SFMMS Fall Wellness Corner

decades of underfunding of our public school system especially in our must vulnerable communities, most public school students in our country will remain at home for their learning at least through January, if not for this year and possibly more. San Francisco public schools are not planning to attempt to reopen at the present and have not committed to a date or a plan.

We must do what it takes to reopen schools safely and equitably. And we must do it urgently. That means keeping community rates of COVID low, even if that means slowing the opening of non-essential businesses like bars and restaurants. When we prioritize bars over the education of our children, our society is making a bad choice. In order to do this we will need enormous resources, financial and human. This is the time to invest those resources in the

SFMMS Fall Wellness Corner

Jessie Mahoney, MD Chair of SFMMS Physician Wellness Task Force

Mindset Strategies- Psychological

PPE for Physicians

While you are “saving” the world, don't forget to take a moment to savor the world.

Thank you for your contributions to the world during the last 6 months. It has been an unusual time in medicine. I want to encourage you all to take some time to savor your own life experience. Savoring the beauty of your daily life is critical to your resilience and fortitude. Learning to pause and be present and to be mindful and intentional is protective against burnout and helps you reconnect with your passion, your purpose, and your loved ones.

Caring for others, fixing things, and working for change is an integral part of being a healer but we must also not miss out on being, noticing, living, and connecting. When you choose to think that everything is exactly as it should be right here in this moment- all the good and the bad, the covid and the anxiety and the stress- you have much more space, clarity, and energy to simultaneously savor AND save the world. Don’t wait for the circumstances to change to start savoring your life. With intention, start to savor each minute as it is right now and see what happens. future of our children, in the future of our economy, in the future of women, in the future of our city. Parents, teachers, pediatricians and child advocates need to make the largest amount of noise over this. Economists and the financial sector should also be making large amounts of noise over this. Reopening schools is an urgent national priority, for all of us.

Kimberly Newell Green, MD is a pediatrician

and past-president of the SFMMS.

The power is in the pause

"Practice the pause. Pause before judging. Pause before assuming. Pause before accusing. Pause whenever you are about to react harshly and you'll avoid doing and saying things you will regret." -Lori Deschene

Practice the pause.

Learn to be present. Choose to be intentional.

Pause and presence change you for the better. Which changes your experience of everything around you for th better. Who doesn't need this right now.

It’s Possible

It’s possible to go from struggling to managing to living more easefully to feeling passionate, engaged and connected. Even in 2020. Even as a physician in a pandemic.

It’s possible to let go of most of the stress and struggle. To grow. To evolve. To rediscover your passion.

It's possible to become more at peace and connected with loved ones. It's possible to be a more content and effective doctor and colleague.

It's possible to lessen drama. It's possible to stop wasting time

To struggle less. and energy.

To decrease worry. To rewrite your story.

To feel at peace. To make decisions with ease. To find ease. To prioritize.

To connect better. To constrain.

To feel more compassion. To move forward.

To feel more connected to your purpose.

Even in a pandemic. Even with distance learning. Even with partners or colleagues who have their own struggles and aren’t behaving as you think they “should.”

It's possible for relationships to strengthen.

It's possible to start a new career.

To start to feel more content at your job.

To find your passion.

To find your voice.

To be authentically you.

It's possible to feel that everything feels manageable and is working out exactly as it is supposed to even when it isn’t all “good.” How? By mindfully managing your mind.

Attention and Intention

What if you approached your life with intention as your motivation rather than being driven by guilt, anxiety, or a fear of not measuring up. Guilt is limiting. It drains your energy and narrows your vision. Anxiety and feelings of inadequacy lead to burnout, frustration, and ultimately exhaustion and isolation. Intention involves attention. Intention is the process of identifying and choosing the qualities and energy, you wish to bring into the world. Intention comes from a place of abundance. Rather than moving through the world reacting and numb, what would be different if you chose attention and intention?

SFMMS PRINCIPLES FOR THE REOPENING OF SCHOOLS CLOSED DUE TO COVID-19

Background

Re-opening schools safely has become one of the most controversial issues of the COVID-19 pandemic. The question is how to best balance the health and educational needs of students, teachers, parents, and the broader population. As physicians, we believe that such a balance can be obtained via careful, databased procedures and practices. The input of all parties must be obtained and considered in doing so. All of us share the same goals of doing what is best for children, and the San Francisco Marin Medical Society (SFMMS) offers this document of principles in that spirit. It can be difficult to find reliable information about whether and how to reopen schools, as media, policymakers, and organized labor associations issue conflicting statements and guidance. This document is intended to provide clarity on the issue from an evidence-based perspective and with a priority on the health and well-being of children and their communities. SFMMS believes that schools are at least as essential as businesses that have already qualified to resume routine operations and as an

essential service, more needs to be done at all levels of state and local government to ensure robust delivery of safe, in

person school to our communities.

