines?

JAN:

Absolutely. So, it's really important that we keep our immunisation schedules up to date, and also, if your child's unwell, that you take them to the doctor or to the hospital if you're particularly concerned. Doctors and hospitals are safe places to be. Most GPs have got really intense screening to make sure no-one with COVID's coming to them. They're sending those people to the COVID clinics. Hospitals have completely separate streams for COVID. But, even if your child's unwell with COVID, you're not going to be separated from your child. That's something that I've seen go round on the internet, that if your child's sick you're not going to be able to be with them. Rubbish. Our hospitals are going to put in place ways that you can be with your child. So, if your child is unwell, it is safe to take them to the doctor, and, if they are particularly unwell, it's very safe to take them to the emergency department, and it's critical that they have their usual immunisations at this point. So, people shouldn't be saying, I don't want to have an immunisation because I can't get to see the GP." You should go and have those regular immunisations, and particularly for the under-5s, the flu shot, which they can get from their GP, as well, and so that's really, really important that the kids stay up to date with their immunisations, but also that you as an educator can help give that confidence to parents that we are being particularly careful in our emergency departments, and that parents will not be separated, carers will not be separated from the children that they look after.

MARTIN:

We've read things saying it's actually more important than ever that we get the flu shot this year. How does that work? Is that a thing people should do?

JAN:

Yeah, absolutely. So, the flu shot will not stop you from getting COVID-19, but what it will do is it will reduce the burden of people being ill this year. We've already got a number of people who can't leave their houses very often because they're immuno-suppressed or because they're older, and we've asked those people to still stay at home, and keep that social distancing as much as possible. So, by getting the flu shot, the number of people who are gonna get sick with flu this year will reduce, which means we're gonna have less absentees in our workplace, fewer people who get really sick with flu and need our hospitals, and people will just generally be in better health, so we're really encouraging the flu shot for the under-5s, anyone with a chronic health condition can get them from the GP. People who don't have a chronic health condition, chemists, wherever. I know that there's been a lot of demand on flu shots this year and so there may be a wait. It's still worth waiting and it's still worth getting it done.

MARTIN:

That's great. So, say the worst thing happens and someone actually has a positive diagnosis for COVID-19. How long should a child remain away from the centre after a positive diagnosis?

JAN:

OK, so, if there's a positive diagnosis for COVID-19 in the centre, the first thing we'll do is work out if the child's been at the centre when they could've made anyone else unwell. As I say, it's really, really unusual for there to be any child-to-adult transmission, but really unusual can sometimes happen. You know, it's like winning lotto. You know? You can win it occasionally but most people won't, so I think... It's like reverse lotto, I guess, in this case, but, anyway, what we'll do is we'll see if the child's been at the centre when they may have been infectious. If they have been, we'll work with the centre to work out who's been at the centre on those days, who are the carers and everything else. Depending on how many carers have been in contact with the child, the centre may need to close because they just might not have enough staff to operate safely, and also generally speaking we just go in and we make sure all the surfaces are really clean before everyone comes back.

MARTIN:

So, you do a much deeper clean than just normal?

JAN:

Yeah, but just being particularly meticulous. It's not so much about deep, it's much more about making sure that we really think about where the child has been, and being really careful about our manual cleaning, because a lot of people think, if I spray enough Glen-20 around, it's all gonna magically dissipate. Unfortunately, what happens, and this is the gross bit, when we talk and spit, we can have, like, a bit of a globule there, and, when the Glen-20 goes over it, it might get to the top bit of the globule, but it's not gonna get to the bottom where the virus actually is. So, that's where it's really important to do the manual cleaning, and so that's... I think the nice word we've come up with is purposeful.

MARTIN:

Purposeful, no, that makes sense.

JAN:

We're actually really thinking carefully about what we're cleaning and how we're cleaning it, so that we're not just doing a bit of a wipe, we're actually really thinking about it and cleaning as carefully as possible. I think that's something that most centres would probably already be doing cause those guidelines for cleaning have been out on the health websites for quite some time, and also on the Australian Government website, and probably..

MARTIN:

We have the department links. So, on the department's website, we have links to all that information.

JAN:

There's huge amounts of information for cleaning out there. The other thing, though, I'd also say to the early childhood centre is just being careful with the hand sanitiser, that we don't leave it where children can drink it.

MARTIN:

Yes, that's quite a good point.

