# Welcome to COVID-19 Classroom! ![Graphic by Constance Wu](/files/-M5x4J9BEdA7Hw0R6F9w) During this global pandemic, everyone is facing questions and uncertainty, including children and adolescents. Sifting through all of the available information and resources to navigate these conversations in effective and age-appropriate ways can feel overwhelming for caregivers and teachers who are facing so many shifting responsibilities. As a team of students at Harvard Medical School, we believe it is critical for students of all ages to have access to accurate, engaging, and developmentally-appropriate information about COVID-19 and how it is impacting their lives, as well as resources to help them effectively cope with the stress and anxiety they are likely facing. We have synthesized available information about Coronavirus to craft curricula for elementary, middle, and high school students in formats that are uniquely tailored to each age group’s needs and abilities: * **Elementary** students will be guided through a series of printable coloring pages. * **Middle school** students will explore the science behind viruses and the timeline of COVID-19 through videos, readings, and an interactive worksheet. * **High school and college** students have the opportunity to take part in a virtual case simulation, where they will learn some of the basics of clinical medicine in the context of a patient with COVID-19. All of the materials published have been reviewed by faculty experts in medicine and child psychiatry and development. We have made every effort to ensure that these curricula will provide age-appropriate, accurate, and empowering information for children and teens, but we advise parents and teachers to review materials first to determine their appropriateness for each individual student. Some students may benefit more from a curriculum outside of their own age group based on developmental and educational progress. Please feel free to share these materials with anyone you think may find them useful! We encourage you to fill out our [guest book](https://forms.gle/zYciv2KbbmJmBN2X8) so that we can see how many students access the site. As of September 15, 2021, the curriculum has been accessed by over 5,500 users from 119 different countries! ![](/files/-MRgDjcX6syvqLKiXg1H) These curricula were entirely written and compiled on a volunteer basis by Harvard Medical School students, and nothing contained on this website is an official publication of the institution. Our materials do not constitute medical advice, and are provided solely as an educational resource. Please share your [feedback here](https://forms.gle/VV2QKz6WL2WRQ8Bm6). **The Pediatric Education Team** **Founder:**\ Rachel Reardon (**)** **Managing Editors:** \ Margaret Irwin (****)\ Priya Shah (****) **Young Children Team:**\ Mengting Qiu, Chandler Moore, Toke Odimayomi **Elementary School Team:** \ Chandler Moore, Logan Beyer, Margaret Irwin **Middle School Team:**\ Kendall Carpenter, Priya Shah **High School Team:**\ Jessica Laird, Katie Kester *Students at Harvard Medical School*\ HMS COVID-19 Student Response Team, [Education for Broader Community](https://covidstudentresponse.org/about/) **Current Team:** \ **Managing Editors:** Margaret Irwin, Priya Shah *(see above for contact information)*\ **Curriculum Updates:** Allison Fialkowski, Chandler Moore\ **Ethics Module:** Sienna Li\ **Social Justice Module:** Angela Bi\ **Translations:** Brittany Wong, Yurika Kazama For specific inquiries about a section, additional contact information is provided on the "Start Here" page. # Caregiver/Teacher Guide Supporting your students/children also involves finding reliable resources for yourself and tending to your own well-being. We encourage caregivers and teachers to review these materials. ## **How to Support Kids and Teens Through the Coronavirus Pandemic** **Medical Student Author:** Priya Shah \[1]\ **Student Reviewers:** Rachel Reardon \[1], Chandler Moore \[1], Logan Beyer \[1], Margaret Irwin \[1]\ **Faculty Reviewers:** Gene Beresin, MD \[2], Rachel Conrad, MD \[3], Janis Arnold, MSW, LICSW \[4]\ *\[1] Harvard Medical School, \[2] Massachusetts General Hospital, Department of Psychiatry, Child Psychiatry Service, \[3] Boston Children's Hospital, Department of Psychiatry, \[4] Boston Children’s Hospital, Department of Social Work* This can be a very stressful time for children and caregivers alike. It can be hard to know how to support children during this unprecedented time with a lot of changes to your daily routine. Below are some tips to help you navigate this new situation. ### **General tips:** * Kids often worry when they are kept in the dark. Don’t be afraid to discuss the coronavirus pandemic with your children. Most of them will have already heard of the virus or seen people wearing face masks, so helping your children feel informed can give them reassurance. Start by asking what they know or have heard about the virus, and where they got that information from. This can be a great way to begin the conversation and dispel myths. * Adopt a developmentally appropriate approach. Do your best to elicit and answer your child’s questions, instead of volunteering too much information. It is okay if you do not know the answers; being available to them is what matters. * Do your best to manage your own anxiety. Children can sense when their caregivers are worried, sad, or upset. Try to take some time to calm down before answering your child’s questions or having a conversation with them. Consider introducing your child to techniques such as the [4-7-8 breathing exercise](https://www.youtube.com/watch?v=PmBYdfv5RSk) and practicing them together. * It is also okay to model to children that there is a range of acceptable feelings to have, and that grown-ups and kids can learn how to handle them together. This can be validating and also teach empathy. However, it is important to have this conversation when you as the adult are calm, and your personal anxieties are relatively controlled. The [Coronavirus Anxiety Workbook](https://thewellnesssociety.org/wp-content/uploads/2020/04/Coronavirus-Anxiety-Workbook.pdf) from The Wellness Society can help provide a framework for these discussions. * Be reassuring and focus on what you are doing to stay safe. Explain the precautions you are taking to make kids feel empowered to do their part. Model behavior such as hand washing, coughing or sneezing into your sleeves, avoiding touching your face, and wiping down frequently used surfaces to reinforce these practices. ### **Age-specific tips (adapted from** [**MassGeneral for Children**](https://www.massgeneral.org/children/infectious-diseases/how-to-talk-to-kids-about-coronavirus)**):** * **Infants and toddlers (<3 years)** * Maintain routines to provide a sense of familiarity and security. * They can sense when a caregiver is worried, sad, or upset. Offer more physical comfort and soothing. * **Preschoolers (3-5 years)** * Elicit your child’s questions, and provide brief factual explanations. * Maintain routines and focus on activities that give your child a sense of control. For example, they can count to 20 or sing the ABC’s while they wash their hands. * Encourage normal play and reading. Children may cope with their fears through repetitive play, such as playing doctor and checking on their stuffed animals every day, or using toys to create a hospital helping people. * Let your child know you are there to keep them safe. Offer increased physical comfort and soothing. * **School-age children (6-12 years)** * Give your child the space to explore their feelings and ask questions. Keep answers simple and factual. * Provide reassurance that you and their school are doing what is best to keep them safe. * Supervise television and social media use. Be available to answer questions that arise from seeing information online. * Everyone is managing this pandemic differently, and there are lots of strong opinions. Try to avoid discussing your own opinions about how other grown-ups are reacting in front of your children. This can help encourage compassion for all types of coping and prevent younger kids from developing (and repeating!) judgements. * **Adolescents (13+ years)** * Adolescents (teens and young adults) may be gathering data from a variety of sources, such as school, friends, social media, online websites, and/or television. Some of these sources may not have accurate information. To encourage use of reliable sources, you can share where you yourself find trustworthy information. * Discuss the facts with your child. Focus on listening to your child and their concerns. Explore the emotions that arise as they encounter new pieces of data. **Informational resources for caregivers:** * Centers for Disease Control (CDC) [Fact Sheet](https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf) * COVID-19 Health Literacy Project [Fact Sheets in 30+ Languages](https://covid19healthliteracyproject.com/) * MGH Clay Center for Young Healthy Minds [Coronavirus and Family Mental Health](https://www.mghclaycenter.org/coronavirus-and-family-mental-health/) and [7 Ways to Support Kids and Teens Through the Coronavirus Pandemic](https://www.mghclaycenter.org/hot-topics/7-ways-to-support-kids-and-teens-through-the-coronavirus-pandemic/) * The Wellness Society [Coronavirus Anxiety Workbook](https://thewellnesssociety.org/wp-content/uploads/2020/04/Coronavirus-Anxiety-Workbook.pdf) # More Resource Links The resources provided here are external links to freely accessible materials not created by this Pediatric Education Team. You can find links to content curated for each age group linked on the "Extra Resources" pages, and within the curriculum materials at appropriate points. Here, we're also including links to materials that many age groups can benefit from: ### [Illuminating Mental Health from the MGH Clay Center for Young Healthy Minds](https://www.mghclaycenter.org/illuminating-mental-health/) This home activity guides families to shine light on their feelings through creating art. ### [Trinka and Sam Fighting the Big Virus](https://www.nctsn.org/resources/trinka-and-sam-fighting-the-big-virus) The National Child Trauma Stress Network has authored and published this free story/coloring book for families to download. ### ["Helping Children Cope with Coronavirus and Uncertainty", from the Harvard Graduate School of Education](https://www.gse.harvard.edu/news/uk/20/03/helping-children-cope-coronavirus-and-uncertainty) This video from Richard Weissbourd, a senior lecturer at the Harvard Graduate School of Education, can help caregivers navigate conversations with children. ### **Camp Cope-A-Lot Online** \[Software] Retrieved from [www.CopingCatParents.com](https://urldefense.proofpoint.com/v2/url?u=http-3A__www.CopingCatParents.com\&d=DwMF-g\&c=WO-RGvefibhHBZq3fL85hQ\&r=XqKKuOynfAI9fTQssVMFXMKYXiAQMX0mHeVfLlhZ-H0\&m=4lurTiWIO9HFdsRJbB80PahOSlmeM863rnie_vJk8NI\&s=_5nMsLKA0bXCymPJ8_ybCfIeSMg8qqWQy8RLifDEwD8\&e=). {% file src="/files/-M5Unwwa9\_M1LvdidBsU" %} Coping Cat Clip 1 {% endfile %} {% file src="/files/-M5Uo2xhcm4dG2GRnEt-" %} Coping Cat Clip 2 {% endfile %} These video clips from the Camp Cope-A-Lot online program help children learn how to handle stress and anxiety. ### [Resources to boost your child's wellbeing during the Covid-19 lockdown](https://www.partnershipforchildren.org.uk/what-we-do/childrens-wellbeing-activities-for-teaching-staff-and-families.html) These 10-minute activities from the Partnership for Children (UK) can augment emotional expression and resilience ### ["My Hero is You" - how kids can fight COVID-19!](https://interagencystandingcommittee.org/system/files/2020-04/My%20Hero%20is%20You%2C%20Storybook%20for%20Children%20on%20COVID-19.pdf) This storybook produced by the Inter-Agency Standing Committee of the WHO can inspire children to help prevent the spread of COVID-19 ### [How to explain Coronavirus to a child with anxiety](https://www.additudemag.com/explain-coronavirus-covid-19-anxiety-adhd-child/) This article from ADDitude magazine can be particularly useful for interactions with children who have anxiety or ADD/ADHD. ### Ramona and Iris and the Coronavirus {% file src="/files/-M8BGpt6xPpjzflIn-Ti" %} Written and illustrated by 2 medical students, this is a rhyming picture book for 5-9 year olds designed to teach children the basics of staying safe during the Coronavirus pandemic. ### [Guide to Temporary Homeschooling](https://study.com/academy/popular/guide-to-temporary-homeschooling.html) This guide from study.com provides suggested answers to common questions that may arise for parents and caregivers interested in homeschooling their children this year. ### [Coding for Resilience](https://bootcamp.cvn.columbia.edu/blog/how-coding-provides-skills-that-can-help-children-cope-with-distress/) Columbia Engineering shares information on how coding can provide an outlet for children to cope with stress and develop creativity and critical thinking skills. Links to coding activities for children from preschool to high school are also provided! # Español ## Introduction/**Bienvenidos** [English/Español - Introduction](https://docs.google.com/document/d/1bR5dSBGK0zbZY024zyqf_jIrQDYfUSWgKuAliHrJzm4/edit?usp=sharing) [Español - Bienvenidos](https://docs.google.com/document/d/1TcU9fumsiQSZ2WbX03l5o1gQS3HDTIH1KEIKRIVW45c/edit?usp=sharing) ## Caregiver Guide/Gu**í**a para padres [English/Español - How to support children & teens](https://docs.google.com/document/d/1JOjyYggA6rQwfCd0BDiItFy_O90qJEmMIivEiQh1_KQ/edit?usp=sharing) [Español - Cómo apoyar a niños y adolescentes](https://docs.google.com/document/d/1uTJIkYMvQsH_-E3FjvoMvC5C9p-h6AK-p4SagehosCE/edit?usp=sharing) ## Elementary School/Nivel Primario [English/Español - Elementary curriculum](https://docs.google.com/document/d/1Z_yxOEXw93CS9uIaFeaPHAOKu5-e5CDQgMEt1LvfPDY/edit?usp=sharing) [Español - Estudiantes del nivel primario](https://docs.google.com/document/d/1H7X5uPvAZ0wqp_HgRBk-V_5_ZPN3yawDBb_aF3Xdw3U/edit?usp=sharing) [Libro para colorear - Edades 5-6](https://static1.squarespace.com/static/5e861d9eeb07d628e1155796/t/5f2985b029fd4652dd68d677/1596556725247/Ages+5-6+SPANISH.pdf) [Libro para colorear - Edades 7-8](https://static1.squarespace.com/static/5e861d9eeb07d628e1155796/t/5f29887debde0b7eab85284f/1596557445259/Ages+7-8+SPANISH.pdf) [Libro para colorear - Edades 9-10](https://static1.squarespace.com/static/5e861d9eeb07d628e1155796/t/5f2985f0622253416abe9345/1596556789872/Ages+9-10+SPANISH.pdf) ## Middle School/Nivel Intermedio [English/Español - Middle school curriculum](https://docs.google.com/document/d/1r1oUDoFOtLYkDmvT2FHQRruCYvcu2qcGTK3tv5KXTOQ/edit?usp=sharing) [Español - Estudiantes del nivel intermedio](https://docs.google.com/document/d/1JOw4Q7_GSFSsO92i-aMitD6yLjsPU2E_-fpJcV7UiV4/edit?usp=sharing) [English/Español - Middle school worksheet](https://docs.google.com/document/d/1zFj0l0rkvw_Haxb8aJC-BKgoe3zSs9GgD6lsqVXanKc/edit?usp=sharing) [Español - Hoja de trabajo](https://docs.google.com/document/d/1YbLvgUdI9e1sIuhG9Ck-pv7XMVCwvvcKG_5jiQnYElg/edit?usp=sharing) ## High School & College/Estudiantes Secundarios y Universitarios [English/Español - High School/College Curriculum](https://docs.google.com/document/d/1TWhrD015sI2UrA5bziYDAZ4mUUJhMviFzQ5XiD_lkoQ/edit) [Español - Estudiantes Secundarios y Universitarios](https://docs.google.com/document/d/181AhCENI9cjl2XNn5i8sP3ZzZSamtTMxdETcpNydrHQ/edit) # Français ## Introduction/**Bienvenue** [English/Français - Introduction](https://docs.google.com/document/d/1GRGNZ_9ntXj_zD8nTNkeslYdIEdfkSzhtb_HUgoXjRc/edit?usp=sharing) [Français - Bienvenue](https://docs.google.com/document/d/12tJwduH-KnkImb-QS_xzGidzjF7CkM2vT9q9SqWMrHc/edit?usp=sharing) ## Caregiver Guide/Gu**ide aux parents** [English/Français - Caregiver/parent guide](https://docs.google.com/document/d/12_WqROtXKcB5J9f25pK_uU8wfXXbBX29-rY0Q_U9ni0/edit?usp=sharing) [Français - Guide aux