iStock/ipopbaBY: DR. ALEXIS E. CARRINGTON, EDEN DAVID, and SONY SALZMAN, ABC News
(NEW YORK) -- Amidst the COVID-19 pandemic, doctors are concerned that the prolonged shutdowns and stay-at-home orders critical in combating the novel coronavirus may have had dire consequences on early cancer diagnosis and treatment.
Now, a new study finds that new diagnoses for six common cancers, including breast and colon cancer, significantly decreased during the peak of the pandemic.
When comparing the number of weekly cancers diagnosed before and during the pandemic, "there was a 46% decrease in diagnosis of the six common cancer types we looked at, which included breast, colorectal, lung, pancreatic, gastric and esophageal cancers,” said Dr. Harvey Kaufman, the study's co-author and director of the health trends research program at Quest Diagnostics.
Researchers observed the weekly counts of first-time tests for patients associated with six cancers at Quest Diagnostics from Jan. 1, 2018, to April 18, 2020. The drop in diagnoses from March to mid-April is consistent with previous reports and are likely a result of the preventative measures taken at the outset of the pandemic to mitigate the spread of COVID-19, including delaying elective procedures and allocating health care resources for treating COVID-19 patients.
In fact, at the beginning of the pandemic, The American Society of Clinical Oncology recommended decreasing clinic visits and postponing cancer screening to "reduce patient contact with health care facilities."
Experts say that the potential consequences of these delayed diagnoses could have negative consequences for patients.
"The decline clearly represents a delay in making the diagnoses and delays matter with cancer," said Dr. Craig Bunnell, chief medical officer of the Dana-Farber Cancer Institute.
According to Kaufman, delays in cancer screening and diagnosis could lead to patients getting treatment at more advanced stages of their disease, which ultimately increases the risk of complications.
"When cancer screenings and resulting cancer diagnoses are postponed, some of these cancers are likely to later be identified at more advanced stages, which will result in poorer outcomes and even increased death rates," he said.
Experts say monitor for symptoms and signs of cancers
While we still continue to combat COVID-19 and adhere to the public health guidance of staying at home as much as possible and practicing social distancing outside, experts say that continuing to monitor for symptoms and signs of different types of cancers should not be overlooked, whether you’re at home or planning to go to the doctor.
"Recommendations for cancer screening depend on a variety of factors, including someone's age, gender, and family and personal history," said Bunnell. "People should consult their doctors, as they normally would, regarding the most appropriate screening tests for them, but they should not defer those tests unless they have first discussed that with their doctors."
He added, “We need to safely perform these diagnostic tests and the public needs to not think of them as optional. Their lives could depend on them."
With hospitals open, it's imperative patients come in for appointments, doctors say.
“Now that hospitals and clinics are reopening, it is important for patients to continue receiving their health screenings and examinations,” said Dr. Marjon Vatanchi, a board-certified dermatologist with the department of dermatology at Brown University.
The only people who may have to push back appointments, she explained, are those who have strict orders from their doctors to stay at home, like high risk populations or people with compromised immune systems.
Be your own health advocate
Doctors also say that you can serve as your own health advocate when it comes to catching cancer early. Even at home you can be on the lookout for any changes in your body that may be early signs of cancer.
Breast cancer: The American College of Obstetrics and Gynecologists and U.S. Preventive Services Task Force recommends that women routinely check their own breasts and notify their doctors about any changes in shape, masses, changes in discharge from the nipples, or redness, which may be signs of breast cancer.
Skin cancer: When it comes to skin cancer, Vatanchi recommends that everyone do their own monthly skin checks. "Americans can do entire body mole checks at home with a family member checking their back. If there is anything suspicious, then immediately call your dermatologist for a skin check and possible biopsy," she said.
Vatanchi also said to be on the lookout for any suspicious skin changes like "moles that are asymmetrical, have abnormal borders, colors beyond a brown monotone, diameter greater than the end of a pencil eraser, and moles that have changed recently."
Make healthy choices: According to the Centers for Disease Control and Prevention, you can also reduce your risk of cancer by making healthy choices like maintaining a healthy diet and weight, avoiding tobacco, limiting the amount of alcohol you drink and protecting your skin. Use the prolonged time at home now to take on healthier habits that you and your whole family will benefit from.
Keep scheduled appointments: These steps, however, do not substitute a visit to the doctor. It is important to keep up with the recommended cancer screenings and routine checkups with your doctor. Due to COVID-19, many doctors now even offer virtual appointments and staying on track with your appointments can be critical in cancer treatment.
"COVID-19 is a serious threat but cancer isn't going anywhere and needs to be caught and treated early," said Dr. Jeffrey Drebin, chair of the department of surgery at Memorial Sloan Kettering Cancer Center.
Alexis E. Carrington, M.D., is a dermatology research fellow at the University of California, Davis in Sacramento, California, and a contributor to the ABC News Medical Unit. Eden David, who studied neuroscience at Columbia University and is matriculating to Icahn School of Medicine at Mount Sinai later this year, is a member of the ABC News Medical Unit.
Contributing physicians Dr. L. Nedda Dastmalchi and Dr. Molly Stout.
Copyright © 2020, ABC Audio. All rights reserved.
Lauren CortezBY: NICOLE PELLETIERE, ABC News
(LITTLE ROCK, Arkansas) -- A doctor who delivered a baby girl 25 years ago has now delivered her newborn son.
Dr. Bryan Cox of Methodist Hospital in San Antonio, Texas, delivered Lauren Cortez on March 23, 1995. Cortez's mom, Isabel Luna, has been his patient for over two decades.
"Lauren came to me as a pregnant lady and she was all excited because her mom loves me, so it was a great situation," Cox, a 33-year practicing OB/GYN told "Good Morning America." "It was fun the whole pregnancy."
Cortez told "GMA" she wanted Cox to be her doctor after her mother spoke so highly of him. All came full-circle when Cox delivered Cortez's son, Logan James, who was born July 26, weighing 6 pounds, 1 ounce.
"Dr. Cox, right when the baby is born, he sings 'Happy Birthday,'" Cortez told "GMA." "The fact that he takes that little time to personalize the birth experience meant a lot to me."
"My mom said he sang 'Happy Birthday' to me, and to my brother who was born in '97," she added.
Cortez posted her story onto Twitter where it was shared over 82,000 times.
25 years later, the doctor who delivered me also delivered our son!! 👶🏻😭 pic.twitter.com/RMgskxGiU2— Lauren Cortez (@_vivalaluna) July 28, 2020
Many of Cox's patients commented on the thread, and others had something in common with Cortez -- their OB/GYNs delivered them, and their children too.
Cortez said she and her husband Peter hope Dr. Cox stays in practice until Logan has children of his own.
Copyright © 2020, ABC Audio. All rights reserved.
ghornephoto/iStockBy the GMA TEAM, ABC News
(NEW YORK) -- One expert says the risk of spread on school busies is low if the right precautions are taken, and that ventilation is key.
School is back in session in some parts of the country, raising major questions about how to transport kids safely to class amid the pandemic.