The argument in favor of reopening schools is informed by factors relating to infection/transmission in children, education as a social determinant of health, economic contributions, and the disproportionate effects of school closures on communities of color. •Children are not as susceptible to COVID-19 infection and/or transmission. Data is early but there is generally a consensus that children, as a rule, don’t get as sick, don’t get sick as often, and current evidence suggests that elementary school-aged children (i.e. less than 10) are much less likely to transmit the virus than older youth or adults. •Being in school is arguably the most important health driver in children in the age of COVID-19. Factors include: o Developmental needs: socialization, adults outside of the household. o Children with special health and educational needs: specialized services provided within the school setting. o Health services: health care services provided within the school setting. o Reduction of child abuse: Evidence that child abuse and neglect, which in normal times kills more than

COVID, increases when kids are not out of the house and in times of economic stress. o Education as a social determinant of health: Educational loss and gaps lead directly to future economic stability and success which trends with health status. o Educational instruction: Education is a social determinant of health. Educational loss and gaps lead directly to future economic stability and success which trends with health status. o Social and emotional health: schools provide a stable and secure environment for children to develop social skills and peer relationships. The school environment where children feel safe and connected is associated with less depression and anxiety. o Nutrition: Food insecurity: vital meals served at schools. o Children with special health and educational needs: specialized services provided within the school setting. o Health services: health care services provided within the school setting. o Safety - Reduction of child abuse and decrease in risktaking behaviors: Evidence that child abuse and neglect, which in normal times kills more than COVID, increases when kids are not out of the house and in times of economic stress. In addition, time in school is associated with less sexual activity and substance use. o Physical activity: loss of physical activity associated with school closure can be particularly harmful to children as it is associated with childhood obesity. •Schools are vital for our current and future economic success: o The adult supervision of children provided in schools is vital for economic productivity. This especially impacts women of all professions, including physicians and other staff in the health care setting. Educational losses for this entire generation will have a negative ‘ripple effect’ on our local, state, and national economies far into the future.

o The negative effects of school closures are amplified and worsened for poor and Black and brown children, intensifying the disparities that already exist in our country. Schools in these communities have been historically underfunded and overcrowded and often lack basic materials and services including even soap and paper towels. These are communities in which both adults and children suffer higher rates and worsened outcomes from COVID-19.

SFMMS Principles for the Reopening of In-Person Schools in California

•Reopening schools for in-person instruction when safe is vital for the health of children, families, and the shortand long-term economic health of our communities. For these reasons, schools should be considered at least as essential as those businesses that have already qualified to resume operations. •As an essential service, elected and public health officials should prioritize schools over other types of non-essential businesses when making reopening decisions and allocating funds. •School closures have a negative and disproportionate effect on women and people of color, including but not limited to reduced labor force participation. School attendance is critical to minimizing health and socioeconomic disparities in our society. •Continued use of stringent control methods to lower community transmission rates so that schools can reopen with an acceptable level of safety should be of utmost priority for public health and other elected officials. •Decisions regarding school re-openings should be made based on the best evidence available, recognizing that new evidence will emerge over time. During school reopening, robust surveillance, testing and data collection must be supported in order to prioritize student, staff and community safety and to inform future efforts in keeping educational and childcare institutions open. •School districts will require substantial financial support to reopen safely and we urge public officials to prioritize this in their spending plans. o We urge governments and schools to invest significant resources into making virtual learning as robust and as effective as possible for all students who cannot safely return to school, including ensuring that all students have internet access and access to devices needed to participate in virtual learning. o We recognize that extensive additional targeted resources will need to be put into communities that have been historically underfunded and therefore at risk for increased learning gaps and health and educational disparities, including communities of

Black and brown children, as well as children with special health care needs. o Tactical guidance and engineering controls developed at the local level are essential for schools as they reopen. Local, county, and state policymakers should convene multidisciplinary task forces comprised of experts from the fields of health and education to assist in crafting such guidance. o Adequate types, usage, and quantities of personal protective equipment, including but not limited to

N95 respirator-style masks and sanitizing gels and sprays, are essential to resuming the operations of schools.

Additional considerations:

•We urge officials to support research into educational outcomes with a particular focus on minimizing disparities in educational supports and outcomes. Future decisions and work in both in-person and distance learning should continue with the goal of narrowing disparities while holding high educational expectations and standards for all students. • We urge elected and public health officials to engage in specific and nuanced decision-making when mandating how and when schools can open, and to recognize the following: o Opportunities exist to re-open elementary schools that may not exist for other types of schools because of the low risk of viral infection or transmission by young children. o The risk for opening schools is different across the state and even within counties. Given the importance of reopening schools, decision-makers should use targeted and nuanced metrics to inform recommendations around school openings. Local county task forces to include county superintendents, teachers, public health leaders, physicians, and parents can help guide these openings. o An incremental approach to reopening schools has immense value. Starting at the elementary school level may allow policymakers to test policies in a lower-risk environment; refine the template for reopening; gain operational experience and develop best practices; and gather data to inform future opening decisions. What is learned because of incremental school reopening will benefit and accelerate reopening elsewhere.