parents](https://docs.google.com/document/d/1oFO0gjya7Zj-QqMQnm_-pqbwQSavydnaeJNIxgLLJV4/edit?usp=sharing) ## Elementary School/École élémentaire [English/Français - Elementary curriculum](https://docs.google.com/document/d/1j3eCdqQPqa0RU-biw9axMw2IGbjZG4arpbddbZ4bCik/edit?usp=sharing) [Français - École élémentaire](https://docs.google.com/document/d/1qdzeL-vBI7e_9g2ii2k9LeLaAogc2gyOF72-5T8pP8o/edit?usp=sharing) ## Middle School/C**ollège** [English/Français - Middle school curriculum](https://docs.google.com/document/d/1GVeN5XqDoqVEGBLMgxw_-Vm0YpOwFRxqNr2Dx5yFXeU/edit?usp=sharing) [Français - Pour les élèves du collège](https://docs.google.com/document/d/1AWQKUGgoj1wZAhGSCjZQ4hyKi7Ec3F17ezlgfUHBMvM/edit?usp=sharing) [English/Français - Middle school worksheet](https://docs.google.com/document/d/1r9-UTbCOk0b2_-af1NLWDiSh1ksqArxKZCg5fAHS-ZE/edit?usp=sharing) [Français - Feuille d’exercices](https://docs.google.com/document/d/1m9MyccE-ek6BaOjC1sP5yxfQ3kk6nS5phK8IlosYoNA/edit?usp=sharing) [English/Français - Safety infographic/Graphique de sécurité](https://docs.google.com/document/d/1Eil0xzr-DYfPTXsEMIgInKZYhYOwLA566nj0wDe7NaM/edit?usp=sharing) ## High School & College/N**iveaux lycée et Université** [English/Français - High School/College Curriculum](https://docs.google.com/document/d/15rWj2cEi8Ufy9OH9-MzDCO3J5ByAD8Mp12v5GSMEQCo/edit?usp=sharing) [Français - Pour lycéen.ne.s et étudiantes universitaires](https://docs.google.com/document/d/1lxlB_5M5NcpuJpZTeOPljjRNWm4mMUQdaPnBxq7W7k8/edit?usp=sharing) # Japanese (日本語) ## Introduction/前書き [English/日本語 – Introduction](https://docs.google.com/document/d/1WRaviThJYdzKdiVovz3-qtyAfkstI6Q3iTlaF9OBPXc/edit?usp=sharing) [日本語 – 前書き](https://docs.google.com/document/d/1zOjRqF-OBHVfrHQRABo7a_RUgZgNDpfSJFZL8T3-B2I/edit?usp=sharing) ## Caregiver guide/保護者用ガイド [English/日本語 – Caregiver Guide](https://docs.google.com/document/d/1PY_lk1QAs291f9PHNL5BLHEvBHYMNp6JqXXBOtX9W-k/edit?usp=sharing) [日本語 – 保護者用ガイド](https://docs.google.com/document/d/1I4dgi47fLJb4XK3faEsLl1Dmn7TWjsC7Xkzr8MsFyjY/edit?usp=sharing) ## Pre-K/就学前 [English/日本語 – Pre-K](https://docs.google.com/document/d/1pNv7v6yN68KT3v73mGl3Nq9w17xKNLtb0yG53RQDUoE/edit?usp=sharing) [日本語 – 就学前](https://docs.google.com/document/d/11bXJ-Llj8j3Fx4eUg4FyhWSYbvM_3q6YzORM8_LQZuY/edit?usp=sharing) ## Elementary School/小学生版 [English/日本語 – Elementary School](https://docs.google.com/document/d/1iL0TxQFafJ6DaTWma2U28aEtQ6_qk3YD2NgrSRy7Yco/edit?usp=sharing) [日本語 – 小学生版](https://docs.google.com/document/d/1ZqKypwRECcAr141RVzwJ2s3dtf-AtkJORDt-nmlS6_o/edit?usp=sharing) ## Middle School/中学生版 [English/日本語 – Middle School](https://docs.google.com/document/d/1faId_5AQOyd7SEsINCrpDCjlScUCcBP4H65LgiwWd_I/edit?usp=sharing) [日本語 – 中学生版](https://docs.google.com/document/d/19OIIxA5NHXKPVjaR6vN5eTuz5g35a2ALkDJSvw9_Bmc/edit?usp=sharing) [English/日本語 – Middle School Worksheet](https://docs.google.com/document/d/1HYZs8hcJmzUrQS7TIV1gkw3op2n8y8F16Hn0tSzuNNk/edit?usp=sharing) [日本語 – 問題プリント](https://docs.google.com/document/d/1o7HqzRsW8Y3rB_Dj1-M2a6cZxUvo24Ci_xmipJvhRtA/edit?usp=sharing) – [Safety Tips/衛生上のアドバイス](https://drive.google.com/file/d/1ZsOOou0ogPwjNx-DMt5RrdS4tzfQB2RW/view?usp=sharing) – [Scientific Method/科学的方法](https://drive.google.com/file/d/12ZgMa6vEbMQCkbvWyW45BR-ppaKHRqQ8/view?usp=sharing) – [Coronavirus Timeline/新型コロナウイルスのタイムライン](https://drive.google.com/file/d/1bNKrOrAGmfKci9yL9QdmGvld_Slgo2LM/view) # \*NEW\* Chinese (中文) Some of these pages have not been faculty-reviewed, but have been posted for your reference. ## Introduction/引言 [English/中文 – Introduction/引言](https://docs.google.com/document/d/1rDJ3QybHHSrdruHrbbYedkrbhWniYFCoecrDigKYPw4/edit?usp=sharing) ## Caregiver Guide/看护人员守则 [English/中文 – Caregiver Guide/看护人员守则](https://docs.google.com/document/d/1_HkzCRvI4DJRY5LGAYINevwFQER-xoS98gI63OVwgfk/edit?usp=sharing) ## Pre-K/幼儿园 [English/中文 – Pre-K/幼儿园](https://docs.google.com/document/d/1cY4Gua51-nqoGYph53uE_XxIieGB7cE8D79FYdLZURo/edit?usp=sharing) ## Elementary School/小学 [English/中文 – Elementary School/小学](https://docs.google.com/document/d/1YEYE2r5O6OOC1TwsebDnHURXY6q7gKrv6FjCH6Zrauk/edit?usp=sharing) ## Middle School/中学 [English/中文 – Middle School/中学](https://docs.google.com/document/d/18oQ82w6lh9NB05zBk8LyzmA-YzOTlaQyTvp-iRwihww/edit?usp=sharing) [English/中文 – Middle School Worksheet/新冠肺炎小课堂练习题](https://docs.google.com/document/d/1pxPwlDSPZ1kyLzZ83XsT0oxf5EaT6QCoGUlCAGMVngg/edit?usp=sharing) Infographics/信息图表: * [1/一](https://docs.google.com/document/d/1duJ5_oma2xgt14rXEw4PTlYfT0FmNK-ai35pGbzJQ1o/edit?usp=sharing) * [2/二](https://docs.google.com/document/d/1O2cx2xU3FGurblblmMGPrn2WY3mwF1jUhgyYDUdXR2I/edit?usp=sharing) * [3/三](https://docs.google.com/document/d/1p6W2lZ_YtIosl1CQC2WQn1JCWSAt5Mmd1Kkf7y5ILXM/edit?usp=sharing) # Ethics in the Time of COVID-19 **Student Author:** Sienna Li \[1]\ **Contact:** \ **Student Reviewers:** Priya Shah \[1], Allison Fialkowski \[1], Margaret Irwin \[1]\ **Faculty Reviewers:** Dr. Louise King \[1] \[2], Dr. Ned Palmer \[1] \[3]\ *\[1] Harvard Medical School, \[2] Brigham and Women's Hospital, \[3] Boston Children’s Hospital* ### **What are ethics?** Ethics are the moral principles that govern a person’s, a community’s, or an organization’s behavior. As a field of study, ethics is a branch of philosophy that examines questions and tries to find logic-based solutions grounded in moral arguments. The COVID-19 pandemic has exposed some important medical, social, and legal issues. While there may be a legal “answer” to these issues, it is important to go above and beyond that to consider what an ethical solution might be–one that takes into account all perspectives and that ensures, to the extent possible, equal and moral treatment of all parties. This pandemic is not the first time in our history when ethical questions have arisen as a result of unprecedented global events. For example, in response to the atrocities committed by the Nazis in World War II, ethical guidelines regarding the treatment of prisoners and human research subjects were reconsidered and a set of principles written and agreed upon by multiple countries. This is known as the Geneva Convention. The HIV/AIDS pandemic in the 1980s brought up questions about whether or not medical professionals should be able to refuse caring for infectious patients out of fear of becoming sick themselves. While ethical analysis dates back to the philosopher Aristotle, our conception of ethics has been under constant revision ever since, resulting in a fluid and rapidly-changing field of study. We’re going to work our way through some important questions that are currently being discussed all over the world. Keep in mind that these are difficult and controversial topics, and they often do not have a clear answer. {% embed url="" %} ### **Do medical professionals have a duty to treat COVID-19 patients, even if it puts them at increased risk of infection?** Medical professionals take many risks as a part of their day-to-day job. These risks include, but are not limited to: * Contracting infectious diseases from patients * Pricking their skin with an infected needle * Threats from patients However, because of the unprecedented and high risk of infection associated with treating COVID-19 patients, many people have asked the question: can doctors refuse to treat a patient solely due to the increased risk to themselves? Importantly, certain groups of people are at higher risk of having serious complications as a result of COVID-19. This includes: 1. Pregnant women 2. Elderly (over 60 years old) 3. Those with an underlying chronic health condition (such as heart failure or diabetes) 4. The immunocompromised (immune system is not working as well as a healthy individual due to a disease or a side effect of a drug, as in cancer treatment) 5. Those with a history of smoking or lung disease (including asthma or exposure to air pollution) In general, many consider it the medical professional’s ethical duty to provide care to COVID-19 patients. By choosing medicine as a career, medical professionals assume and accept the responsibilities of caring for patients, including the risk of contracting an infection. However, it is important to consider situations in which: 1. *Adequate personal protective equipment (PPE) is not available*. Unfortunately, due to scarcity of resources, this was the situation at nearly every hospital in the United States. Thus, while issues of inadequate PPE need to be addressed, they do not absolve medical providers of their duty to provide care as safely as possible. We will talk more about resource allocation later on. 2. *The provider is in one of the high-risk categories mentioned above.* In these cases, medical professionals should use their judgment to assess their individual risk for contracting COVID-19. Stopping or reducing in-person clinical practice may be appropriate, if the risk to an individual’s health is significantly greater than the general population. That being said, medical professionals also have a duty to provide their patients with continuous care, to the best of their ability. A medical provider is required–both legally and ethically–to find an alternative provider to take over their clinical responsibilities before discontinuing care of a patient for any reason. It is within one’s legal and ethical right to resign from a job. However, in most circumstances, medical providers cannot simply refuse to do their job, even for reasons of personal safety. Importantly, doctors are not the only people being asked to risk their health during this pandemic. Nurses and other essential employees (housekeeping, maintenance, dietary staff etc.) are paid much less and often must keep working to support their family or keep their insurance. {% embed url="" %} ### **How do we balance patient rights and confidentiality with effective contact tracing and quarantining?** When a person is diagnosed with COVID-19, it becomes extremely important to identify any people whom they have been in close contact with and to notify the contact that they might be at risk. The national organization Centers for Disease Control and Prevention (CDC) defines a close contact as someone who: 1. Was within 6 feet of someone who has COVID-19 for a total of 15 minutes or more 2. Provided care at home to someone who has COVID-19 3. Had direct physical contact with a COVID-19 patient, including shared eating or drinking utensils 4. Came into contact with respiratory droplets from a COVID-19 patient (from sneezing, coughing, etc.) In addition, the CDC recommends that people who may have been exposed to COVID-19 stay home and monitor their health for 14 days. Quarantining can impose significant burdens–financially, mentally, and socially–on people, but this public health measure is an important and effective method to slow the rapid spread of the virus. While doctors have an ethical duty to maintain patient confidentiality and not disclose a diagnosis without consent, they also have a duty to protect other people who may be at risk of exposure. Medical professionals are legally and ethically required to report transmissible disease. Public agencies, like the CDC, provide standards for when to make these disclosures of confidential patient information by law. Given how deadly and contagious COVID-19 has proven to be, it is in the people’s best interest to keep hospitals and public agencies informed of any COVID-positive patients. This notification will not only help contain spread and reduce the risk of transmission to close contacts but could also help inform which areas we need to dedicate the most resources. {% embed url="" %} ### **How do we decide who gets which resources, especially when they are running out?** Unfortunately, because of the global scale of the current pandemic, necessary resources–such as masks, ventilators, and available hospital beds–have become scarce, and in many communities not everyone has access to them. Even in the U.S., one of the richest countries in the world, hospitals are severely ill-equipped to handle the volume of COVID-19 cases inundating their emergency departments. Additionally, resources have not been distributed equally, with low-income and underserved communities receiving far less than wealthier areas and healthcare systems. This has led to dramatic socioeconomic and racial disparities in incidence and outcomes of COVID-19. Unfortunately, doctors everywhere have been forced to make difficult decisions about which patients get life-saving medical resources and attention. There have been many allocation principles used in the past to distribute resources, including: 1. Lottery system 2. First-come, first-served 3. Sickest first 4. Youngest first 5. Save the most lives 6. Save the most life-years (prognosis) 7. Reward future social usefulness 8. Reward past usefulness (reciprocity) The field of organ transplantation, which involves replacing a missing or damaged organ with one from another person, is one example of when these principles have been combined. There are many more people waiting for an organ transplant then there are healthy, viable organs from donors. Thus, the medical community has had to come up with guidelines for how to decide which patients get organs first. In general, these decisions are made to optimize the survival of the organ recipient, and thus the organ itself. The organ allocation system combines three of the above principles–sickest first, first-come, first served, and prognosis–to rank patients waiting for an organ transplant. Ideally, the patient’s perceived social status or life accomplishments are not taken into account. However, factors such as lack of medical insurance, absence of social support networks, and substance abuse can be disqualifying. While this allocation system has advantages, it is inherently flawed as it is vulnerable to bias and manipulation and discriminates against low-income, disabled and persons of color. A similar framework has been applied to distributing resources during this pandemic. At the beginning of the pandemic, when less was known about the virus, some hospitals began “scoring” COVID-19 patients based on their: 1. Age 2. Health status 3. Other health complications Theoretically, the patients that score the highest are the most in need of resources and medical attention and have the highest chance of surviving if given them. While this may appear to be a relatively unbiased method for ranking patients based on need, there is a critical problem. Patterns of structural and environmental racism and economic injustice throughout our country’s history have led to higher rates of health conditions (such as diabetes, asthma, and heart disease) that could significantly impact long-term survival with COVID-19. Thus, using the scoring criteria above, low-income persons and people of color are statistically less likely to receive life-saving resources. It is important to take into account political and social determinants of health in order to assure equitable allocation of resources. You might ask: what then, is a fair and equitable way to allocate scarce resources? There is a controversial question and does not have a clearly accepted answer. One [paper](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(09\)60137-9/fulltext) suggests a “complete lives system” that prioritizes younger people who have not yet led a complete life, but have a good chance of living one if given resources. This system creates a priority curve on which individuals aged between \~15-40 years are given the most substantial chance, whereas the very young and very old get slightly reduced chances. This is by no means a perfect system, but it prioritizes morally relevant values, resists corruption, and treats life-years as equally valuable to all. Another [paper](https://www.nejm.org/doi/full/10.1056/NEJMp2008300) recommends using clinical “survivability” scores, instead of broad exclusions by demographic