With 26 million bus-riding students, districts are taking extra precautions to help stop the spread of COVID-19.
A video released by Casey County Schools in Kentucky, shows what a new morning commute might look like for its students.
All students must wear a mask and parents are asked to take their child's temperature before they board the back of the bus. Children are asked to use hand sanitizer as they head to their seats. Once they leave, a team fully disinfects the bus.
Dr. Mary Beth Sexton with Emory University School of Medicine said the risk of spread on buses is low if the right precautions are taken, and ventilation is key.
"The main problem with a bus is that you don't have a lot of circulation," Sexton told "Good Morning America." "There's nothing that happens naturally unless you're in a position where you can open the windows."
The Center for Disease Control and Prevention recommends students wear face coverings and sit one child per row while skipping rows whenever possible.
To achieve that, the National Association for Pupil Transportation said there should be fewer kids on board.
"One of the largest things that's being done is the changing of bell times that will enable school buses to run multiple routes during the day to get students to and from school safely," said Steven Simmons, president of the NAPT.
Some superintendents are encouraging families to avoid the bus altogether if they can, though that may not be an option for working parents.
As more students go back to school amid the COVID-19 crisis, school buses are adapting to keep kids safe during the pandemic. @WhitJohnson has more. https://t.co/v3xKiEi4a7 pic.twitter.com/XWOOkLcgKH
— Good Morning America (@GMA) August 6, 2020
"If they have the ability to transport their children to school, we'd ask them to do so," said Chris Piper, superintendent of Troy City Schools in Ohio.
Another proposal is "walking school buses," which is a pre-pandemic program which could be a big help in Kentucky.
The Department of Education said this model could allow groups of kids who live nearby get to school safely by way of an adult chaperone who would pick up children along the way.
Dr. Jennifer Ashton, chief medical correspondent for ABC News, said when it comes to school transportation, it's about lowering the risk as much as possible.
"It's really about ventilation and distance, so there are viral factors, there are human factors," Ashton said.
"It's not a one-size-fits-all approach," she added. "It will have to depend on what's going on in that area, what's going on in that region, what kind of transmission we're seeing and the individual health and risk factors of those students and the people at those students' homes."
Copyright © 2020, ABC Audio. All rights reserved.
maroke/iStockBy GENEVIEVE SHAW BROWN, ABC News
(NEW YORK) -- With all the uncertainty surrounding going back to school, shopping for supplies seems like a quaint idea from another time.
But school, in one form or another, will resume in the coming weeks, and supplies, whether for remote learning or in-person, will still be required.
"As a parent, I think, 'should I be buying PJs and sweats or back-to-school clothes?' Who knows?" said sixth-grade teacher and mom of four, Kassia Messina.
ABC News' Good Morning America asked several teachers what's on their back-to-school wish lists -- what otherwise unusual items may prove essential for teaching during these trying times?
From special masks to hand sanitizer -- and lots of it -- consider stocking up on these items to get on the good side of your favorite teachers:
Clear face masks
For Laurel Wyatt, a preschool teacher of 4-year-olds in New York City, clear face masks for both teachers and kids are an item she thinks will be useful this coming year.
"It's important for the kids to see my mouth while I teach them letter sounds and to see my expressions throughout the day," she said. "Kids pick up so much from facial cues in addition to spoken word."
And she hopes the kids can have them too.
"Kids rely on social cues from one another," she said. "Peer modeling is also crucial for building language and problem-solving skills."
For schools that require teachers to wear face coverings, wireless microphones are wanted to help keep their voices from being muffled. The Chicago Tribune reported that 300 had been ordered for one school district this fall.
Susan Gianiodis, a teacher in Buffalo, New York, wrote that she has one on order: "I'm nervous that my voice, never very strong, will be hard to hear through the mask."
For kids on an alternate in-person schedule or who are exclusively learning remotely, several school districts are asking every child to have their own headphones.
At Centennial Elementary in Circle Pines, Minnesota, headphones are required for all students up through fifth grade. At Huddleston Elementary School in Peachtree City, Georgia, headphones or earbuds are required depending on the age of the child.
Headphones are important, "especially for kids with lots of background noise at home or for sheer focus, headphones can really help with communication on both sides [for both] student and teacher," said New York City preschool teacher and mom of a middle schooler Brassfield Honores.
This "must-have" back-to-school item was mentioned by nearly every teacher we talked to, but it's going to be almost impossible to find: Clorox wipes. ABC News reported Clorox said fresh supplies may not be available until later in 2021.
In an earnings call earlier this week, Clorox company president and CEO-elect Linda Rendle announced the company might not be able to restock the product in stores until next year.
Every teacher GMA spoke to mentioned hand sanitizer as a must-have item, and even if your school is stocked up, they said there's no harm in having your child take their own.
Messina in her 14th year of teaching in Marlboro, New York, told GMA that "If your child is responsible enough to have it with them, it can't hurt."
Copyright © 2020, ABC Audio. All rights reserved.
smolaw11/iStockBy ELLA TORRES, ABC News
(WAKE FOREST, N.C.) -- Fourth graders at a school in North Carolina have been asked to quarantine for 14 days after a student there tested positive for COVID-19.
The school, a Thales Academy in Wake Forest, said it was notified on Monday that the student became infected after having contact with an infected family member.
The student was asymptomatic and was last at school on Friday. Teachers who were exposed also will be quarantined.
Thales Academy, a network of private non-sectarian community schools with eight locations in North Carolina, made the news last week after Vice President Mike Pence and Secretary of Education Betsy DeVos visited a classroom and applauded the school for reopening.
Pence and DeVos visited a campus in Apex, not Wake Forest.
"We're here today because to open up America, we've got to open up America's schools and Thales Academy is literally in the forefront," Pence said.
Pence also said that the administration was going to make sure schools had the resources to open safely.
"We really do believe that it's in the best interest of our children to be back in the classroom," the vice president added.
Thank you to Mrs. Combs’ 4th Grade Class! We are so proud and happy to see you all back in school! @Thales_Academy has taken careful steps to keep everyone healthy and we are grateful for the countless hours put in to open the academy and get kids back in the classroom! pic.twitter.com/KgtuHLDPt2— Mike Pence (@Mike_Pence) July 29, 2020
Thales welcomed students back July 20. It offered parents two options: fully online or fully in-person, according to ABC Durham affiliate WTVD-TV.
Students had their temperatures taken and completed a medical questionnaire after they were dropped off, according to WTVD. Staff and faculty also reminded students to wear masks.
Because the school network is private, it doesn't have to adhere to North Carolina Gov. Roy Cooper's school reopening guidelines.
Cooper announced in July that schools could reopen with both in-person and remote learning.
He said that schools that choose to reopen should operate in person at no more than 50% capacity and buses at no more than 33%.
The U.S. Centers for Disease Control and Prevention has swayed on national guidance for reopening schools. Originally, the federal agency warned of the risks that come with reopening schools and issued recommendations. But on Thursday, two weeks after President Donald Trump demanded schools reopen, the CDC shifted its tone and released statements about children not being at a high risk of getting seriously ill, though its original guidance still remained on its website.