JAN:

Cause it's quite pretty in some places. Anyway, so, we've got the child at home. They're gonna stay home for two weeks. Any close contacts, we'll ask them to also stay home for two weeks, and we may actually ask them to present for swabbing now because we're not usually swabbing asymptomatic people, but now that we've got a little bit more testing capacity, we're really going after anyone who might have it, even if they're in that very early stage. That doesn't mean everyone should go out and get a test if they don't have symptoms. This is in the context of a public health unit saying to you, We'd like these five people to go and get swabbed," for example. The other thing that will happen is we'll watch you all carefully for two weeks, you'll be monitored, you'll stay at home, you'll try and isolate from the other members of your household, and then, hopefully, at the end of that two weeks, everyone's well and things go on as normal. What we have found is it's much less likely that a child's going to present than an adult presenting, and so, again, that's where sometimes keeping our physical distance, and trying to keep that cohort of people together about who works with whom and where, we can actually reduce the number of educators exposed, and that may actually make life easier for keeping the centre going longer term.

MARTIN:

That's great. One of the specific questions we've had is about toys and books.

So they're the things that kids share.

JAN:

Absolutely.

MARTIN:

What should we be doing about that?

JAN:

So with the toys, what we're trying to suggest is maybe, with the very soft ones, is thinking very carefully about whether we need the soft toys in that area 'cause they're just that little bit harder to clean. Any plastic toys, wherever there's been a good group of kids playing with them, probably wipe them down with, like, a disinfectant wipe between groups of children playing with those particular toys. So, it may mean about removing some toys from the environment that are harder to clean and keeping the toys in the environment. Generally speaking, books, the Coronavirus isn't particularly fabulous at living on paper and cardboard, but plastic, it can survive a little bit longer, so, again, if a group of children's been using a book, wipe it down, the cover, and maybe put that in the book bin for the Monday books. Pull it out again on Wednesday, for example. 24 hours should be enough for the virus to go. So, it can be about just rotating things. So, the Monday things go into a bin, and then they can come out on Wednesday. Tuesday things go into a bin, they come out on Thursday, so it's about rotating things through so we're giving both time and cleaning agents enough time to work. So, it might be about rotating, you know, even some of the toys. You've given them a clean, they should be fine, but, if you're super worried...

MARTIN:

Give them a rest.

JAN:

Give them a rest for a couple of days, pull something else out, and that'll give people some novelty, as well, with what they're doing.

MARTIN:

That's great, that's very practical, thank you. One question people have had is, if a child's parents are health workers, does that present any greater risk of bringing that COVID in from, you know, a hospital environment?

JAN:

So, what we're finding is that, generally speaking, healthcare workers are really aware of what they need to do to protect themselves from COVID-19. As such, children of healthcare workers are no greater risk than children from anywhere else, so it's really important that, particularly if you're providing a service on a hospital campus, because we know many of the services are on hospital campuses, or if you're in a setting where you do provide a lot of care for healthcare workers' children, just remember the children are not the problem usually. So, the healthcare workers will hopefully be keeping their physical distance from you because, one, they don't want to catch it from you, and, two, you can keep your physical distance from a healthcare worker, but please understand that the healthcare workers' children are no greater risk than all the other children in the world, so, and perhaps will be at lesser risk because the healthcare workers, too, will be particularly obsessing about their hand hygiene and protecting themselves and their families.

MARTIN:

Final question. So, imagine I feel unwell or I've got a child who's unwell, and I'm worried I may have COVID or, you know, I'm concerned that I don't want to bring it into work. Who should I get in touch with?

JAN:

So, you can ring your GP, and see if they are doing testing. If your GP's not doing testing, your GP can refer you to a pathology collector, or else you can go into one of the free NSW COVID-19 clinics. Now, that's available for anyone in NSW, doesn't matter about your residential status, doesn't matter about anything else. If you need a COVID-19 test, if you come to one of the NSW Health COVID-19 clinics, that care is completely free for you, so come one, come all, if you have symptoms. So, if you've got a slightly runny nose, scratchy, sore throat, feeling a bit hot and cold, got a bit of a cough, or sometimes people, particularly with asthma, are finding that their asthma's playing up a bit more than usual, that could just be the cold weather. Don't put it down just to the cold weather, go and get a test.

MARTIN:

That's great. Look, thank you very much for your time here today. We've got questions will be up on our website. If you have any concerns or questions about anything, we've also got a phone number you can call us in the department, and we can either help you or refer you to people who can help you. Finally, thanks to Dr Jan for coming in today. It's great to get some practical advice. We know that it's not simple, and there's not just one answer that suits everybody, so we really thank you for making it practical for people so they can actually get about looking after children, so, thank you, everyone.


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