category, to determine the patients who are most likely to die without resources but and most likely to survive with them. This system allows for near-term survivability to be determined independently from disability and does not treat a year lived with a disability as inherently less valuable than a year lived without one. {% embed url="" %} ### **Sources** 1. [**https://www.journalacs.org/article/S1072-7515(20)30309-4/pdf**](https://www.journalacs.org/article/S1072-7515\(20\)30309-4/pdf) 2. [**https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html**](https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html) 3. [**https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277007/**](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277007/) 4. [**https://www.slu.edu/medicine/diversity/open-letter.pdf**](https://www.slu.edu/medicine/diversity/open-letter.pdf) 5. [**https://pubmed.ncbi.nlm.nih.gov/32789816/**](https://pubmed.ncbi.nlm.nih.gov/32789816/) 6. [**https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60137-9/fulltext**](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(09\)60137-9/fulltext) 7. [**https://www.nejm.org/doi/full/10.1056/NEJMp2008300**](https://www.nejm.org/doi/full/10.1056/NEJMp2008300) # Parents/Caregivers of Young Children: Start Here **Student Authors:** Mengting Qiu \[1], Chandler Moore \[1], and Toke Odimayomi \[2] **Contact:** **Faculty Reviewers:** Juliana H. Chen, M.D., Child and Adolescent Psychiatrist \[1,3]**,** Rachel Conrad, M.D., Child and Adolescent Psychiatrist \[1,4], Helene Pinches, M.D., Fellow in Developmental Behavioral Pediatrics \[4] **Student Reviewers:** Allison Fialkowski \[1]**,** Margaret Irwin \[1], Katie Kester \[1], Rachel Reardon \[1] *\[1] Harvard Medical School, \[2] Harvard T.H. Chan School of Public Health, \[3] Massachusetts General Hospital and Newton-Wellesley Hospital, \[4] Boston Children’s Hospital* **Education Reviewers:** Donna Fialkowski, M.Ed., Special Education Teacher, Atlanta City Public School System; Jennifer Pitt-Lainsbury, School Administrator, University of Toronto Schools ## Introduction Everyone has been impacted by the COVID-19 pandemic. It can be particularly difficult to take care of a young child while facing numerous other challenges. It is okay if you are not doing everything perfectly “right” during this time. This guide hopes to provide some foundational guidance and links to a variety of resources which you may find useful. It is not meant to offer professional or medical advice. As always, you should reach out to your child’s doctor if you have concerns about your child. Here, you will find [tips for new parents](/young-children-0-5/parents-caregivers-of-young-children-start-here/for-new-parents), suggestions for [managing daily routines](/young-children-0-5/parents-caregivers-of-young-children-start-here/managing-the-day-to-day), ways to [support your child's development](/young-children-0-5/parents-caregivers-of-young-children-start-here/supporting-your-young-childs-development), tips for [stress management and resilience-building](/young-children-0-5/parents-caregivers-of-young-children-start-here/stress-management-and-resiliency-building) for you and your child, ideas for [activities to do together,](/young-children-0-5/parents-caregivers-of-young-children-start-here/activities) and strategies to[ address your child’s questions about COVID-19](/young-children-0-5/parents-caregivers-of-young-children-start-here/what-should-i-tell-my-child-about-covid-19). Every child, every parent/caregiver, and every family is unique. We encourage you to decide for yourself which suggestions best fit your family’s individual needs and what will allow you to parent at your best (even if it’s not “the best”) during this time. Our [References](/young-children-0-5/parents-caregivers-of-young-children-start-here/references) and [Additional Resources](/young-children-0-5/parents-caregivers-of-young-children-start-here/additional-resources) pages list sources consulted (ordered by section and subsection), as well as additional resources you may find helpful.
# For New Parents ## Caring for Your Baby The role of parents during the first few months of their child’s life is to “[protect, nurture, and enjoy](https://supportingchildcaregivers.org/)” their baby. Sometimes, this can feel challenging when your baby is fussy or doesn’t sleep well. One way to soothe an infant is by using the [5 S’s](https://childrensmd.org/browse-by-age-group/newborn-infants/5s-method-soothing-baby/): Swaddling, Side/stomach positioning (for holding, not for sleeping), Shushing, Swinging, and Sucking. These first few months can be exhausting. Finding and enjoying the “magic moments” of connection, playfulness, and pleasure are important during these potentially stressful early months. \ Click [here](https://www.healthychildren.org/English/ages-stages/baby/crying-colic/Pages/Tips-for-Coping-with-a-New-Baby.aspx) for other tips on caring for a newborn during the pandemic from the American Academy of Pediatrics. ## Caring for Yourself Remember that feelings of frustration, loneliness, and exhaustion are common during the first few months of parenting. The cries of your newborn--and maybe even your own tears--do not mean that you are a “bad parent” or “can’t handle things.” Sadness, anxiety, and feeling overwhelmed are normal responses during this significant transition as you juggle incredible demands while struggling with sleep deprivation and other challenges of parenthood. However, the normal stresses of having a newborn can be multiplied by the added challenges of a global pandemic. These struggles can become more difficult when the people you depend on for support aren’t able to visit in person. And because you aren’t able to leave the house as freely, you may feel trapped. “Baby blues” and postpartum depression are both common experiences during the first few months of parenting. It is important to talk about difficult feelings with your friends and family as well as your doctor. Although many people are facing challenges right now, your loved ones want to support you, even virtually. If these feelings don't go away after about 2 weeks or make it hard to care for your baby, you should: * Speak with your baby’s doctor; * Speak with your own doctor; and/or * Call or Text the [PostPartum Support International](https://www.postpartum.net/) HelpLine at 1-800-944-4773 (4PPD). Untreated postpartum depression can hurt you, your baby, and your family. But speaking with a therapist or using medication can help. A list of available resources for new parents can be found [here](https://www.postpartum.net/get-help/help-for-moms/). If you begin to feel that life is not worth living, think about hurting yourself or your baby, or if you see or hear things that aren't there, you should immediately: * Go to the nearest emergency room; * Call the National Suicide Prevention Hotline at 1-800-273-8255 or reach them [online here](https://suicidepreventionlifeline.org/); * Call or text the [HopeLine](https://www.hopeline-nc.org/) at 919-231-4525 or 877-235-4525; and/or * Text the [Crisis Text Line](https://www.crisistextline.org/) by texting HOME to 741741 to connect with a Crisis Counselor. [References](/young-children-0-5/parents-caregivers-of-young-children-start-here/references#for-new-parents) # Managing the Day-to-Day ## **Encouraging Good Behavior** The changes caused by the COVID-19 pandemic can place additional stress on caregivers and children. As a caregiver, you may notice changes in your child’s behavior or find it more difficult to manage your child’s behavior. Below are some helpful tips for using positive discipline to encourage good behavior: * **Your attention is an effective and important parenting tool.** Notice and specifically name your child’s good behavior and give praise for it. When it is safe to do so, ignore bad behavior. Giving attention when your child misbehaves can reinforce poor behavior. * **Use positive reinforcement and rewards as a way to increase good behavior at home.** For example, a child might get a big hug and high five or a sticker for getting along with siblings or staying quiet while mom or dad is having a work meeting. Some other ideas include using special family time, such as a movie night, to reward good behavior. * **Model good behavior yourself.** Be patient and kind, and point out your own positive behaviors as a way for your child to learn by observing. This could include times when you share with others or engage in healthy hygiene behaviors such as handwashing and coughing into elbows. * **Recognize that this time of stress and change may affect your child’s behavior.** These changes might include increased fussiness, frequent tantrums, or experiencing a “regression” to a behavior from the past. For example, a child may wet the bed or want to use a pacifier. These behavior changes can be signs that your child is worried or stressed, and extra patience and affection from you can be very comforting. * **Time-outs can discourage poor behavior.** Time-outs can be an effective way to reinforce a few important household rules, such as not hitting siblings. Designate a specific space in your house for time-outs (e.g. corner of playroom or living room) and use a specific length of time (one minute per year of age up to a total of 5 minutes is a good rule of thumb). For more information about time-outs, click [here](https://www.healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Time-Outs-101.aspx). * **Avoid using punishments such as spanking and harsh language.** These types of punishments do not effectively increase good behavior and instead can increase aggression in children and negatively affect their physical and mental health. For more information on this from the American Academy of Pediatrics, click [here](https://www.healthychildren.org/English/news/Pages/AAP-Updates-Corporal-Punishment-Policy.aspx). * **Know when to ask for help yourself.** Taking care of yourself is a critical part of being able to take care of your child. For more information, please see our section on “[Self-Care for Parents and Caregivers](/young-children-0-5/parents-caregivers-of-young-children-start-here/stress-management-and-resiliency-building#self-care-for-parents-and-caregivers).” ## **Facilitating Interactions Between Children at Home** It is understandably difficult to navigate having multiple children at home at the same time, especially when no one is able to participate in their typical routines and everyone wants your attention. You might find yourself refereeing interactions between your children. Although some sibling rivalry and arguing is normal, there are steps you can take to help your kids interact more positively with each other. Below are some suggestions to support your family. For more tips, click [here](https://theconversation.com/how-to-stay-calm-and-manage-those-family-tensions-during-the-coronavirus-lockdown-137166). * Allow older children to act as “helpers” with younger children. * Try to maintain a routine for your children that includes having them spend designated time together and apart. * Empower your children to help make the rules or plan how they will interact with one another. * Look for ways to prevent difficult situations rather than punishing children after these situations happen. * Encourage your children to identify and name the emotions that are really bothering them, and to use their words to say why they are feeling that way. ## **Working from Home While Caring for Children** During the COVID-19 pandemic, many in-person schools, childcare facilities, and offices have closed, and parents may find themselves struggling to work from home while simultaneously caring for their young children. Here are suggestions to navigate balancing your many priorities: * **Set realistic expectations for your productivity during this time.** It is understandable and expected that your work productivity will fall while you are also caring for children at home. Adjust your expectations and be kind and understanding towards yourself. * **Take your work schedule into account when setting your child’s routine.** If you know you have an important meeting or conference call at a specific time during the day, consider setting aside that time as naptime, quiet time, or screen time for your child. * **If you live with a partner or other trusted adult, work together to create a daily schedule.** Set aside blocks of time where one of you can work without distractions while the other cares for your child(ren), and then switch off. * **For specific tips for infants, toddlers, and preschoolers,** see “[Age-Based Tips to Help Juggle Parenting & Working at Home During COVID-19](https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Tips-to-Juggle-Parenting-and-Working-at-Home-COVID-19.aspx)” from the American Academy of Pediatrics. * **It is ok to temporarily relax limits on screen time for your child,** especially if it gives you the opportunity to get more work done. However, when possible, try to balance screen time with physical activity, and make choices so that screen time is as engaging and educational as possible: * [PBS Kids](https://www.pbs.org/parents) is a great online resource for educational games, TV shows, and apps. They offer a [newsletter](https://www.pbs.org/parents/pbskidsdaily?source=pbsparents) that you can sign up for to receive daily ideas for activities and age-appropriate technology use. ## **Routine** Children thrive on consistency. Establishing a daily routine for your child can provide structure and a sense of order during an otherwise stressful time. A daily routine does not need to be planned minute-by-minute, but can serve as a flexible framework for approaching each day. Once you have decided on a routine, work with your child to make a chart depicting your family’s schedule in pictures or words. Discuss the schedule with the older children and adults who are living in your home so that everyone knows what to expect from each day. Routines will vary based on each family’s needs and the ages of children in the household, but some general tips are below. * Begin the day by waking up at a consistent time, eating breakfast, and getting dressed. * Organize the day around consistent meal and snack times. * Set aside specific time for different types of activities (arts and crafts, naptime, etc.) * Children often have difficulty transitioning between activities. Set a timer at a short interval (1-5 minutes) towards the end of each activity to signal to your child that they will soon need to leave one fun activity to start another. This strategy can help your child mentally prepare before moving on to a new activity. * You can also use a fun song or phrase to indicate that it is time to transition. This can be something from a favorite show or character, or something you make up yourself! * Incorporate physical activity into the daily routine as much as possible. See our section on “[Healthy Physical Activity While Physical Distancing](/young-children-0-5/parents-caregivers-of-young-children-start-here/stress-management-and-resiliency-building#healthy-physical-activity-while-physical-distancing)” for more on physical activity. * Develop a structured approach to bedtime. One suggestion is to follow the [3 B’s of Bedtime](https://healthychildren.org/English/healthy-living/oral-health/Pages/Brush-Book-Bed.aspx): help your child **brush** their teeth, read a **book** together, and put your child to **bed** at around the same time each night. Ensure your child is getting adequate sleep based on [age-specific sleep guidelines](https://healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx). * During these stressful and unusual times, bedtime may be more challenging than normal for your child. Your child may have trouble falling or staying asleep due to worries or stress. Consider offering additional comfort such as a special stuffed animal, or placing a family photo by your child’s bed. [**References**](/young-children-0-5/parents-caregivers-of-young-children-start-here/references#managing-the-day-to-day) # Supporting Your Young Child's Development Children are constantly developing, even during stressful times, and it is important to continue supporting your child in their growth and development to the best of your ability. Below are a few tips and activities to support your child’s development, based on resources from the [Center on the Developing Child at Harvard University](https://developingchild.harvard.edu/). To learn more about child development and COVID-19, see the Center’s [infographic](https://developingchild.harvard.edu/resources/what-is-covid-19-and-how-does-it-relate-to-child-development/). * **“**[**Serve and return**](https://developingchild.harvard.edu/resources/5-steps-for-brain-building-serve-and-return/)**.”