Copyright © 2020, ABC Audio. All rights reserved.
Dr. Jacqueline Delmont is the chief medical officer of SOMOS, which has expanded from New York City to other cities affected by the coronavirus to provide testing. - (ABC News) By KRISTOFER RIOS, CLAIRE PEDERSEN, DEBORAH KIM and ANTHONY RIVAS, ABC News
(NEW YORK) -- One doctor in Miami started her own COVID-19 testing site while another in New York City partnered with a group of testing sites in order to better treat these underserved populations.
In a predominantly Latino neighborhood in the Bronx, New York, doctors working through the non-profit group SOMOS Community Care have spent months on the frontlines of the coronavirus pandemic.
Now, those same doctors are traveling to other cities around the country that have been seeing surges in new COVID-19 cases in an effort to get free testing to communities of color, which have already been hit disproportionately hard by the virus and face scarcities in access to testing as well.
One of these doctors is Dr. Jacqueline Delmont, chief medical officer of SOMOS, who has been working for free operating a pop-up free testing site in Miami Lakes, Florida for the past two weeks.. The doctor, who is originally from Venezuela and has devoted her career to helping fellow immigrants, said “the moment” they arrived, people were lining up as early as 4 a.m. to get tested.
The pandemic has pushed Delmont to use all the skills she’s learned during her career.
“It’s an unprecedented time. … I’ve been able to use my administrative skills, but my clinical skills, the empathy coming from a family with limited resources, understanding that there are definitely differences in the communities in terms of access to information, to medication, to mobile devices, to appropriate internet,” she said.
Dr. Yomaris Peña, a volunteer with SOMOS, said working at one of the organization’s testing sites is “another mission where I’m helping my Hispanic, my Latinos, my African American family … everyone that is underserved.”
Medical experts have said testing is a key tool in stopping the viral transmission of COVID-19. Yet, an ABC News and FiveThirtyEight review review of U.S. Census data and testing site info throughout the 50 states and the District of Columbia found that in many cities, testing sites in and near predominantly Black and Latino neighborhoods were likely to serve more patients than those in predominantly white neighborhoods. The review also found disparities between richer and poorer neighborhoods, with testing sites scarcer in poorer ones.
It noted “particularly” large disparities in testing access in and around many cities, so called urbanized areas, like San Antonio, Baltimore, Los Angeles and Miami.
“It’s devastating that the communities that need it the most, the communities that have been most affected, the communities that we could have made a greater impact in controlling the pandemic, have not had the access to testing,” Delmont said.
She said it’s “very disheartening” being unable to test many within these communities early because it doesn’t allow them to be proactive in isolating those who become ill. With many people in these communities living with their families -- including elders -- this puts them at risk.
Natalie Choy, 16, recently received a second COVID-19 test two weeks after her first one came back positive. She says her whole family has been sick with the virus, and hopes the second test will give her the all clear.
“My mom, my dad, my little brother and then my two little baby siblings and my grandpa all live with me, and pretty much everyone experienced symptoms, including the babies,” Choy said.
She said it was easier to social distance inside the house when it was just her father who was sick -- he was the first to test positive. Once other people in the family contracted the virus, it became more difficult. “I share a room with my brother, so it wasn’t realistic at all. We really couldn’t do anything at all except wear a mask. We still do.”
With such a large family, the SOMOS testing site has also helped people, who otherwise may not be able to afford testing, have access to the service.
“People who can have the money and the things just to be able to pay for every single test, they have much easier access. … That’s fine, but when it’s five, six or seven people, some people simply can’t afford it.”
Delmont pointed out that some families have other obstacles to receiving these services.
“Many patients have lost their insurance. They fear that they’re going to get a bill. Many of them are undocumented,” she said. “We understand that the federal government is not necessarily covering these tests for undocumented [immigrants].”
Carmen Guerra, an associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, specializes in health disparities. She says that for people who don’t have insurance, “the only other options are to rely on publicly funded means of testing, whether that’s through public health sites in your city or town, or through philanthropic funds.”
SOMOS is one of the organizations around the country that has been there to fill in these gaps. In Houston, Sonia Gomez’s husband had been reluctant to get a test despite their family showing symptoms of the virus.
When they arrived at SOMOS’ Houston site, she said her husband was “very happy that they weren’t asking for any information about … status or papers.”
Gomez said she drove 30 minutes to get to the testing site and that they were taken in quickly by SOMOS doctors -- she said she had tried other places and the wait was about three to four weeks “because the testing sites are very full right now.”
A few days after receiving a test, Gomez tested positive for the virus.
“It was very shocking and scary to know that all of us are tested positive and it’s so dangerous. People are dying. It’s just crazy,” she told ABC News.
SOMOS was co-founded in 2015 by Dr. Ramon Tallaj after he immigrated to the U.S. from the Dominican Republic in the 1990s, and now has over 2,500 doctors who can speak five languages with their patients.
“Our patients are immigrants like us,” he said. “We speak the same language. We know exactly what’s their problem about housing, money, jobs. Then we had to work with them in any way possible.”
When the pandemic first swept through New York City, the Bronx was the epicenter of the epicenter, and SOMOS was there to help -- the organization partnered with New York State to expand to 28 additional sites. As the organization has expanded its efforts to other cities, Tallaj says SOMOS doctors have conducted close to a quarter million tests.
“From the beginning, we’ve been crying to get testing in our community,” Tallaj said. “But we did it ourselves. We put on the line a lot of money … and we want to continue for our own people.”
Copyright © 2020, ABC Audio. All rights reserved.
Courtesy Malone MukwendeBy LARA PRILUCK, ABC News
(NEW YORK) -- Upon arriving at medical school at St. George's, University of London, 20-year-old Malone Mukwende was often taught to look for symptoms that only pertain to white skin.
For instance, Kawasaki disease, which is inflammation of the body's arteries and is mostly found in children, is often associated with a red rash. But as Mukwende, who is originally from Zimbabwe, sat in class, he was disturbed by the fact that a simple red rash was not how the symptom would appear on his own dark skin.
In fact, beyond Kawasaki disease, there were a whole host of images in Mukwende's textbooks and slides in his classes that didn't accurately describe the way symptoms would appear on dark skin.
"When flagging to tutors, it was clear that they didn't know of any other way to describe these conditions," Mukwende said. "And I knew that I had to make a change to that."
Mukwende continued asking questions, but he was often sent to go and look for the answers himself.
"It was clear there was a major gap in the current medical education," he said.
Enter Mind the Gap: A Handbook of Clinical Signs in Black and Brown Skin, a book Mukwende is set to publish along with two lecturers at St. George's: Dr. Peter Tamony, a senior lecturer in clinical skills who also works to improve inclusivity and diversity in medical education, and Margot Turner, a lecturer on diversity in medical education.
The three received a student-staff partnership grant and the project took off. The resource will feature images to help medical workers identify conditions on darker skin, as well as suggested language for them to adopt while describing the symptoms.
"I am excited to see the change in the curriculum and learn medicine to be able to treat a wide range of patients," Mukwende said of his efforts, which have come with their own set of challenges. "Many people rejected the work initially, stating that it is common sense or it is stuff that everybody knows."
"I knew that I had to make a change as I wasn't happy with the way things were currently being taught," he said.
Doctors, and especially doctors of color, have been flagging gaps in medical education for years. It appears now, underscored by the work of Mukwende, that their concerns are gaining a wider audience.
This comes as the world continues to reel from the impact of the coronavirus pandemic, which has shined a spotlight on the ways systemic racism has disproportionately affected health and social inequality of racial and ethnic minority groups. In the United States, Black people are dying at 2.5 times the rate of white people. They're more likely to be working front-line jobs, experience poverty, and, as a result, have the pre-existing medical conditions that lead to more dire outcomes should they contract covid-19. It also comes amid the social and political unrest surrounding the death of George Floyd in police custody.
Dr. Adewole Adamson
Dr. Adewole Adamson, a dermatologist and assistant professor at the University of Texas at Austin Dell Medical School, is passionate about health policy and teaching about health care inequality.
"There have been decades of, particularly, dermatologists of color that have been screaming about this issue and not getting much traction," Adamson said.
Taylor and Kelly's Dermatology for Skin of Color, which Adamson identifies as the premier work on the subject, was first published more than 10 years ago. There have been other established resources for dermatologists and clinicians, as well as organizations such as the Skin of Color Society, that strived to better explain how conditions manifest on dark skin for years as well. Adamson is happy Mukwende is adding to this work.
He still sees a lack of representation in literature he encounters as a specialist, a practicing dermatologist whose focus and expertise is on the skin itself, so he's not surprised Mukwende, too, experienced a lack of representation sitting in his medical school classes.
Ultimately, though, separate handbooks and manuals educating people on what conditions look like on darker skin is not the goal, Adamson said.
"We should be striving for inclusion in the 'main text,'" he said. "Even in the field of dermatology, some of our main textbooks, they have fallen short on that, which tells you just how intractable the problem is."
Dr. Vanessa Grubbs
Dr. Vanessa Grubbs, a nephrologist and associate professor at the University of California, San Francisco, says the issue of racism in kidney care manifests often in the grouping of Black and dark-skinned patients together as a biological group, leading to medical assumptions that don't take into account the care an individual needs.
"It's been 20 years and they've not bothered to try and figure out what Black race really stands for, because in this country there's an assumption that Black people are somehow genetically different than everyone else," she said.
Here, she says, race is used as a genetic marker when it's not one.
"We should be focusing on the differences between people that actually make a difference, like skin color and how rashes look differently on different skin color," Grubbs said.
She recalls a time during her medical training that she was called into the emergency room to see a young patient with dark skin who doctors thought had deep vein thrombosis, or clots in the large blood vessels. She remembers he had raised quarter-sized bumps on his shins and, to her eye, they had a little redness. When she looked at his chest x-ray, she realized he didn't have clots in his leg. He had sarcoid, or an inflammatory disease often affecting the lungs.
She reflects on how early in her career, as a doctor of color, she caught this issue as the doctors around her could not -- largely because they weren't trained to notice the symptoms.
"To me it was like, that's exactly what it is," she said. "But I think the doctors in the ER could not recognize that he had what are classic bumps on your shins, because they couldn't really tell that -- on his dark skin -- that they were red."
She added, "I think about if I didn't have that ability for myself, then his diagnosis would have been completely missed."
LaShyra "Lash" Nolen
LaShyra "Lash" Nolen was named the first Black female class president at Harvard Medical School last September, and she's been using her platform to raise awareness on issues of racial equity and social justice within the institution ever since. An article she wrote on the lack of training medical students receive on detecting Lyme, a flu-like disease carried by deer ticks, on dark skin, was published by the New England Journal of Medicine last month.
On white skin, Lyme typically manifests early in the infection with a bull's-eye shaped red rash. After a student in Nolen's class asked what that rash would look like on darker skin, the professor said it would be more difficult to see. The early stages of Lyme disease cause fever, headache and fatigue, and can be treated with a few weeks of antibiotics. But, if left unnoticed and untreated, the disease can spread to the joints, the heart and the nervous system.
As a public health-focused major in undergrad, Nolen said she studied the toll institutional racism has on the physical body.
"I learned that a lot of the conditions that I saw my family members experience, growing up in these dilapidated communities because of systemic racism, and lack of access to health care and insurance, etc., were the reason that they now suffer from so many preventable diseases," she said. Diseases, she enumerated, such as depression and diabetes.
But she hopes for change, and part of that change takes root in the classroom.
"My goal is that for every person that's graduating from medical school or health professional school to have the tools that they need to serve communities that look like mine," she said. But she recognizes that her work, and the work of Mukwende in London, comes after the work of generations of doctors and health care professionals fighting for awareness.
"I think that Malone and I, we now have the platform. We now have this energy where society is like, 'Oh yeah, we need to do the work of anti-racism,'" she said. This moment in history is amplifying their voices, bringing them to a wider audience than ever before.
"We're in the middle of this awakening, so it's the perfect time to really start to push the envelope," she said. "But I do think it's important for us to recognize that there are scholars who have dedicated their entire careers to doing this work and I think that it's important we uplift that."
Copyright © 2020, ABC Audio. All rights reserved.
Rawf8/iStockBy NICOLE CURTIS and ANGELINE JANE BERNABE, ABC News
(PITTSBURGH) -- With the coronavirus pandemic keeping Americans at home, many have learned how easy it is to develop unhealthy habits like over-snacking or not exercising.
But Joe Mull, a 43-year-old father of three from Pittsburgh, has used his time during quarantine to develop a healthier lifestyle.
"The thing about quarantine is a lot of the distractions were no longer there for me," he told Good Morning America. "The weight just started falling off."
Before the pandemic, Mull said he always had a toxic relationship with food and was on track to have a heart attack by age 50.
"I was miserable. I spent a lot of time being awful. I had no energy," he said. "I started to believe that I didn't have a lot more 'next times' left."
Instead of dwelling on the things that he felt negative about, he changed his mindset and turned to the keto diet to help him shed some weight.
On the keto diet -- with its focus on a low carbohydrate and high fat way of eating -- Mull went from eating a cheeseburger and French fries for lunch to having a salad with avocado and turkey and cheese on a low-carb wrap instead.
"I started on March 9th with a commitment to keto and just took it one day at a time," he said. "I said I’m going to show up today and eat this way. I’m going to be active, and at the end of every day I got to experience that feeling of accomplishment."
"And then when you start stacking days together like that, you get momentum," said Mull.
In a matter of months, he dropped 45 pounds.
"I have to focus on making a small, daily commitment, which is ironic because I make a living speaking about commitment in the workplace," said Mull. "I had to apply the same lessons to myself that I teach managers across the country, which was to focus on making small changes to your routines and your habits that will produce the results that you want."