** When your young child “serves” up a chance to engage--such as making movements, sounds, facial expressions, or gestures--you can “return” that engagement with attention and encouragement. * “[**Executive function and self-regulation**](https://developingchild.harvard.edu/science/key-concepts/executive-function/).” It is important for children to develop skills in working memory, mental flexibility, and self-control. Skills in these areas help children hold onto and use information they acquire, focus or refocus their attention based on demand, and set priorities and minimize impulsive behavior. Here are links to activities that you can do with your child to facilitate development of these skills based on their age (from a [full activity guide](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Enhancing-and-Practicing-Executive-Function-Skills-with-Children-from-Infancy-to-Adolescence-1.pdf) for children of all ages): * [6-18 months](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-6-to-18-month-olds.pdf) * [18-36 months](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-18-to-36-month-olds.pdf) * [3-5 years](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-3-to-5-year-olds.pdf) Please also see the following section on “[Stress Management and Resiliency-Building](/young-children-0-5/parents-caregivers-of-young-children-start-here/stress-management-and-resiliency-building).” [**References**](/young-children-0-5/parents-caregivers-of-young-children-start-here/references#supporting-your-young-childs-development)
# Stress Management and Resiliency-Building Resilience can be described as “the ability to overcome serious hardship” (“[Resilience](https://developingchild.harvard.edu/science/key-concepts/resilience/)”, Center on the Developing Child at Harvard University). When children have effective coping strategies and positive experiences, they are better able to withstand negative or difficult situations. ## **Self-Care for Parents and Caregivers** The first step to taking good care of your child is to take good care of yourself. You may have heard the saying, “you have to put on your own oxygen mask before you can help others.” This is especially true for parents. Try the tips below based on resources from the [University of Colorado School of Medicine](https://medschool.cuanschutz.edu/psychiatry/covid-19-support) and [Zero to Three](https://www.zerotothree.org/resources/3262-young-children-at-home-during-the-covid-19-outbreak-the-importance-of-self-care) to develop your own personal resilience. * Maintain a daily routine for yourself. * Take regular breaks when possible to exercise, meditate, and regroup. * Pay attention to and acknowledge your feelings. * Adjust your expectations of yourself and practice self-compassion. Now is the time to be more flexible and forgiving of yourself and your parenting. * Focus your time and energy on things that you do have control over instead of things that you don’t have control over. * Spend a few minutes each day thinking about what you are grateful for. * Stay connected. Schedule regular check-ins with friends, family, and/or mental health providers. ## **Supportive Relationships** Supportive relationships are critical to a child’s healthy development. Here are some suggestions of ways that you can reinforce a supportive relationship with your child: * Give your child “[**positive attention**](https://raisingchildren.net.au/guides/first-1000-days/loving-relationships/positive-attention)”: eye contact, smiles, gestures of affection such as a hug or pat on the back, praise for completed tasks, and interest in your child’s daily accomplishments. * If possible, have regular **one-on-one time** with your child. Plan time to spend with your child one-on-one doing an activity of their choosing. This may be drawing, playing a game, or listening to music together--it does not have to be fancy or complex! Even 10 to 15 minutes of uninterrupted attention a few times a week can be significant to your child and can reinforce your loving relationship. * Spend “[**quality time**](https://raisingchildren.net.au/guides/coronavirus-covid-19-guide/coronavirus-physical-distancing-and-family-wellbeing)” with your child while completing day-to-day tasks. For example, share a laugh during bath time, chat while doing housework, or share a snack break. * Help your child **be part of your family’s team**. You can promote a sense of belonging by giving your child the opportunity to contribute to the family. This can include having your child take on simple chores; for example, picking up their toys (2-3 year-olds), or helping sort clothes after they’ve been washed and dried (4-5 year-olds). You can also give your child the opportunity to make some decisions independently (for example, deciding how to organize their clothes or stuffed animals), and participate in family decisions (for example, what activity to do as a family or what to have for dinner). ## **Healthy Physical Activity While Physical Distancing** Engaging in regular physical activity helps improve children’s bone health, fitness, and movement skills. Physical activity has also been shown to improve cognition and reduce depressive symptoms in school-aged children. Below are some guidelines and suggestions for activities (organized by age group) to help encourage your child to stay physically active. Doing activities with your child can help you stay physically active as well! Remember to be safe when supporting your child’s active play and physical activity, and follow your local guidelines on physical distancing. * **Under 1 year:** play on the floor, and be physically active several times a day. Young infants who aren’t yet mobile should have tummy time spread throughout waking times of day. * For more guidance on tummy time, see [here](https://pathways.org/topics-of-development/tummy-time/). * See also “[Activities for babies and toddlers](https://activeforlife.com/activities-for-babies-and-toddlers/)” from Active For Life. * **1-2 years:** target \~3 hours or more of physical activity at any intensity. This can include active play at home and outdoors (when safely possible), spending less time in strollers, and exploring different movements such as walking, jumping, and balancing on one leg. * Here are some activities you can do with your child at home: [play with a ball](https://activeforlife.com/content/uploads/2014/11/AFL_activity_1-2_toddler_ball_play.pdf); climb stairs or onto soft places like a bed or sofa; [peek-a-boo](https://activeforlife.com/content/uploads/2014/11/AFL_activity_1-2_toddler_peek-a-boo.pdf); [enact movements of different animals](https://activeforlife.com/activity/animal-friends_1/); [throw and catch](https://activeforlife.com/activity/basket-catch_30/) (you can do this with a sock ball!); and [picking things up](https://activeforlife.com/activity/picking-up-things_58/) around your home. For more activities, see [here](https://activeforlife.com/activities/) (search by age). * **3-5 years:** target \~3 hours or more of physical activity at various intensities. This can include time for active play, such as walking, running, skipping, hopping, riding a bicycle/tricycle, and jumping (when possible with physical distancing). * Here are some activities you can do with your child at home: games with [sock balls](https://activeforlife.com/6-active-games-kids-can-play-with-a-pair-of-socks/) like soccer, bowling, and catch; play with a [balloon](https://activeforlife.com/activity/balloon-juggling_39/); [copy or mirror](https://activeforlife.com/activity/mirror-mirror_2/) movements; have a family dance party; and have your child help with things like picking up toys or even folding laundry with you. For more activities, see [here](https://activeforlife.com/activities/) (search by age). ## **Staying Socially Connected While Physical Distancing** Staying socially connected during this time of physical distancing is crucial for the well-being of children and adults. Here are some suggestions for ways to stay connected: * Connect with physically distant family members virtually with any platform and encourage your child to participate. * From a safe distance, wave hello or say something nice to neighbors and passers-by. * Make a positive sign together as a family and hang it in your window. * Help your child make cards for or write something to friends and family. ## **Managing Your Child’s Emotions During Uncertainty** Right now, you may find it difficult to know how to help your child navigate their experiences. Below are some tips to help your child (and maybe even you!) process uncomfortable emotions and uncertainty. (Visit the [University of Michigan](https://storage.trailstowellness.org/trails-2/covid-19-resources/tips-for-supporting-student-wellness-during-covid-19-with-mi-and-national-resources.pdf) or [NASP](https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/helping-children-cope-with-changes-resulting-from-covid-19) for more information.) * **Acknowledge** that your child, no matter how young, may feel some of the stress of the COVID-19 pandemic and all of the changes that come with it. This does not mean that you have not done your best to support and protect them. * **Recognize** how young children may react to stress. Young children may have difficulty separating from trusted caregivers, may cry more often, or may have difficulty sleeping. They may also show signs of regression, such as bed wetting in a child who is already potty trained. * Help your child 1) express their **thoughts, feelings, and worries;** 2) **explore** their thoughts and consider what is true and not true; and 3) come up with **new thoughts** that are true but also less worrisome. As much as possible, allow your child to express their thoughts and feelings, and validate their concerns. Then, help them focus on positive thoughts and gratitude. See our section on “[What should I tell my child about COVID-19?](/young-children-0-5/parents-caregivers-of-young-children-start-here/what-should-i-tell-my-child-about-covid-19)” for tips on how to have conversations about the COVID-19 pandemic with your child. [**References**](/young-children-0-5/parents-caregivers-of-young-children-start-here/references#stress-management-and-resiliency-building)
# Activities Looking for ways for your child to stay busy and engaged while staying at home? See below for some examples of age-appropriate activities you can do with your child. Remember to be creative, stay flexible and safe, and have fun! The Center on the Developing Child at Harvard University has also compiled a list of resources with ideas for activities [here](https://developingchild.harvard.edu/resources/covid-19-resources/). \ 1\. **Phone call or video chat with family members or friends**. This is a great time to reinforce your child’s relationships with grandparents, cousins, and friends. 2\. **Try a new recipe with your child**, or let them help you plan meals for the week by looking through the refrigerator and pantry together. 3\. **Go on a treasure hunt** around the neighborhood or in your own house or backyard. Give your child a basket or bucket to collect leaves, rocks, or objects around your home. This is a great way to help your child develop motor skills while also getting some fresh air if possible. 4\. **Color!** Our website includes coloring pages (linked at the top of [this page](https://kids.covidstudentresponse.org/grades-1-3)) that depict healthy hygiene habits and basic information about coronavirus for kids. While the coloring books were designed for children in Grades 1-3, you may find them age-appropriate for your preschoolers or older toddlers. 5\. **Build a fort or obstacle course** in a safe place in the home using soft objects such as blankets and cushions. Remember to supervise your child to prevent injuries. 6\. **Listen to an audio story.** Right now, Audible is offering [free audio stories](https://stories.audible.com/start-listen) for kids up to age 18. The stories are available in multiple languages including English, Spanish, French, Japanese, German, and Italian. 7\. **Create a Spirit Week for your household.** Choose themes for each day of the week. Some examples include pajama day, jersey/sports day, crazy socks day, superhero day, and favorite animal day. Have fun with this! 8\. **Build a masking tape racetrack** by using masking tape to create “traffic lanes” on your floor or carpet. Your child can guide toy cars along the tracks all throughout the room or house. See [here](https://kidsactivitiesblog.com/17823/build-a-track/) for an example. 9\. **Engage in water play** **at the kitchen sink or in the bathtub** using toys or household objects of different sizes like sponges, cups, and buckets. You can also use things like empty (and cleaned) milk jugs and yogurt containers! 10\. **Combine dress-up and story time.** Have your child create their own costume using items around the house such as hats, scarves, belts, or other old clothing items. Then, have your child make up a story to go along with the costume and practice acting the story out. 11\. **Practice gratitude through art.** Color and cut out paper hearts, and tape them to your doors or windows to show support for frontline workers during the COVID-19 pandemic. This could be a great opportunity to talk with your child about the many groups of people who are working to keep them safe during this time. Check out this [news story](https://www.wwlp.com/news/photo-galleries/hearts-on-doors-windows-show-support-for-local-healthcare-workers-during-coronavirus-fight/) for examples from a project called “Hearts for Healthcare Workers.” 12\. **Create a family marching band** using bells, whistles, and household objects like pans and spoons. Let your child lead the marching band around your home as you make music together. 13\. **Open a pretend restaurant together**. Make food items (like pizza, cookies, or fruits) out of materials you have available, such as playdough or even food drawn onto paper, and have your child “serve” the food to dolls or stuffed animals in your pretend restaurant. 14\. **Go on virtual tours** to learn about new places. Consider these virtual tours of the Metropolitan Museum of Art ([MetKids](https://www.metmuseum.org/art/online-features/metkids/)), the [Smithsonian National Museum of Natural History](https://naturalhistory.si.edu/visit/virtual-tour), and [Yellowstone National Park](https://www.nps.gov/yell/learn/photosmultimedia/virtualtours.htm?fbclid=IwAR0Rp_oZPGrLXssyopv4KFYPH9z4QTL7Utg5XJMYmx5Ggu3Gznnfjt7keeo) as some starting points. For a more complete list of virtual art museums, click [here.](https://artsandculture.google.com/partner?hl=en\&tab=pop) 15\. **See our “**[**Healthy Physical Activity While Physical Distancing**](/young-children-0-5/parents-caregivers-of-young-children-start-here/stress-management-and-resiliency-building#healthy-physical-activity-while-physical-distancing)**”** section for more ideas on physically active fun.