The hardest part about following the keto diet for Mull has been resisting the foods he has in the house for the rest of his family and instead choosing what he describes as "real foods, whole foods that are low in carbs and low in sugar."
"I’ve got three kids at home under the age of 10 and so we have snacks and treats in the house and so it’s learning how to recognize those urges, pause, walk away and choose something else," he said. "That’s something that will always be a struggle but that I have to just take one day at a time."
Copyright © 2020, ABC Audio. All rights reserved.
CDCBy DR. MOLLY STOUT, ABC News
(NEW YORK) -- The Centers for Disease Control and Prevention issued a call to action to warn of a potential outbreak between the end of this summer and winter of a rare, but potentially lethal disease that affects young children, where seeking medical attention right away could make all the difference.
Acute flaccid myelitis "is a medical emergency that requires immediate recognition and care," urged CDC director Robert Redfield on a conference call with the media Tuesday.
AFM is a rare, rapid onset neurological disease affecting the spinal cord leading to paralysis. Symptoms of AFM include sudden arm or leg weakness, difficulty walking, limb pain, back pain or neck pain. AFM can cause paralysis over the course of hours to days, which may require a ventilator for breathing.
It most commonly affects young children. Parents are being asked to seek medical care immediately if a child develops a sudden arm or leg weakness.
Most children with AFM will have a fever or respiratory illness about six days before weakness occurs. For this reason, AFM has been associated with viruses, and specifically one called Enterovirus D68.
But why some children get AFM and some don't isn't yet clear.
"We've learned a lot, but we have a lot to learn about AFM ... We are working at CDC and collaborating with the NIH on a couple of prospective large studies, which will help us better understand risk factors for AFM," said Redfield.
The CDC began tracking cases of AFM in 2014 and a wave of cases has occurred every other year since then. In 2018, the U.S. experienced the third and largest outbreak of AFM with 238 cases in 42 states between August and November.
The average age was just 5 years old.
At least 98% of those children were hospitalized, and over half were admitted to the intensive care unit, while 20% required a ventilator to breathe.
And while most parents sought medical attention within one day of developing AFM symptoms, a concerning 10% were not hospitalized after four days of weakness.
While many children will recover to their usual state of health after AFM, unfortunately, many kids will have permanent disability.
"Early and aggressive physical therapy and occupational therapy can help strengthen the functioning they will retain and go about their lives with the best functioning possible," said Dr. Thomas Clark, a pediatrician and CDC deputy director of the division of viral diseases.
With the 2020 peak season looming, AFM is a priority for CDC as it prepares for an outbreak this year.
"As a parent and a grandparent my heart goes out to the families affected by AFM," Redfield said.
Parents should look out for any sudden weakness of the arms or legs in addition to pain in these areas, the neck or the back. If your child recently had a viral cold or fever, this should heighten your suspicion for AFM.
Clark urged pediatricians and other health care providers to "consider and properly recognize [AFM], hospitalize immediately, take specimens as soon as possible and report [the case] to local health authorities."
If suspecting AFM, health care providers should order an MRI in order to distinguish AFM from other neurological conditions.
"It's vital that all health care providers maintain a high index of suspicion for AFM in children with acute limb weakness or neck or back pain that develops after an upper respiratory illness from late summer through fall," said Dr. Robert Glatter, an emergency physician at Lenox Hill in New York City.
"We expect that AFM will likely have another peak in 2020. That said, it's still unclear if or how COVID-19's recommended social distancing measures and attention to mask wearing and hand hygiene will impact how much enterovirus we end up seeing, along with cases of AFM," Glatter said.
The same hygiene precautions for COVID-19 apply to viruses that cause AFM.
As some of the symptoms of COVID-19 may overlap with AFM, parents should be on high alert this season.
Non-COVID-19 emergency room visits dropped off sharply in 2020 due to fear of COVID-19. If this trend continues, parents need to know that time is critical and potentially lifesaving with AFM, so even in the age of COVID-19, seek medical attention immediately if your child has sudden numbness in their arms or legs.
"We are concerned in the midst of a COVID-19 pandemic that cases [of AFM] might not be recognized or that parents might be concerned about taking their kids to the doctor," Clark said.
Copyright © 2020, ABC Audio. All rights reserved.
PeopleImages/iStockBy DR. SABINA BERA and DR. ALEXIS E. CARRINGTON, ABC News
(NEW YORK) -- A new study has found that parents can nudge their children to be honest and truthful by using invisible cues.
The study, published in Proceedings of the National Academy of Sciences, found that young children cheated less in class when a transparent frame was set up as a barrier. The researchers of the study tested the "moral barrier hypothesis": the idea that a boundary, even one that does not actually prevent a child from cheating, will cause them to act honestly.
They wanted to know if a "nudge" could encourage a child to be honest. A nudge is a change to the environment that is so small the person doesn't realize it.
An example of a nudge, in an adult situation, is how switching to smaller plates can result in eating less food. Another example is how when fruits are placed attractively in a cafeteria, it can lead to children eating more fruits.
The researchers picked cheating as their test for honest or dishonest behavior. The authors set up a few different scenarios for 5- and 6-year-old children. All kids were given a math test where the first four problems were easy but the last problem was impossible. An answer sheet was left on the desk right next to them and a steel frame with a transparent cover was placed between the two desks. Even though the children could see the answer key next to them, they didn't cheat as often. In fact, this scenario had the least amount of cheating.
In the next scenario, only the steel frame itself was placed between the two desks. There was nothing preventing the children from seeing the answer key. Still, children cheated significantly less compared to when there was nothing at all between the desks.
In another scenario, when a researcher came and waved an imaginary wand between the two desks, that also led to significantly less cheating.
Dr. Kerry-Ann Williams, a child psychiatrist in Boston, was not surprised that waving a magical wand worked for young children. She explained that "this is the age of magical thinking, and so the idea the magical barrier worked" was not shocking. Williams also pointed out that children at that age want to please adults, so they are more likely to follow commands from the examiner.
Although the authors of the study concluded that a real or even imagined boundary could lead to less cheating, experts are still unsure why this happens. One possibility is that humans are all trained to use environmental cues, such as staying on a crosswalk or following a "no trespassing" sign.
"In human-made environments, we are constantly exposed to different types of markers that tell us what we are allowed to do, such [as] social distancing lines and circles that indicate where we are allowed to stand," said Dr. Gail Heyman of the University of California, San Diego's department of psychology, and one of the researchers who conducted the study.
"Because children grow up surrounded by these kinds of markers, they may look for them when they are unsure about what to do," he said. "We believe the presence of these types of markers can cause children to stop and think about the moral implications of their actions."
Katie Romach, a fourth-grade teacher in East Rochester, New York, said that even kids in kindergarten know that cheating is wrong. Although a study carrel (similar to a cubicle) is far from a small nudge, she said it does deter children from cheating.
While there are still many unanswered questions about how the human brain processes spaces and how this affects humans' behavior, the study has gotten experts one step closer to figuring it out.
Does this mean schools should start using transparent barriers to prevent cheating?
"We think it's too early to start recommending this," Heyman said. "This is just the first study on this topic, and it may be that barriers would become ineffective and fade into the background after children get used to them. We also don't know if these kinds of barriers would work for older children, who are probably considering a wider range of factors when they make decisions about whether to cheat."
Williams said, "The design of this study seemed very well-suited for this age group."
In order to test the same experiment in older age groups, she said, "they would have to design a study that is suited for the age group they are testing."
Williams explained that 5 and 6-year-olds can think concretely in terms of right and wrong, but as children age into adulthood, decision making and morality become "a lot more complex."
"A 5-year-old's brain can be very different from a 10-year-old's brain," she said.
"Our study does suggest that we should give some thought to how we structure children's environments to gently push them in the right direction," Heyman concluded.
Copyright © 2020, ABC Audio. All rights reserved.
monkeybusinessimages/iStockBy DR. SABINA BERA, ABC News
(NEW YORK) -- Paula Christodoulides, who is raising her 8-year-old and 10-year-old grandchildren, said being a parent for the second time around hasn't always been easy, but she's determined to do the best she can for them.
"I felt it is a decision I have made to take these children, so I told myself I have to make the best of it," she said.
Grandparents who act as primary caretakers are now facing the difficult choice of sending grandkids back to school amid a pandemic that is far more deadly for older Americans.
"Millions of children who are in the [care] of their grandparents [pose] a greater health risk to their caregivers," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Cohen Children's Medical Center of New York, and one of the authors of the recent study.
And Adesman says the challenges grandparents face proceed our current pandemic. He is the coauthor of a recent study which finds that compared to parents who act as primary caretakers, grandparents are far more likely to be raising children experiencing emotional or medical issues.
The study, published in Pediatrics this week, found children living with grandparent caregivers were more likely to be diagnosed with attention deficit hyperactivity disorder, have a history of adverse childhood experiences or developmental problems, and were more likely to suffer from "poor temperament" -- becoming frustrated or easily angered.
There are myriad reasons grandparents may be caring for children who are more likely to experience these diagnosed medical issues. Adesman and other experts say it's unclear why children experiencing underlying issues like ADHD and poor temperament are far more likely to be raised by grandparents rather than by parents.
But they say the information gleaned by this study can help grandparents and pediatricians alike better arm themselves to take care of children living in grandparent-headed households. And they say their data shows that grandparents are resilient, despite these greater challenges.
The recent study explores in great detail some issues grandparents are facing. Researchers used an existing national survey to compare 2,407 grandparent and 78,239 parent-headed households.
"We found there's a greater number of adverse childhood experiences or psychosocial adversity for children in the grandparent-headed households. On average, those children were five times as likely to experience one or more adverse childhood experiences," Adesman said.
Adverse childhood experiences included "[living] in a home with drugs, a home with individuals with psychiatric illness, [witnessing] domestic violence, or whether the parents were divorced, separated or possibly deceased," he said.
Researchers found school-aged children in grandparent-headed households were almost twice as likely to have ADHD, and preschool children were more than five times as likely to have ADHD.
Children with ADHD may have trouble paying attention, act without thinking things through, or be overly active.
The study suggests ADHD may play an important role in the lives of grandparent caregivers. Although school-aged children were more likely to have poorer temperament, and grandparent caregivers more likely to report greater aggravation, these differences disappeared when children with ADHD were taken out of the picture (roughly 18% of grandparent-headed households). Adesman said this finding is "particularly distinctive," illustrating the "contribution of children with ADHD."
Dr. Anju Hurria, a child psychiatrist at the University of California, Irvine, said, "the article advocates for pediatricians screening for [Adverse Childhood Experiences] (ACEs) and ADHD, especially in grandparent-headed households."
Hurria also added, "Adverse experiences have previously been connected with having difficulties in school, so it makes sense to involve the school when possible for extra support."
There is some positive news, too. Although some grandparents are raising children with poor temperament and ADHD, there was no difference between them and parent-headed households when asked how they saw themselves and the day-to-day demands of parenting.
"Grandparent caregivers felt that they were handling their demands equally well as the parents," said Adesman.
Christodoulides has a grandchild with ADHD and relaxed rules around the house more so than when she raised her own children. For example, she sometimes allows her grandchildren to eat dinner in front of the TV. She said that she feels this change "is much better, because you don't put too much pressure on children." She also found it helpful to keep the kids busy and to be patient with them.
Still, it's clear that grandparents face additional challenges when raising children. Adesman points out 41% of single grandparent caregivers, compared to 31% of single parent caregivers, felt they didn't have somebody they could turn to for day-to-day emotional support.
"Pediatricians, child psychiatrists, and therapists should appreciate the lack of social support for grandparent-headed families and refer to support groups, such as the one the article mentioned," Hurria said.
"The advice I will give to any grandparent is [to give children] hugs and kisses -- you always have to make sure they know they are perfect," said Christodoulides.
Copyright © 2020, ABC Audio. All rights reserved.
ABC NewsBy NICOLE CURTIS and ANGELINE JANE BERNABE, ABC News
(CINCINNATI) -- Single mom Jackie Wilson chose intermittent fasting as her method to lose weight, motivating herself by buying the next size down on her favorite jeans.
While the coronavirus pandemic has put a pause on life for many, one woman has used time in quarantine to restart hers.
When the pandemic first hit, things weren't going great for Jackie Wilson, a single mom from Cincinnati, Ohio, who lost her job and had to juggle homeschooling her son after schools closed.
But instead of dwelling on the negative, she decided to change her mindset and give her health a shot. At 290 pounds, she knew it was time for a change.
"I just kept thinking to myself: 'At some point, my luck is going to run out,'" Wilson told "Good Morning America." "I got fatigued and started to notice that there were health problems creeping up on me."
So, Wilson turned to intermittent fasting, an eating pattern that limits the times of day during which you eat.
Wilson's plan allowed her to eat only between 11 a.m. and 7 p.m., and she added to her diet foods that she hoped would help reduce her risk of type 2 diabetes.
"Making those foods ideally whole and minimally processed -- things that are like fruits and vegetables, whole grains, lean proteins -- go in a way that keeps your blood sugars leveled rather than giving you a spike," said registered dietitian and nutritionist Maya Feller.
It turns out that intermittent fasting worked for Wilson, who was able to drop down to 235 pounds.
"Giving that gift to myself honestly has put me in a better position through quarantine to be there and be a help for my friends and family," said Wilson. "I try really hard to do a gut check every morning. 'What do you have control over? Do you have control over a job offer? Do you have control over whether or not school will come back this year? I have control over the choices that I make in terms of what time I'm going to eat today."
While she's accomplished a lot, Wilson said she's not stopping there. If anything, shedding the weight and changing her eating habits has only motivated her to continue the process.
"Life is uncertain and there's a lot we don't have control over," Wilson said. "It really is about what you choose to do next."
Copyright © 2020, ABC Audio. All rights reserved.