[**References**](/young-children-0-5/parents-caregivers-of-young-children-start-here/references#activities) # What should I tell my child about COVID-19? It’s less about what you say and more about how you say it. What you tell your child will depend on your child’s age and stage, their specific questions, and what they already know about COVID-19. Below are some tips for speaking with your child. For more information, see this [COVID-19 Caregiver/Teacher Guide](https://kids.covidstudentresponse.org/caregiver-guide). * Let your child’s questions guide your answers. Try to make sure you know what they are really asking--don’t assume! * Be honest, but--especially with young children--don’t provide unnecessary information or too many confusing details. * Give simple, brief explanations. * Provide lots of reassurance and highlight the ways that your family is staying safe. * Highlight actionable ways your child can make positive contributions, such as through hand washing, calling a loved one, completing chores, and modeling good behavior to siblings. * Here is an [infographic](https://covid19healthliteracyproject.com/#english) about COVID-19 designed for 3-6 year-olds: ![](/files/-MAacR8CQuLgaWhNENm-) [**References**](/young-children-0-5/parents-caregivers-of-young-children-start-here/references#what-should-i-tell-my-child-about-covid-19) # Additional Resources The resources provided here are external links to freely accessible materials not created by this Pediatric Education Team. The Center on the Developing Child at Harvard University has compiled a list of alphabetized [resources](https://developingchild.harvard.edu/resources/covid-19-resources/) for parents and children. Here are more resources you may find helpful: * [Action for Happiness 30-Day Coping Calendar](https://www.actionforhappiness.org/coping-calendar?fbclid=IwAR3pqh90uwRXfXp8OyIr9gK2fbByPMJ1omMxdL4LOZrlfW9yzcDVRQDZ5x0) * [Sesame Street](https://www.sesamestreet.org/caring) resources * “[How to Explain Social Distancing to Kids](https://www.youtube.com/watch?v=2HTA3ql6uWY)” video * The [Fussy Baby Network](https://www.erikson.edu/fussy-baby-network/) * The [Meal Train](https://www.mealtrain.com/) * Some COVID-19 resources from children’s hospitals: * [Boston Children’s Hospital](http://www.childrenshospital.org/conditions-and-treatments/conditions/c/coronavirus) in Boston, MA * [AboutKidsHealth](https://www.aboutkidshealth.ca/COVID-19) at The Hospital for Sick Children in Toronto, Canada \ You may also find our website’s page with [external resources](https://kids.covidstudentresponse.org/resource-links) helpful. Note that this page contains resources for children of varying ages. # References Sources consulted are ordered by section and subsection. ## **For New Parents** **Caring for Your Baby** * [**https://www.healthychildren.org/English/ages-stages/baby/crying-colic/Pages/Tips-for-Coping-with-a-New-Baby.aspx**](https://www.healthychildren.org/English/ages-stages/baby/crying-colic/Pages/Tips-for-Coping-with-a-New-Baby.aspx) * [**https://www.arnoldpalmerhospital.com/content-hub/soothing-your-baby-after-shots-with-the-5-ss**](https://www.arnoldpalmerhospital.com/content-hub/soothing-your-baby-after-shots-with-the-5-ss) * [**https://supportingchildcaregivers.org/**](https://supportingchildcaregivers.org/) * [**https://supportingchildcaregivers.org/resources**](https://supportingchildcaregivers.org/resources) * [**https://childrensmd.org/browse-by-age-group/newborn-infants/5s-method-soothing-baby/**](https://childrensmd.org/browse-by-age-group/newborn-infants/5s-method-soothing-baby/) **Caring for Yourself** * [**https://www.postpartum.net/**](https://www.postpartum.net/) * [**https://suicidepreventionlifeline.org/**](https://suicidepreventionlifeline.org/) * [**https://www.hopeline-nc.org/**](https://www.hopeline-nc.org/) * [**https://www.crisistextline.org/**](https://www.crisistextline.org/) * [**https://www.postpartum.net/get-help/help-for-moms/**](https://www.postpartum.net/get-help/help-for-moms/) * [**https://www.healthychildren.org/English/ages-stages/baby/crying-colic/Pages/Tips-for-Coping-with-a-New-Baby.aspx**](https://www.healthychildren.org/English/ages-stages/baby/crying-colic/Pages/Tips-for-Coping-with-a-New-Baby.aspx) ## **Managing the Day-to-Day** **Encouraging Good Behavior** * [**https://pediatrics.aappublications.org/content/142/6/e20183112**](https://pediatrics.aappublications.org/content/142/6/e20183112) * [**https://services.aap.org/en/news-room/news-releases/aap/2020/the-american-academy-of-pediatrics-advises-parents-experiencing-stress-over-covid-19/**](https://services.aap.org/en/news-room/news-releases/aap/2020/the-american-academy-of-pediatrics-advises-parents-experiencing-stress-over-covid-19/) * [**https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/How-to-Shape-Manage-Young-Child-Behavior.aspx**](https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/How-to-Shape-Manage-Young-Child-Behavior.aspx) * [**https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Disciplining-Your-Child.aspx**](https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Disciplining-Your-Child.aspx) * [**https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Positive-Parenting-and-COVID-19\_10-Tips.aspx**](https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Positive-Parenting-and-COVID-19_10-Tips.aspx) * [**https://www.healthychildren.org/English/news/Pages/AAP-Updates-Corporal-Punishment-Policy.aspx**](https://www.healthychildren.org/English/news/Pages/AAP-Updates-Corporal-Punishment-Policy.aspx) * [**https://www.triplep-parenting.com/us/hot-parenting-topics/parenting-during-covid-19/?cdsid=n5oi3eih5o134dghdtk2li6j34**](https://www.triplep-parenting.com/us/hot-parenting-topics/parenting-during-covid-19/?cdsid=n5oi3eih5o134dghdtk2li6j34) * [**https://www.healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Time-Outs-101.aspx**](https://www.healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Time-Outs-101.aspx) **Facilitating Interactions Between Children at Home** * [**https://theconversation.com/how-to-stay-calm-and-manage-those-family-tensions-during-the-coronavirus-lockdown-137166**](https://theconversation.com/how-to-stay-calm-and-manage-those-family-tensions-during-the-coronavirus-lockdown-137166) **Working from Home While Caring for Children** * [**https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Working-and-Learning-from-Home-During-the-COVID-19-Outbreak.aspx**](https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Working-and-Learning-from-Home-During-the-COVID-19-Outbreak.aspx) * [**https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Tips-to-Juggle-Parenting-and-Working-at-Home-COVID-19.aspx**](https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Tips-to-Juggle-Parenting-and-Working-at-Home-COVID-19.aspx) * [**https://www.yalemedicine.org/stories/8-tips-work-at-home-with-kids-covid-19/**](https://www.yalemedicine.org/stories/8-tips-work-at-home-with-kids-covid-19/) * [**https://www.pbs.org/parents**](https://www.pbs.org/parents) * [**https://www.pbs.org/parents/newsletter**](https://www.pbs.org/parents/newsletter) **Routine** * [**https://healthychildren.org/English/healthy-living/oral-health/Pages/Brush-Book-Bed.aspx**](https://healthychildren.org/English/healthy-living/oral-health/Pages/Brush-Book-Bed.aspx) * [**https://dey.org/wp-content/uploads/2020/04/Guidance-FINAL.pdf**](https://dey.org/wp-content/uploads/2020/04/Guidance-FINAL.pdf) * [**https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Tips-to-Juggle-Parenting-and-Working-at-Home-COVID-19.aspx**](https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Tips-to-Juggle-Parenting-and-Working-at-Home-COVID-19.aspx) * [**https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Working-and-Learning-from-Home-During-the-COVID-19-Outbreak.aspx**](https://healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Working-and-Learning-from-Home-During-the-COVID-19-Outbreak.aspx) * [**https://healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx**](https://healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx) * [**https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Positive-Parenting-and-COVID-19\_10-Tips.aspx**](https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Positive-Parenting-and-COVID-19_10-Tips.aspx) * [**https://www.firstthingsfirst.org/first-things/parenting-in-the-time-of-coronavirus/**](https://www.firstthingsfirst.org/first-things/parenting-in-the-time-of-coronavirus/) ## **Supporting Your Young Child’s Development** * **From the Center on the Developing Child at Harvard University (**[**https://developingchild.harvard.edu/**](https://developingchild.harvard.edu/)**):** * [**https://developingchild.harvard.edu/resources/what-is-covid-19-and-how-does-it-relate-to-child-development/**](https://developingchild.harvard.edu/resources/what-is-covid-19-and-how-does-it-relate-to-child-development/) * [**https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Enhancing-and-Practicing-Executive-Function-Skills-with-Children-from-Infancy-to-Adolescence-1.pdf**](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Enhancing-and-Practicing-Executive-Function-Skills-with-Children-from-Infancy-to-Adolescence-1.pdf) * [**https://developingchild.harvard.edu/resources/5-steps-for-brain-building-serve-and-return/**](https://developingchild.harvard.edu/resources/5-steps-for-brain-building-serve-and-return/) * [**https://developingchild.harvard.edu/science/key-concepts/executive-function/**](https://developingchild.harvard.edu/science/key-concepts/executive-function/) * [**https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-6-to-18-month-olds.pdf**](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-6-to-18-month-olds.pdf) * [**https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-18-to-36-month-olds.pdf**](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-18-to-36-month-olds.pdf) * [**https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-3-to-5-year-olds.pd**](https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Executive-Function-Activities-for-3-to-5-year-olds.pdf) ## **Stress Management and Resiliency-Building** * [**https://developingchild.harvard.edu/science/key-concepts/resilience/**](https://developingchild.harvard.edu/science/key-concepts/resilience/) **(Center on the Developing Child at Harvard University)** **Self-Care for Parents and Caregivers** * [**https://medschool.cuanschutz.edu/psychiatry/covid-19-support**](https://medschool.cuanschutz.edu/psychiatry/covid-19-support) * [**https://www.zerotothree.org/resources/3262-young-children-at-home-during-the-covid-19-outbreak-the-importance-of-self-care**](https://www.zerotothree.org/resources/3262-young-children-at-home-during-the-covid-19-outbreak-the-importance-of-self-care) **Supportive Relationships** * **National Scientific Council on the Developing Child (2004). Young Children Develop in an Environment of Relationships: Working Paper No. 1. Retrieved from** [**www.developingchild.harvard.edu**](http://www.developingchild.harvard.edu/)**.** * [**https://developingchild.harvard.edu/resources/wp1/**](https://developingchild.harvard.edu/resources/wp1/) **(Center on the Developing Child at Harvard University)** * [**https://raisingchildren.net.au/guides/coronavirus-covid-19-guide/coronavirus-physical-distancing-and-family-wellbeing**](https://raisingchildren.net.au/guides/coronavirus-covid-19-guide/coronavirus-physical-distancing-and-family-wellbeing) * [**https://raisingchildren.net.au/guides/first-1000-days/loving-relationships/positive-attention**](https://raisingchildren.net.au/guides/first-1000-days/loving-relationships/positive-attention) * [**https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Positive-Parenting-and-COVID-19\_10-Tips.aspx**](https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Positive-Parenting-and-COVID-19_10-Tips.aspx) * [**https://raisingchildren.net.au/grown-ups/family-life/rules-chores-pocket-money/chores-for-children**](https://raisingchildren.net.au/grown-ups/family-life/rules-chores-pocket-money/chores-for-children) * [**https://raisingchildren.net.au/grown-ups/family-life/routines-rituals-relationships/good-family-relationships**](https://raisingchildren.net.au/grown-ups/family-life/routines-rituals-relationships/good-family-relationships) #### **Healthy Physical Activity While Physical Distancing** * [**https://www.healthychildren.org/English/ages-stages/toddler/fitness/Pages/default.aspx**](https://www.healthychildren.org/English/ages-stages/toddler/fitness/Pages/default.aspx) * [**https://www.healthychildren.org/English/ages-stages/toddler/fitness/Pages/The-Active-Toddler.aspx**](https://www.healthychildren.org/English/ages-stages/toddler/fitness/Pages/The-Active-Toddler.aspx) * [**https://www.healthychildren.org/English/ages-stages/toddler/fitness/Pages/Caution-Children-at-Play.aspx**](https://www.healthychildren.org/English/ages-stages/toddler/fitness/Pages/Caution-Children-at-Play.aspx) * [**https://health.gov/sites/default/files/2019-09/Physical\_Activity\_Guidelines\_2nd\_edition.pdf**](https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf) * [**https://www.aboutkidshealth.ca/Article?contentid=642\&language=English\&hub=COVID-19**](https://www.aboutkidshealth.ca/Article?contentid=642\&language=English\&hub=COVID-19) * [**https://csepguidelines.ca/early-years-0-4/**](https://csepguidelines.ca/early-years-0-4/) * [**https://pathways.org/topics-of-development/tummy-time/**](https://pathways.org/topics-of-development/tummy-time/) * **Sources for Activity Ideas:** * [**https://activeforlife.com/activities/**](https://activeforlife.com/activities/) * [**https://activeforlife.com/activities-for-babies-and-toddlers/**](https://activeforlife.com/activities-for-babies-and-toddlers/) * [**https://activeforlife.com/content/uploads/2014/11/AFL\_activity\_1-2\_toddler\_ball\_play.pdf**](https://activeforlife.com/content/uploads/2014/11/AFL_activity_1-2_toddler_ball_play.pdf) * [**https://activeforlife.com/content/uploads/2014/11/AFL\_activity\_1-2\_toddler\_climbing.pdf**](https://activeforlife.com/content/uploads/2014/11/AFL_activity_1-2_toddler_climbing.pdf) * [**https://activeforlife.com/content/uploads/2014/11/AFL\_activity\_1-2\_toddler\_peek-a-boo.pdf**](https://activeforlife.com/content/uploads/2014/11/AFL_activity_1-2_toddler_peek-a-boo.pdf) * [**https://activeforlife.com/activity/animal-friends\_1/**](https://activeforlife.com/activity/animal-friends_1/) * [**https://activeforlife.com/activity/basket-catch\_30/**](https://activeforlife.com/activity/basket-catch_30/) * [**https://activeforlife.com/activity/picking-up-things\_58/**](https://activeforlife.com/activity/picking-up-things_58/) * [**https://activeforlife.com/6-active-games-kids-can-play-with-a-pair-of-socks/**](https://activeforlife.com/6-active-games-kids-can-play-with-a-pair-of-socks/) * [**https://activeforlife.com/activity/balloon-juggling\_39/**](https://activeforlife.com/activity/balloon-juggling_39/) * [**https://activeforlife.com/activity/mirror-mirror\_2/**](https://activeforlife.com/activity/mirror-mirror_2/) * [**https://activeforlife.com/recipe-for-an-active-day-at-home/**](https://activeforlife.com/recipe-for-an-active-day-at-home/) **Staying