MarianVejcik/iStockBy OLIVIA RUBIN, LAURA ROMERO, KATHERINE FAULDERS and DR. JAY BHATT
(NEW YORK) -- Childhood vaccination rates are still down in at least 20 states, public health officials in those areas told ABC News, a worrying trend that has continued in the days and weeks before children are set to head back to school in parts of the country. The continued decline in pediatric visits comes as parents are fearful about possible infection amid the ongoing coronavirus pandemic.
All of the states reporting decreases relative to prior years say that vaccinations of preventable diseases like the measles, whooping cough and the mumps have begun to rebound after seeing their most drastic decreases in the spring, when the coronavirus pandemic hit hardest in many states and people were not leaving their homes for routine doctor visits.
In May, ABC News contacted public health officials in all 50 states and reported that 20 states across the country were seeing drastic decreases in vaccination rates; every state ABC News spoke to reported the drop. In New York, those rates fell as much as 91% for children over the age of two.
Now, vaccinations are improving, according to officials, but still have not returned to pre-pandemic levels, which experts say is critical to prevent outbreaks of certain diseases at the same time the country is combating the coronavirus. The number of vaccines administered in June in Florida, for example, is still down 25% compared with 2019.
Maryland is looking at a 16% decrease in June, though that is a sharp improvement from the 65% decrease the state reported in May. Wyoming has rebounded from a 42% decrease in April to just a 7% decrease in June, according to a spokesperson for the Department of Health. A spokesperson for the Department of Health in Virginia said the state has not rebounded completely, with pediatric vaccines entered into the Virginia Immunization Information System being only 68% of 2019 numbers as of mid-July.
Potential for 'devastating' outbreaks of other diseases
For this report, ABC News contacted all 50 states and received relevant information from 24 of them. Just four of those states -- Arkansas, Delaware, Connecticut and Massachusetts -- reported that vaccinations had rebounded completely, which shows they are trying to catch up the children who had previously fallen behind, those officials said. Massachusetts even surpassed 2019 levels by 13%.
Dr. Sean O'Leary, vice chair of the American Academy of Pediatrics Committee on Infectious Disease, called the drop in vaccinations “a real problem,” noting that “it sets us up for potential outbreaks of vaccine preventable diseases.”
“With our public health infrastructure already stretched very thin responding to the pandemic, outbreaks of any of these other life-threatening diseases would be devastating," he added.
A public health official in North Dakota echoed those concerns, noting that the state had been notifying parents whose children still needed immunizations before school this fall.
“We have also told the public that immunization requirements for school this fall are still in place and we have no intention to waive or delay requirements,” said Molly Howell, MPH, the assistant director of the Division of Disease Control at the North Dakota Department of Health.
Schools have already reopened in some parts of the country even as some states see the worst of the pandemic, and it took just days before schools began reporting outbreaks of the coronavirus.
Dr. Joan Alker, the executive director of the Center for Children and Families at Georgetown University, said that recent outbreaks of preventable diseases make the trend especially worrisome.
"We already had some problems, some measles outbreaks in the past few years because vaccination rates weren't where they needed to be, so any decline from where we were is not good news," Alker said.
To “catch up” on the missed vaccinations in the spring and summer, current vaccination rates would need to double and remain doubled for at least three months on the East Coast, according to a report by HealthEfficient, a non-profit group that supports community health centers, analyzed immunization data from 19 of those centers on the East Coast. No states ABC News spoke to reported seeing vaccinations increase to these levels, or anywhere near it.
East Coast rates rebounding
The HealthEfficient report also found immunization rates on the East Coast rebounded in June and were nearly at 2019 levels after seeing their lowest point in April, when they were down 43%, only to fall again in July to a decrease of 31%.
In Rhode Island, there was a 50% decrease in vaccine doses administered across the board from March to June 2020, compared with March to June 2019, said Joseph Wendelken, a public information officer with the Rhode Island Department of Health. Rates in North Carolina were down nearly 18% for the month of July.
Officials have acknowledged the trend and pleaded with the public to return to their doctors, with some launching campaigns to try to reverse the trend.
In Washington, D.C. officials did not provide data but told ABC News that child vaccinations are still down. DC Health, the District's Department of Health, has launched a campaign called "Stay on Track!" to encourage parents to vaccinate their children.
“Across the nation and within the District, preventative and chronic disease care visits have decreased amid the COVID-19 pandemic,” said Alison Reeves, a spokesperson for DC Health. “For children, this has resulted in a decrease in pediatric vaccine administrations. DC Health is leading a coordination effort with hospitals, health centers, schools, and health insurers to ensure easy and high access to pediatric immunizations for all District children.”
Pick up a free meal, get a vaccine
Cities like Houston and New Orleans are providing immunizations in drive-throughs and free vaccinations at feeding sites, where students pick up meals in an effort to make child vaccinations more accessible.
“With the rise of COVID-19 cases in New Orleans, we have seen a decline in the number of patients coming in for routine vaccinations,” said New Orleans Mayor LaToya Cantrell on Wednesday. “As flu season approaches, it is even more critical that we ensure that all residents, including our kids, are up to date on their vaccinations. It is vital that we keep our cases of flu subdued as we continue to focus our efforts toward flattening the curve.”
Richmond Mayor Levar Stoney announced a “Don’t Wait, Vaccinate” campaign on Wednesday afternoon "in order to prevent the spread of other infectious diseases and ensure our children stay healthy during this most critical time.”
Copyright © 2020, ABC Audio. All rights reserved.
fstop123/iStockBy GENEVIEVE SHAW BROWN, ABC News
(NEW YORK) -- With so much about school reopenings around the nation still unknown, one thing seems certain: If schools do reopen for in-person learning, many of those same schools will require children to wear masks.
Even if your child has become accustomed to wearing a mask to enter a store or play on the playground, chances are even the most compliant best mask-wearers have yet to wear one for seven hours a day, as they may be expected to in school.
"Parents have asked me this question a lot in recent weeks; their main concern has been, 'Will it cause breathing problems?' And the answer is no," Dr. Edith Bracho-Sanchez, a pediatrician in New York City, told ABC News' Good Morning America.
She has, however, been asking families in her practice to educate the children on not touching their faces while wearing the mask.
"I've suggested they make it a game, pointing out in a playful way when they've touched their face," Bracho-Sanchez said. "I've been saying this because while we absolutely need them to wear their masks, if they're constantly touching their face with dirty hands, they may catch a number of things more easily, not only COVID-19."
GMA consulted with child development experts to get their top tips for what parents can do now -- prior to school resuming -- to best teach their kids about mask-wearing best practices.
Get the right fit
Danielle LoVecchio, executive director of Bridge Kids New York and a Board Certified Behavior Analyst, said you may need to try multiple options before finding the right fit.
If your child has sensory issues, LoVecchio recommends parents "rub the material on the child's hands and then face to ensure comfortability and acclimate to the new texture before requiring them to wear the mask on their face."
And don't forget to get them used to the feeling of pulling on the ears, she said: "This is an uncommon feeling and may seem uncomfortable. You can do this by practicing hanging the mask on the ears before pulling it over their mouth."