Socially Connected While Physical Distancing** * [**https://developingchild.harvard.edu/resources/how-to-support-children-and-yourself-during-the-covid-19-outbreak/**](https://developingchild.harvard.edu/resources/how-to-support-children-and-yourself-during-the-covid-19-outbreak/) **(Center on the Developing Child at Harvard University)** * [**https://preventchildabuse.org/coronavirus-resources/**](https://preventchildabuse.org/coronavirus-resources/) **Managing Your Child’s Emotions During Uncertainty** * [**https://storage.trailstowellness.org/trails-2/covid-19-resources/tips-for-supporting-student-wellness-during-covid-19-with-mi-and-national-resources.pdf**](https://storage.trailstowellness.org/trails-2/covid-19-resources/tips-for-supporting-student-wellness-during-covid-19-with-mi-and-national-resources.pdf) * [**https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/helping-children-cope-with-changes-resulting-from-covid-19**](https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/helping-children-cope-with-changes-resulting-from-covid-19) * [**https://earlyimpactva.org/resources/covid-19/Supporting-Young-Children-Isolated-Due-to-Coronavirus.pdf**](https://earlyimpactva.org/resources/covid-19/Supporting-Young-Children-Isolated-Due-to-Coronavirus.pdf) ## **Activities** * [**https://developingchild.harvard.edu/resources/covid-19-resources/**](https://developingchild.harvard.edu/resources/covid-19-resources/) **(Center on the Developing Child at Harvard University)** * [**http://earlylearningnation.com/2020/03/a-parents-guide-to-surviving-covid-19-8-strategies-to-keep-children-healthy-and-happy/**](http://earlylearningnation.com/2020/03/a-parents-guide-to-surviving-covid-19-8-strategies-to-keep-children-healthy-and-happy/) * [**https://www.instituteforchildsuccess.org/covid-19-pandemic-20-activities-to-do-with-your-kids/**](https://www.instituteforchildsuccess.org/covid-19-pandemic-20-activities-to-do-with-your-kids/) * [**https://www.zerotothree.org/resources/169-play-activities-for-24-to-36-months**](https://www.zerotothree.org/resources/169-play-activities-for-24-to-36-months) * [**https://www.zerotothree.org/resources/3264-at-home-activity-guide**](https://www.zerotothree.org/resources/3264-at-home-activity-guide) * [**https://discoveries.childrenshospital.org/keep-kids-busy-during-covid/**](https://discoveries.childrenshospital.org/keep-kids-busy-during-covid/) * [**https://activeforlife.com/loose-parts-self-directed-play/**](https://activeforlife.com/loose-parts-self-directed-play/) * [**https://kids.covidstudentresponse.org/grades-1-3**](https://kids.covidstudentresponse.org/grades-1-3) * [**https://stories.audible.com/start-listen**](https://stories.audible.com/start-listen) * [**https://kidsactivitiesblog.com/17823/build-a-track/**](https://kidsactivitiesblog.com/17823/build-a-track/) * [**https://www.wwlp.com/news/photo-galleries/hearts-on-doors-windows-show-support-for-local-healthcare-workers-during-coronavirus-fight/**](https://www.wwlp.com/news/photo-galleries/hearts-on-doors-windows-show-support-for-local-healthcare-workers-during-coronavirus-fight/) ## **What should I tell my child about COVID-19?** * [**https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/helping-children-cope-with-changes-resulting-from-covid-19**](https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/helping-children-cope-with-changes-resulting-from-covid-19) * [h**ttps://www.aacap.org/App\_Themes/AACAP/Docs/latest\_news/2020/Coronavirus\_COVID19\_\_Children.pdf**](https://www.aacap.org/App_Themes/AACAP/Docs/latest_news/2020/Coronavirus_COVID19__Children.pdf) * [**https://www.zerotothree.org/resources/3265-answering-your-young-child-s-questions-about-coronavirus**](https://www.zerotothree.org/resources/3265-answering-your-young-child-s-questions-about-coronavirus) * [**https://covid19healthliteracyproject.com/#english**](https://covid19healthliteracyproject.com/#english) # COVID-19 Elementary Curriculum - Start Here ![Graphic by Hae Lin Cho](/files/-M5x4TUhDeZay0DBU6GA) **Student Authors:** Logan Beyer \[1], Margaret Irwin \[1], and Chandler Moore \[1] **Contact:** **Graphic Designers:** Emily Kragel \[2], Hae Lin Cho \[1], Pamela Chen \[1] **Faculty Reviewers:** Gene Beresin, MD \[3], Baruch Krauss, MD, EdM \[4], Rachel Conrad, MD \[5], Dr. Alan Woolf, MD \[6], Janis Arnold, MSW, LICSW \[7] **Student Reviewers:** Jessica Laird \[1], Priya Shah \[1], Rachel Reardon \[1], Katie Kester \[1] *\[1] Harvard Medical School, \[2] ECU Brody School of Medicine, \[3] Massachusetts General Hospital, Department of Psychiatry, Child Psychiatry Service, \[4] Boston Children's Hospital, Division of Emergency Medicine, \[5] Boston Children's Hospital, Department of Psychiatry, \[6] Boston Children's Hospital, Director of Environmental Medicine, \[7] Boston Children's Hospital, Department of Social Work* **Teacher/Family Reviewers:** Mrs. Samantha Rouse, Lower and Middle School Art Teacher, Arendell Parrott Academy; Ms. Wendy Burr, 3rd Grade Teacher, St. Timothy's School; Mrs. Wendy Riley, 2nd Grade Teacher, Arendell Parrott Academy; Dr. Jenny Wood Crowley, PhD, Parent, Academic Dean, Duke University; Dr. Adam Hollowell, PhD, Parent, Senior Research Associate, Samuel DuBois Cook Center on Social Equity; Dr. Jesse Summers, PhD, Parent, Academic Dean, Duke University; Cora, 7-year-old ## Who is this curriculum for? This section contains two series of modules: one for grades 1-3, and one for grades 4-6. Both will guide students through interactive coloring pages, which are linked throughout the materials and as printable pdf's below. Children can work through the website and pages on their own, or teachers/parents can use the guide on the next page to work through it with them. ## Are you interested in a medical student tutor? COVID-19 Classes for Kids (CCFK), spearheaded by medical students at the University of California, San Francisco (UCSF), is mobilizing health professions graduate students across the USA to teach these modules to children who are currently “sheltering in place” at home. If you or your child/student are interested in working through this curriculum with a medical student tutor, please [fill out this form](https://docs.google.com/forms/d/e/1FAIpQLScw9HAE9FDWLBmEbcC3DSrSABlKuJ6rGaoO6rA-6abwQ-LflQ/viewform). # Caregiver/Teacher Guide COVID-19 Classroom is designed to give children the opportunity to learn about Coronavirus in an interactive and developmentally-appropriate way. The elementary curriculum is divided into two sections: one for children in grades 1-3, and the other geared toward children in grades 4-6. Whether you work through these modules together with your child or allow them to explore the material on their own, we hope you find COVID-19 Classroom a useful resource to talk with your child about COVID-19 and the new changes in your family’s routine (why school is closed, why sports practice has been cancelled, why mom or dad may be working from home now, etc.) It is important to ask your children what they know, and where they heard that information. Encourage them to ask their own questions as they work through the curriculum, and remind them that no question is silly, and we all want to learn. Give them permission to express their emotions by asking them how they are feeling and what they're worried about or afraid of. The COVID-19 Classroom elementary curriculum is based on the Coloring for COVID-19 “Germ Busters vs. Coronavirus” coloring book. Many coloring pages are embedded within the curriculum. You may print out each page one at a time as your child works through the learning materials online, or print out all images in advance in a workbook format here: We’ve also provided additional information about the virus below, to help you answer questions your child may have as they work through the COVID-19 Classroom curriculum. ## **Fast Facts about COVID-19 (adapted from the CDC COVID-19** [**Fact Sheet**](https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf) **and** [**Frequently Asked Questions**](https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Coronavirus-Disease-2019-Basics)**)** * COVID-19, also known as SARS-CoV-2 and sometimes referred to as a “novel coronavirus,” is a member of the coronavirus family of viruses. * The first cases of COVID-19 were reported in Wuhan, China in December 2019. Since then, the virus has spread to countries all throughout the world. In March 2020, the World Health Organization classified the spread of COVID-19 as a pandemic based on its global transmission. * COVID-19 is spread person-to-person through droplet transmission. These respiratory droplets enter the air when an infected person coughs, sneezes, or breathes. It is currently believed that the virus can spread distances up to 6 feet between people. * Persons infected with COVID-19 can have different presentations, ranging from being asymptomatic to showing severe respiratory symptoms. The most commonly reported symptoms include fever, cough, and shortness of breath, and diarrhea in children. * So far, there is no evidence that children are at an increased risk for becoming sick with COVID-19 when compared with adults. The symptoms of COVID-19 can be similar in both children and adults, with children often having less severe symptoms. ## **Ways to Stay Healthy and Safe (adapted from the CDC** [**How to Protect Yourself & Others**](https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html) **and** [**MGH Clay Center for Young Healthy Minds 7 Ways to Support Kids and Teens Through the Coronavirus Pandemic**](https://www.mghclaycenter.org/hot-topics/7-ways-to-support-kids-and-teens-through-the-coronavirus-pandemic/)**)** * Wash your hands often. The Centers for Disease Control and Prevention (CDC) recommend washing hands often with soap and water for at least 20 seconds. To estimate 20 seconds, have your child sing the “Happy Birthday” song two times (or another one of their favorite tunes). If you’re on the go and away from soap and water, use a hand sanitizer that contains at least 60% alcohol. * Stay home as much as possible and avoid large groups of people. Limit unnecessary travel as well as trips to the grocery store, parks, or restaurants whenever possible. Since COVID-19 spreads from person-to-person over distances of 6 feet or less, this practice, sometimes called physical or social distancing, is meant to slow the spread of the virus. * Cover your mouth and nose with a cloth or mask when you are out in public. The CDC now recommends using cloth covers or masks as a way for you to protect the people around you, even if you may not feel sick. Do not use cloth coverings for children under 2 years old or for people who have trouble breathing. For more information, click [here](https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html). * Talk with your kids about COVID-19. COVID-19 has provoked worry and stress in many people, and children are no exception. Try to calmly begin a conversation with your child and see what they may already know about COVID-19. Ask them what questions they have before or after completing the COVID-19 Classroom modules. Provide reassurance that no question is silly or unimportant. You may also consider asking them to tell a story about the virus: “How has coronavirus affected your family or daily life?” * Validate your child’s feelings of worry or sadness. These are normal reactions. Encourage your child to talk with you or another trusted adult when they feel scared or confused. Other ways for them to process their feelings might include writing in a journal or drawing. For additional age-specific tips about supporting your child during this difficult time, check out this great resource: {% content-ref url="/pages/-M5D8aaxKyr0CHpINNoB" %} [Caregiver/Teacher Guide](/caregiver-guide) {% endcontent-ref %} * Set a daily routine at home. This could include time set aside for individual play, reading, family time, quiet time, or getting some fresh air. Consistent bedtimes and wake-up times may also help to establish a “new normal” for your child. Talk with your child to see how the adjustment to staying at home is going. * Encourage your child to stay involved in school through reading, completing worksheets, watching educational TV shows, or staying connected with classmates over video chat ### **Sources** \
# Extra Resources ### **Fact Sheets** ![](https://lh5.googleusercontent.com/ZrYVd9uAjU0VLZnYQWZOo9FtOlM5Y0MxLh7Zl82Ihd3pYx10bx2_17JfbOxtQxzcaEhiDfgmTBuklxe1GZbnlvARg0UZGQryNp00bYZrXGlVgaZQi9r0hrDVVtUGoZ4iBiRfWBi0) ![](https://lh6.googleusercontent.com/MEHUZYtKyv_jBwWvzXOps0GoCSLitnmwtvra5DBv2Ymi7OKEbTf4rV6iyrmk9mP-gR2K18kkLxk5BesP9Q32yhFg_yFisNpQl3KN7QYC0f2uWcXLnBa_H5YnOzyccqfy8_EmZ9pC) Source: Visit the website to download translations to over 30 languages, and sheets for adults! ### **For more coloring sheets and age-appropriate information about coronavirus designed just for kids, visit** [**www.coloringforcovid.com**](http://www.coloringforcovid.com/)**.** ### **The National Child Traumatic Stress Network.** [**Supporting Children During Coronavirus (COVID19)**](https://www.nctsn.org/resources/supporting-children-during-coronavirus-covid19) **and** [**Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019**](https://www.nctsn.org/resources/parent-caregiver-guide-to-helping-families-cope-with-the-coronavirus-disease-2019) ### Ramona and Iris and the Coronavirus {% file src="/files/-M8BHQHUTA5q3vtU3OWv" %} Written and illustrated by 2 medical students, this is a rhyming picture book targeted towards 5-9 year olds designed to teach children the basics of staying safe during the Coronavirus pandemic. # Summer Activities Recommended for ages 4-10. Please also see the middle school section for options for older children! **Student Authors:** Margaret Irwin, Katie Kester, and Allison Fialkowski *(Harvard Medical School)* **Contact:** **Graphic Designers:** Emily Kragel *(ECU Brody School of Medicine)* **Faculty Reviewers:** Jennifer Pitt-Lainsbury, *High School and Middle School Administrator, University of Toronto Schools* Donna Fialkowski, M.Ed., *Special Education Teacher, Atlanta City Public School System* Juliana H. Chen, M.D., *Child and Adolescent Psychiatrist, Massachusetts General Hospital/Harvard Medical School and Newton-Wellesley Hospital* Rachel Conrad, M.D. *Child and Adolescent Psychiatrist, Boston Children’s Hospital, Harvard Medical School* **Student Reviewers:** Mengting Qiu, Chandler Moore, Rachel Reardon *(Harvard Medical School),* Toke Odimayomi *(Harvard T.H. Chan School of Public Health)* ## What to do this summer? There is still a lot of uncertainty in the world, and the summer can be a tricky time for many kids and their families, especially after having several months of virtual school and making changes to normal household routines. Here are some more coloring pages for your child to complete as we think about summer and the changing guidelines for physical distancing.
### What does summer mean when coronavirus is still around? ![](https://lh6.googleusercontent.com/w_3S32zIVJg2kdIPnaz1XHHZ-dJ2jE7tvkqqWbT8icEZxNzf_5V79Pi2P2Cx4DbNv3SMMrX6dzaxlf-gJTcfJINyBzoW3g1EjZ1XHcNgbcHlBLdgpNv2sAa4oJTTTWoF6WCbTOLz) ### **There are many ways to keep your brain thinking during the summer. Read a book, do some worksheets, learn a new fun skill!** ![](https://lh6.googleusercontent.com/c6qbbo2uudKhMExvsKj-KO3qne1FcLIZ6diHsykvK79998Jry5CNCHNt1BwE-WkwNpXUJsGXZ4TBeVgyk89QIZDSzFkK3-ntNz0hSNzWLVYHZs9ALWyFbap8gG-5skbl1UPwJXs9) ### **Some things may change in the next few months with new rules about “physical distancing” and going outside. Make sure to listen to adults so you know how to stay safe! And remember to always ask questions if you have them.** ![](https://lh5.googleusercontent.com/mLhjIam2JOPw501yBXGUfRLTTYSoYNurrX4rmMoaW-RgmhXuHsFCIsV7NndZvYQd8_Fz5bkj0EjVUJA-K-nK3v_kYgGjCS_hp7bs3LD4A4odCKaLeUUvwPFnVLDtB-PHos9jrSBI) ## **Tips for Caregivers** * **Develop and maintain a new routine.** * To signify that it is summer, consider switching the routine you had during the school year to a different summer version. * **Be honest.** * Do not shy away from talking with your child about what is happening in the world. Especially when physical distancing measures start to lift, some children may become more confused and have more questions. * Before answering, listen to their questions. Focus on answering their questions honestly rather than giving too many confusing details. * **Focus on gratitude.** * Have your child practice listing 3 things they are thankful for at the end of each day. * **Find small ways for your child to feel like they are helping.** * Consider teaching your child to help sew masks, write notes, or leave cards out for frontline workers. * Leave notes for small business in your neighborhood that your child misses * Making a child feel like they are helping can give them the opportunity to feel like they have a purpose, and may decrease their stress and anxiety. * **Stay connected virtually.** * Remember to video chat with friends and family members that your child has not been able to see in person. * **Encourage your child to develop a new skill.** * This is a unique time with a lot of free time where a child can focus on developing a new skill or exploring an interest they have always had. * Some ideas include learning a new language with videos online, learning how to sew or knit, or learning about different species of birds that live near your home. * Working on reading skills is an especially useful practice during the summer. You might consider scheduling designated “reading time” each day, which can consist of a combination of your child reading a book by themselves and you reading aloud from a book with slightly more advanced vocabulary. Some read-aloud options might include Mary Poppins, Anne of Green Gables, Mr. Popper’s Penguins, Harry Potter, or Wizard of Oz. Teaching new words in daily life (i.e. identifying unfamiliar foods in the grocery store or naming items around the house) is another great way to build vocabulary. * **Foster independence and exploration** # Grades 1-3 ## Before you start, you can click here to print your coloring pages! {% file src="/files/-M5PCcJA\_MUTJ4dJqnp0" %} Grades 1-3 Coloring Pages {% endfile %} ## What is happening in the world? ![](/files/-M5YFSlfqDR9h9eUtTZ4) ## **Let’s color to learn more!** ![](/files/-M5PDLeg9FVT4i23WV9x) ## **We have been hearing some BIG news!** ![Today we got BIG news!](/files/-M5Y6LbC00jiRZRhKDd2) ## **Schools, stores and even parks are being closed because of something called coronavirus.** ![](https://lh5.googleusercontent.com/0E_tOL3pD5uBAm7Ybiu5-PJntgMXS_mSHPnthMV-KEO-Q39tp13d0-_WNHNUpH0gVWT8dPmcUhkh6fFm1Cemd0-p4lgfmI4oNa8t81BvE-iK4bK5PPIw9DksERvUg70gqocRzwNx) ## **What is coronavirus?** ![](/files/-M5PD17yh-O0znFm830b) ## **Coronavirus is a germ that is really small. It makes people sick.** ![](/files/-M5PEFNROWQWPHRl4qVl) ## **Coronavirus spreads when people are together. When we stay at home, we are staying away from coronavirus. This keeps us all healthy.** ![When we stay home from school, it helps us stay healthy.](/files/-M5Y6WtLNz_k86TgaJeC) ## **Grown-ups are working really hard to stop coronavirus.** ![Grown-ups are working very hard to stop coronavirus.](/files/-M5Y5WBv-gOGbJNijdO3) ## **Are you ready to be a germ buster?** ![](/files/-M5Y7ecDug2Z1W99RIMG) ![](https://lh6.googleusercontent.com/icl9Pt5Oi2shc-0uSPqKAmkW9MvAr9XZcC_AxqMjx99E3vmh7QXj0SgMnkPcWn8X_1qBPRninp6WH76pTHhza-jUplVsN-6ZcQT9_yoWr5eqFbtYCbFZamELuc5xoqGCTZKXqVf1) ## **Germ busters have 3 jobs!** ![](/files/-M5YFYx6w6YXKVEV6nvx) ### **Job #1: Wash your hands for 20 seconds. To count to 20 seconds, sing the Happy Birthday song or Baby Shark twice.** ![](https://lh5.googleusercontent.com/fSdJA0R33KXwCdYeTDL9DgfobZKCoERs3PzjAmhzEU1sKpwrPneKT2fuvgNDzHXsugLGKhK_z04R89AfyZSGz3ivREpigohlqkFDfmmiivcI8XT1WZRX6rAaOOAM_x8xxdMZ-RYA) ### **You can watch this video about washing your hands:** {% embed url="" %} Source: CDC ### **Job #2: Cover when you Cough or Sneeze.** ![I use my elbow or a tissue to cover my nose and mouth.](/files/-M5Y5guf_nk-t5nUAL0R) ### **Job #3: Send love from a distance. Germs can spread when lots of people are close together.** ![](https://lh3.googleusercontent.com/nXKms_Vfm7jy50c_TE8-_bo2GIM_1NaQF3AtXKIcwcdl113T-_fkgw2PGqtDELatV9G9A6dC71Jr-vBOCVp72ymEtZuVFhXBFdE4BJVaztBCfmE-iySTxfzamprCZKr9EVIFTCUJ) ### **We will STOP coronavirus! I am happy I can help keep the virus away from my friends and family.** ![](https://lh6.googleusercontent.com/Slu3sceW8FUlaR7MepDl1eTsKsrsSUDEopMgwgl26ArjWhfsXwWMMCMFr4AQ5hLm79Wf7RynEUSkKxTI9Cr-n_nJPUgMtCj217_0m27lLc2leoM0VzjwQGl5xe32BoPxA20JxmlC) **The End. Thank you for coloring with us! If you want to keep coloring, click** [**HERE**](https://www.coloringforcovid.com/)**!**\
----------------------------------------------------------------------------------------------------------------------------------------- # Grades 4-6 Lately, grown-ups have been talking a lot about something called Coronavirus. If you have a lot of questions, you are not alone. This website has facts about Coronavirus and fun coloring pages, too. When you’re finished, you can post your creations on social media to spread the word. **Tag @covid\_classroom or @coloringforcovid for your chance to be featured, or use the hashtags #covidclassroom, #covidkindness, #germbuster, or #covidkids.** You can download and print your coloring pages here. {% file src="/files/-M5PMysGBSkQdC8RxQ7L" %} Grades 4-6 Coloring Pages {% endfile %} Let’s learn together! Click "Next" to begin. # Module 1: What is Coronavirus? ## **Module 1: What is coronavirus?** ### **Lately, we have heard a lot of BIG news.**
![Today we got BIG news!](/files/-M5Y6lUZXDak2LO0YiQE) ### **Schools, parks, and restaurants are closing because of something called Coronavirus.** ![](https://lh5.googleusercontent.com/0E_tOL3pD5uBAm7Ybiu5-PJntgMXS_mSHPnthMV-KEO-Q39tp13d0-_WNHNUpH0gVWT8dPmcUhkh6fFm1Cemd0-p4lgfmI4oNa8t81BvE-iK4bK5PPIw9DksERvUg70gqocRzwNx) ### **But what exactly is Coronavirus?** ![](/files/-M5PD17yh-O0znFm830b) ### Coronavirus is a germ that can make people sick. It can spread from person to person. But coronavirus doesn’t have legs, so it likes to travel on tiny drops of water. These water drops can fly in the air when we cough, sneeze, or talk. **If they land on our hands and we touch things, the virus can land on those things and other people might touch them.** ![](/files/-M5PGo-fQ3qZF-hi6a6A) ### **Here's a video about droplets:** {% embed url="" %} Video courtesy of Elena Perez, @elena4prez on Instagram ### Coronavirus can also hide on things we touch like phones, tablets, and toys. Coronavirus is so small that you can’t even see it! ![](/files/-M5PHhBjp7LbRKPm6Jqf) ### If coronavirus gets inside a person’s body, it can give them a fever and a cough, and sometimes it can make it feel hard to breathe. Luckily, our body can fight back against coronavirus! ![](/files/-M5YFohNQB-tYculo5M1) ### Inside our bodies, there are special immune cells that travel all around our bodies searching for germs. When they find germs, the immune cells destroy them and keep us healthy! When we feel sick from a cold or flu and then start to feel better, we can thank our immune cells for helping us fight the germs. ![](/files/-M5YBdx0qkDtSpc4v0h4) ### One of the best ways to stop coronavirus is through physical distancing. Physical distancing means staying at home and away from large groups of people. Since coronavirus travels in water droplets, it can only travel a small distance. If we try to stay six feet apart from other people, we can stop the spread of coronavirus. ![](/files/-M5PIjAH2IxkF_9I7bGn) ### Physical distancing is why schools, stores, and movie theaters are closed right now. Let’s stay home to stop Coronavirus. ![When we stay home from school, it helps us stay healthy.](/files/-M5Y6uTNnYqEPjp0rd4o) ### Grown-ups are working together to stop coronavirus and keep everyone healthy. Doctors, nurses, truck drivers, grocery store workers, and even moms and dads are all helping. ![Grown-ups are working very hard to stop coronavirus.](/files/-M5Y5vxHyVOW8FpVf2sO) ### **And YOU can help too! Click on the next lesson to learn how you can be a GERM BUSTER and help fight coronavirus.** ![](/files/-M5Y7ecDug2Z1W99RIMG) ![](https://lh6.googleusercontent.com/icl9Pt5Oi2shc-0uSPqKAmkW9MvAr9XZcC_AxqMjx99E3vmh7QXj0SgMnkPcWn8X_1qBPRninp6WH76pTHhza-jUplVsN-6ZcQT9_yoWr5eqFbtYCbFZamELuc5xoqGCTZKXqVf1) # Module 2: How can I help? ## **Germ busters have 5 jobs.** ![](/files/-M5YG7eTtnJgPnL5JAnw) ![](/files/-M5YG0s8Hylf0GJh8V3D) ### **Job #1: Wash your hands.** **Wash your hands! Cleaning hands with soap and water is our most powerful weapon against coronavirus. When coronavirus comes into contact with soap, it disappears after 20 seconds. Doctors say this is the most effective way to kill germs.** ![](https://lh5.googleusercontent.com/fSdJA0R33KXwCdYeTDL9DgfobZKCoERs3PzjAmhzEU1sKpwrPneKT2fuvgNDzHXsugLGKhK_z04R89AfyZSGz3ivREpigohlqkFDfmmiivcI8XT1WZRX6rAaOOAM_x8xxdMZ-RYA) **It takes time to make sure that every part of your hands are covered with soap to destroy the germs. To make sure all the germs are gone, I sing the Happy Birthday song twice while washing my hands. Sometimes I even make up my own words to the same tune, or try Baby Shark!** {% embed url="" %} Souce: CDC {% endembed %} ### **Job #2: Cover your mouth and nose when you cough and sneeze.** **Cover your mouth and nose with your elbow or a tissue. Coughs and sneezes release water droplets, and coronavirus can use these water droplets to spread from person to person. If you instead cough into your elbow or sneeze into a tissue, the water droplets don’t fly and coronavirus gets stopped in its tracks. Be sure to wash your hands after you throw the tissue away!** ![I use my elbow or a tissue to cover my nose and mouth.](/files/-M5Y65-VOfCSgZoiBANH) ### **Job #3: Send love from a distance.** **Keep away from people who don’t live with you. This is my least favorite part of being a Germ Buster. I miss being out with my friends at school and giving my grandparents hugs. But if we all keep safe, we will be able to do those things again soon.** **But you can call and video chat with family and friends. I think it makes them happy to say hello through the phone.** ![](https://lh3.googleusercontent.com/nXKms_Vfm7jy50c_TE8-_bo2GIM_1NaQF3AtXKIcwcdl113T-_fkgw2PGqtDELatV9G9A6dC71Jr-vBOCVp72ymEtZuVFhXBFdE4BJVaztBCfmE-iySTxfzamprCZKr9EVIFTCUJ) ### **Job #4: Clean your room and your toys.** **Coronavirus can hide in messy places for a long time. When everything is washed with special cleaners that contain alcohol and other chemicals, the germs are killed. I am extra careful to clean the screen on my tablet and computer, since I use them a lot. I also help mom and dad clean around the house. We are all on the same team to beat germs!** ![](https://lh6.googleusercontent.com/uGAyTSSqMYweP0-JsQEtA9FkgkaCeq_jlzdrhThlY0wp4Irfti6OBUBnFkorikg2BbAEtcvM3ruljaAN8Sy7PKwXZ2QvXJ7u2QUBIQZGQCQfh2Y-O52KEaQZ5lX3sqUHVSm82Fx5) ### **Job #5: Eat healthy and drink lots of water.** **It is important to give your body the nutrients it needs. Nutrients help your immune cells work better, so they can track down and kill germs. Eat fruits and vegetables every day, and drink a glass of water with every meal. I take care of my body, to help it stay healthy and strong!** ![](https://lh6.googleusercontent.com/AKXKnLXxfJPuQpUwzSzCjgK3T56P4c8eLWGDHxQcCaUKKtIf195YpAhdItL0wIKKumaZbbiVgQJehMvMAftDcXZFCzLMCIgOkjLFZOubRhi3KBRtHGW2kpo1VF_AZETkYdKLKLbK) ### **We will STOP Coronavirus! I am happy I can help keep the virus away from my friends and family.** ![](https://lh6.googleusercontent.com/Slu3sceW8FUlaR7MepDl1eTsKsrsSUDEopMgwgl26ArjWhfsXwWMMCMFr4AQ5hLm79Wf7RynEUSkKxTI9Cr-n_nJPUgMtCj217_0m27lLc2leoM0VzjwQGl5xe32BoPxA20JxmlC) ### **The End. Thank you for coloring with us. If you want to keep coloring, click** [**HERE**](https://www.coloringforcovid.com/)**!**
# COVID-19 Middle School Curriculum - Start Here ![Graphic by Pamela Chen](/files/-M5x4gbw-i5Q8KN0Whpn) **Medical Student Authors:** Kendall Carpenter \[1], Priya Shah \[1], Audrey Effenberger \[2] **Contact**: **Graphic Designer:** Constance Wu \[1] **Faculty Reviewers:** Gene Beresin, MD \[3], Baruch Krauss, MD, EdM \[4], Janis Arnold, MSW, LICSW \[5] **Teacher Reviewer:** Tory Small, M.S.Ed. **Student Reviewers:** Margaret Irwin \[1], Chandler Moore \[1], Rachel Reardon \[1], Katie Kester \[1] *\[1] Harvard Medical School, \[2] Massachusetts Institute of Technology, \[3] Massachusetts General Hospital, Department of Psychiatry, Child Psychiatry Service, \[4] Boston Children’s Hospital, Division of Emergency Medicine, \[5] Boston Children's Hospital, Department of Social Work* ## **Introduction:** You’ve been hearing a lot about the coronavirus lately. Maybe you’ve even heard these other words too, like: COVID-19, SARS-CoV-2, and pandemic. And you may have some questions like: What is a virus anyway? Why do people get sick? Why can’t we go to school? And most importantly, how can I help? We’ve heard your questions and put together an interactive website to help answer your questions, as well as get you thinking about other questions that we don’t know the answers to yet. After all, science is all about discovery. Please download or print out the COVID-19 worksheet and complete it as you go through the module: {% file src="/files/-M5UAYVpcD9OyzhAyy-V" %} MiddleSchool\_Worksheet\_WordDoc {% endfile %} {% file src="/files/-M5UAdHaQrjPN4nJdPjx" %} MiddleSchool\_Worksheet\_PDF {% endfile %} **Now let’s get started…** ## **Learning Goals:** We built this curriculum to help students better understand the history and implications of the virus, and what we can do to help! **Learning Objectives:** At the end of this activity, we hope students will be able to: 1. **Define** what a virus is and describe why and how viruses cause illness. 2. **Explain** orally and in writing the different terms used to reference the virus. 3. **Recall** the general timeline of the virus and evolving pandemic, both at an individual level (what happens when you get sick) and at a population level (how this affects our society). 4. **List** the ongoing efforts to contain the virus and explain why they are useful (hand-washing, social distancing, mask-wearing, shelter-in-place). 5. **Identify** one question that they still have about COVID-19 and design a study for how we might be able to discover the answer. 