Set clear expectations
"It's only fair to your child to set them up for success by communicating clearly what you expect from them in relation to wearing their mask," said Megan Elizabeth Sedlacek, early childhood expert and Head of Product at Batelle Remote Sleep School, adding that predictability and consistency creates a sense of security.
"Just as you would help kids to visualize their day, sit them down and help them to visualize the expectations around mask wearing," she said. "Use a day planner with visuals, or make a custom book, for example, 'Hazel Wears Her Mask' to help them familiarize themselves with how it may look and feel."
Model what you want your kids to imitate
LoVecchio said when you are asking your child to wear a mask, you should wear it along with them.
"Model wearing a mask frequently around the child and wear the mask around the house, " she suggested.
Another idea is to arrange socially distancing playdates to practice wearing the mask and have peer models.
Make it fun
Sedlacek suggested a remote of small-group mask decorating party. Kids can make masks for their stuffed animals or display it in their rooms.
LoVecchio told GMA to have kids help in picking out their own mask so they are more motivated to wear it. Matching with a friend or family, having a favorite character on a mask, using different masks for days of the week and doing other activities are all ways kids will get onboard more quickly.
And photos go a long way: while Sedlacek suggested taking lots of photos of the mask decorating party, LoVecchio said to let kids take selfies with fun filters while wearing the mask.
Start small and stay positive
"Start by having the child wear the mask for short periods of time throughout the day, for example, 1-3 minutes, 10 times a day," LoVecchio told GMA. "Slowly increase the length of time that they keep the mask on for as the child becomes more acclimated."
Increase the time by having sibling contests on who can wear it longer or have them color in a chart for all the minutes they wore the mask all day to earn something special, she also suggested.
"While the child is wearing the mask, pair having the mask on with positive activities. If you only have the child wear the mask during non-preferred activities the mask will become unpreferred as well," LoVecchio said.
Watching TV or an iPad or playing games are all activities that can easily be paired with mask wearing.
"Reinforce the small steps they are taking towards putting the mask on by giving social praise," she said. "Never punish your child for refusing to put a mask on, or for taking the mask off before you tell them to. Keep it positive and try again."
The bottom line
"I think it's hard for parents to imagine their kids doing this right now, but many forget that kids take cues from their friends and their teachers," said Bracho-Sanchez. "I am very hopeful that when they get back to school and look around and see everyone else is wearing masks, they'll go, 'Oh, OK!' and keep it on."
And keep the conversation going.
"Bring [mask wearing] up every now and then, saying things like, 'School is going to be a little different this fall, how are you feeling about that?' I'm finding some kids are scared and anxious, and what scares them is not always what adults think is scaring them," said Bracho-Sanchez.
Sedlacek said patience is key.
"Remember it may not happen overnight: Kids will process the change at varying degrees," she said. "Some may take a month! So don't wait, start sooner rather than later. Even if your child is starting school remotely, ask your teacher at school to have a mask wearing day or an expectation that the kids all wear their masks during the morning meeting or circle time for example. This way, they can get used to the remote version of this process where there is more room for error before they get to school."
Copyright © 2020, ABC Audio. All rights reserved.
ThitareeSarmkasat/iStockBy KATIE KINDELAN, ABC News
(NEW YORK) -- The ketogenic, or keto, diet is one of the well-known diets out there, but a simplified version of the high fat, low carbohydrate diet is gaining in popularity too.
With "lazy keto", the name of the simplified version, people just count their carbohydrates, and skip the detailed counting of macronutrients, or macros -- fats, carbohydrates and proteins.
"People are very interested in keto and have heard success stories about it," said Dawn Jackson Blatner, a New York City-based registered dietitian nutritionist. "And this is the variation that tries to make it more doable for the everyday person."
Here are five things to know about the buzzy way of eating:
1. Lazy keto dieters start by setting a daily carb limit.
Based on the rules of the keto diet, the total number of carbohydrate grams per day should be 5 to 10% of your calories, according to Blatner.
On a 2,000 calorie diet, example, it would be 25 to 50 grams of carbs per day. Carbs on the keto diet are typically counted as net carbs, so total carb grams minus the grams of fiber in a serving.
Most people following a lazy keto diet typically set a limit of 25 to 50 grams of carbs of per day, according to Blatner.
For reference, people following a strict keto diet and counting all of their macros typically aim for a range of 60 to 75% fat, 15 to 30% protein and 5 to 10% carbohydrates, based on total caloric intake, explained Blatner.
2. Lazy keto will not put you into ketosis.
The keto diet is designed to get your body into a state called ketosis whereby your body is so low on carbohydrates, which both make glucose, that it starts burning fat for fuel.
Ketosis also occurs in the body during fasting.
When you are on the lazy keto diet and not counting exactly how much protein and fat you are eating, you may eat too much protein, which will prevent you from going into ketosis, according to Blatner.
"Does that really matter? Not really," she said. "People who are cutting their carbs so dramatically and paying attention so specifically to their diet still end up losing weight and feeling better, but they may just not do it with the actual ketosis."
Blatner recommends just eyeballing protein sizes on the lazy keto diet to make sure the portion is not too much.
"You’re looking for the moderate, palm of hand protein portion sizes," she said.
3. 'Lazy keto' is not the same as 'dirty keto.'
"Lazy [keto] means you’re taking the easy approach to the counting of macros," said Blatner. "Dirty [keto] is when people are eating [high-fat foods] like fast food and bacon and not caring so much about the quality of food."
4. Carbs are still important on the lazy keto diet.
Carbohydrates include not just bread and potato chips but also more nutritious foods like fruits and vegetables, lentils, whole grains, beans and dairy.
"Carbs can do a body good if you choose the right ones," said Blatner. "The good ones can do a lot for your gut health, your immunity, your mood and they can do a lot for disease-free, strong, healthy selves."
People who lower their carb intake need to make sure the carbs they are taking in are the ones that are good for them, like leafy green vegetables and berries and whole grains.
"When you cut carbs so low, if you are not very cautious about how you are spending your carbs, you could wind up with some pretty low nutrition," said Blatner. "So be aware that if you’re going to cut carbs, make sure that you’re spending them on the healthiest carbs that you can be and make sure that you’re adding those nutritious [fruits and vegetables] every day."
5. Lazy keto is a diet that needs to be done carefully, ideally with expert advice.
People should always consult with a healthcare provider before starting a new diet, especially one like the lazy keto diet that drops carb intake so severely for most people and risks changing a person's nutritional intake.
Blatner said she does not recommend the lazy keto diet to her clients. She does though encourage people who bring up the diet themselves, in hopes it will excite them into a wellness change.
"I don’t preach this but if it’s done responsibly and it makes somebody excited and excited to care about what they’re eating, I’m all for it," Blatner said of lazy keto. "And it is true that pretty much everyone should get on the bandwagon that your carbs are too much and we're eating bad versions of [carbs]."
Copyright © 2020, ABC Audio. All rights reserved.