6. **Create** a personal stress action plan with activities/approaches they can use if they are feeling stressed during this uncertain time. ## Are you interested in a medical student tutor? COVID-19 Classes for Kids (CCFK), spearheaded by medical students at the University of California, San Francisco (UCSF), is mobilizing health professions graduate students across the USA to teach these modules to children who are currently “sheltering in place” at home. If you or your child/student are interested in working through this curriculum with a medical student tutor, please [fill out this form](https://docs.google.com/forms/d/e/1FAIpQLScw9HAE9FDWLBmEbcC3DSrSABlKuJ6rGaoO6rA-6abwQ-LflQ/viewform). # Caregiver/Teacher Guide ## **Introduction:** This curriculum is designed to help middle-schoolers learn more about COVID-19 in an interactive and educational way. Beyond helping to increase their knowledge, it is designed to get them excited about the scientific process, a method that is on full display during this time of uncertainty and discovery. ### **How to Use This Curriculum:** Kids can work through this curriculum on their own or in partnership with their caregivers/teachers. The curriculum is split into two parts: Part 1 - Building Background Knowledge and Part 2 - Action and Exploration. Students can complete the whole curriculum all in one sitting or split the two parts over multiple days. There is a worksheet (that can be downloaded or printed out) that children should fill out as they move through the curriculum in order to get the most out of the material: {% file src="/files/-M5UAYVpcD9OyzhAyy-V" %} WordDoc Worksheet {% endfile %} {% file src="/files/-M5UAdHaQrjPN4nJdPjx" %} PDF Worksheet {% endfile %} **For teachers -** the worksheet can be used as an assignment to show that your students completed the module. Students can also create a Prezi or Google Slides presentation about their Scientific Method discovery question to share with the class as a culminating project. **For parents and caregivers -** the worksheet is a good tool to use to get a sense of how your child is feeling during this uncertain time. Further tools for beginning this discussion can be found on the guide linked below. In particular, The Wellness Society’s [Coronavirus Anxiety Workbook](https://thewellnesssociety.org/wp-content/uploads/2020/04/Coronavirus-Anxiety-Workbook.pdf) is a great resource filled with interactive strategies to reduce stress. ### **Managing Worry and Stress:** This can be a very stressful time for children and caregivers, alike. Focusing on family mental health can help us support one another. Check out our guide for caregivers: {% content-ref url="/pages/-M5D8aaxKyr0CHpINNoB" %} [Caregiver/Teacher Guide](/caregiver-guide) {% endcontent-ref %} All of the printables found in this curriculum can be downloaded here: {% content-ref url="/pages/-M5DlHlHCo47oFK3MKTK" %} [Extra resources](/middle-school/untitled/extra-resources) {% endcontent-ref %} # Extra resources ## Printables embedded in this curriculum: {% file src="/files/-M5UAYVpcD9OyzhAyy-V" %} Middle School Worksheet WordDoc {% endfile %} {% file src="/files/-M5UAdHaQrjPN4nJdPjx" %} Middle School Worksheet PDF {% endfile %} {% file src="/files/-M5UFAwsLmPmbkadvMkU" %} Timeline Graphic PDF {% endfile %} {% file src="/files/-M5UFMJ2l751Rinyh\_jJ" %} Safety Graphic PDF {% endfile %} {% file src="/files/-M5UFUoiw9S5a5sVFiKq" %} Scientific Method Graphic PDF {% endfile %} ## **Interested in learning more? Check out these other resources:** [**A Kid’s Guide to Coronavirus**](https://www.nytimes.com/2020/03/27/podcasts/the-daily/kids-coronavirus.html) **- The Daily podcast** [**Coloring for COVID-19**](http://www.coloringforcovid.com/) [**Fact Sheet for Kids**](https://drive.google.com/file/d/1Az2n7Xa1f_GTJApr5gFvlcanOggWcCWq/view) **from COVID-19 Health Literacy Project** [**NPR Comic**](https://www.npr.org/sections/goatsandsoda/2020/02/28/809580453/just-for-kids-a-comic-exploring-the-new-coronavirus) # Summer Activities **Student Authors:** Margaret Irwin, Katie Kester, and Allison Fialkowski *(Harvard Medical School)* **Contact:** **Faculty Reviewers:** Jennifer Pitt-Lainsbury, *High School and Middle School Administrator, University of Toronto Schools* Donna Fialkowski, M.Ed., *Special Education Teacher, Atlanta City Public School System* Juliana H. Chen, M.D., *Child and Adolescent Psychiatrist, Massachusetts General Hospital/Harvard Medical School and Newton-Wellesley Hospital* Rachel Conrad, M.D. *Child and Adolescent Psychiatrist, Boston Children’s Hospital, Harvard Medical School* **Student Reviewers:** Mengting Qiu, Chandler Moore, Rachel Reardon *(Harvard Medical School),* Toke Odimayomi *(Harvard T.H. Chan School of Public Health)* ## Summer Calendar Activities Challenge: **Here are some ideas , but remember it is your own calendar, so have fun with it!** * **Monday: Arts and crafts.** * Make a scrapbook * Paint by numbers * **Tuesday: “Try a new physical activity” day.** * How many pushups can you do? * Make a dance to your favorite song * Learn how to do a handstand, forward roll, cartwheel * Run around your neighborhood (with a mask, if it is safe to do so) * **Wednesday: Cook or bake.** * Bake bread for the first time * New cookie recipe you’ve always wanted to try * **Thursday: Go outside and explore a safe new place.** * Be sure to attend to your local guidelines on physical distancing * Quiet parks or uncrowded outdoor spaces can be good places to visit * **Friday: Social.** * Catch up with a friend over FaceTime * Call your grandparents, aunts and uncles, or other family members * **Saturday: Learning or Teaching.** * Do a worksheet, crossword or logic puzzle read a nonfiction book, or read through the COVID Curriculum (Link to the Curriculum) * OR choose a topic you are passionate about, become an expert on that topic, teach your family/friends * **Sunday: Self-care.** * Write in a journal * What makes you feel most like yourself? * Snuggle up with a furry friend, paint your nails, read a book, play some video games # Middle School Learning Modules ## **Introduction:** You’ve been hearing a lot about the coronavirus lately. Maybe you’ve even heard these other words too, like: COVID-19, SARS-CoV-2, and pandemic. And you may have some questions like: What is a virus anyway? Why do people get sick? Why can’t we go to school? And most importantly, how can I help? We’ve heard your questions and put together an interactive website to help answer your questions, as well as get you thinking about other questions that we don’t know the answers to yet. After all, science is all about discovery. Please download or print out the COVID-19 worksheet and complete it as you go through the module: \*Please note that these worksheets were updated on 6/22 for clarity {% file src="/files/-MASa42pRfN4Mkd70Jzo" %} Word Doc Worksheet {% endfile %} {% file src="/files/-MASa9wqt3pm1rS0p-Or" %} PDF Worksheet {% endfile %} Now let’s get started… # Part 1: Building Background Knowledge ## **What is a virus? How does it make you sick? How does it spread?** Please watch the following video to answer these questions and more: {% embed url="" %} Now that you’ve learned all about viruses, try and **answer the true/false questions** on your worksheet! If you love science and want to learn more, consider challenging yourself with the Khan Academy “Intro to Viruses” and “Viral Replication” sections. This resource is designed for high schoolers, but we think you can handle it! [**https://www.khanacademy.org/science/high-school-biology/hs-human-body-systems/hs-the-immune-system/a/intro-to-viruses**](https://www.khanacademy.org/science/high-school-biology/hs-human-body-systems/hs-the-immune-system/a/intro-to-viruses) ## **We don’t always get sick from viruses. How does our body fight off viruses?** **Please watch the following video to learn about our immune system:** {% embed url="" %} Now that you've learned a little about the immune system’s response to viruses, **complete the matching exercise** on your worksheet to test your knowledge! ## **What is the new coronavirus?** Now you know about viruses in general, but what about this new virus? ### **Let’s learn some terms:** * **Coronavirus:** a type of virus that has spikes on its membrane, making it look like a crown. “Corona” means crown in Latin! There are other coronaviruses that can cause the common cold. * **SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2):** This is the name of the new virus. Many people just call it the coronavirus. * **COVID-19 (Coronavirus Disease 2019):** This is the name of the disease caused by SARS-CoV-2. * **Pandemic:** when a disease spreads to many people across many continents. * *How is a pandemic different from other diseases that are spread around the world?* * The seasonal flu, which affects many people every year, is not a new disease. We have vaccines to prevent flu and medicines to treat flu. Though the flu can be dangerous, most people are somewhat immune due to past flu exposures. * COVID-19 is a pandemic because it is the worldwide spread of a new disease. It seems that a higher percentage of people get more sick from COVID-19 than the flu. Very few or no people are immune because the virus is new. * Remember the video about our immune system? When our bodies see a virus, it creates these antibodies that latch onto the virus and allow our immune cells to kill the virus. These antibodies can protect us in the future if we come in contact with that virus again. We call this immunity. The virus was able to spread so rapidly because no one was immune to it yet. ## **What happens when you get COVID-19:** * **Asymptomatic:** Some people who get infected with the virus never feel sick and might not know that they are infected with the virus. We say that these people are “asymptomatic.” Even though these people don’t feel sick, they can still give the virus to other people who can become sick from it! * **Mild/moderate:** Some people who get infected will feel sick. They often have a cough, fever, and can be very tired. Less commonly, these people may have a sore throat, runny nose, muscle pain, headaches, nausea, vomiting, and diarrhea. * **Severe:** Some people who get infected can get very sick from the virus. This can affect their whole body including their lungs, heart, and kidneys. Sometimes they need a machine at the hospital to help them breathe, called a ventilator. The people who are most at risk for these severe complications are older people (older than 65 years old), those with previous heart/lung diseases, or other diseases that make them weak such as diabetes or high blood pressure. ### **What about me?** * Children are more likely to be asymptomatic or have mild symptoms compared to adults if they get infected with the virus. * But if you are infected (even if you don’t have any symptoms), the virus can still spread. The good news is that there are awesome safety tips (discussed below) that you can use to keep yourself and those you love safe and healthy! * You may have heard people talking about children getting “Kawasaki disease” or “MIS-C” after having COVID-19. MIS-C is a very, very rare complication of COVID-19 that happens in a few children. Children with MIS-C can have symptoms such as stomach pain and a rash after getting COVID-19. MIS-C can also affect the heart, and that is why people get scared. Most children, however, recover quickly from COVID-19 and can go back to playing and learning as you normally do. If hearing about MIS-C makes you feel scared or worried, talk to a parent or teacher, so you can learn more ## **So how did this all happen?:** ![](/files/-M5Q1Il_cPMYLygFAMpf) {% file src="/files/-M5UFAwsLmPmbkadvMkU" %} Timeline Graphic Printable PDF {% endfile %} * **Dec 31st, 2019 -** China reports that there were a cluster of lung infections from an unknown cause in Wuhan, China. * The people with these lung infections had visited a market which suggested the virus was transmitted to humans from an animal (possibly a bat). * **Early January 2020 -** The cause of these lung infections is found to be a new virus that has never been seen in humans before. Doctors think that the virus may have originally come from a virus that used to only infect animals. \* * Some viruses began in animals, like Swine flu (pigs) and Bird flu. This one may have come from bats. However once it became infectious to humans, the animals from which it came is no longer a problem. * **January 12th, 2020 -** China shares information about the new virus’s genomic sequence with the world. \* * Why is this important? **(Go to your worksheet to answer the question)** * **January 13th, 2020 -** Thailand reports a person infected with this new virus. * This is the first case reported outside of China, indicating that the virus was spreading. * **January 22nd, 2020 -** The World Health Organization (WHO) announces that there is evidence of human-to-human transmission of the virus, meaning people can transmit the virus to other people. * Human-to-human transmission is necessary for rapid spread of the disease. To show how quickly the virus spread around to world, see the following animated chart from the New York Times: * **February 11th, 2020 -** The WHO names the new coronavirus SARS-CoV-2 because of its similarity to a previous coronavirus, SARS-CoV. The SARS-CoV-2 virus causes the disease called COVID-19. * **March 11th, 2020 -** The WHO classifies COVID-19 as a pandemic due to its rapid spread throughout the world as a new virus. # Part 2: Action and Exploration ### **What can we do to stay safe?** ![Click on this picture to make it larger and print!](/files/-M5Q-uMH8wLm5c_NVDCF) {% file src="/files/-M5UFMJ2l751Rinyh\_jJ" %} Safety Printable PDF {% endfile %} * **WASH YOUR HANDS** * **What:** Wash your hands often (especially before you eat and after you use the bathroom) with soap and water for at least 20 seconds. To time yourself, you can sing the Happy Birthday song twice! * **Why:** Washing your hands with soap removes germs (including viruses) from your hands and prevents them from spreading when you touch other people or surfaces. **AVOID TOUCHING YOUR FACE** * **What:** Don’t pick your nose, touch your mouth/ears, or rub your eyes. * **Why:** These are places where germs (including viruses) can enter our bodies. **WEAR A MASK** * **What:** You and your family can [make cloth masks](https://www.youtube.com/watch?v=REtQwwRoxuY) (using a t-shirt, bandana, or other fabric) that cover your nose and mouth. No sewing machine required! * **Why:** Coronavirus spreads through tiny droplets of fluid from your lungs when you talk, cough, or sneeze. Masks provide a physical barrier between you and others that helps stop the virus from spreading. **PHYSICAL DISTANCING** * **What:** Stay at least 6 feet away from people who do not live in your home. * **Why:** When someone who has coronavirus talks, coughs, or sneezes, tiny, invisible droplets of fluid from their lungs can spread to the people around them. This is why schools and activities like sports practice are cancelled for now. We want to avoid large groups of people gathering together so that the virus cannot spread easily from person-to-person. **STAY AT HOME** * **What:** Many state governments have asked people to stay at home, except for essential activities such as grocery shopping or picking up necessary medications. * **Why:** Staying at home (instead of going to the park or your friend’s house) helps limit the spread of the virus and keeps everyone safe. ## **Next steps and scientific discovery** **What other questions do you have about coronavirus?** Scientists have a lot of similar questions! They use a process called the Scientific Method to discover answers to their questions. There are many unknowns, and the Scientific Method helps us deal with the uncertainty by solving problems step-by-step. **Steps:** ![Click the picture to make it bigger!](/files/-M5UDeUC8_33hsKjr5hK) {% file src="/files/-M5UFUoiw9S5a5sVFiKq" %} Scientific Method Printable PDF {% endfile %} * **Ask a question.** * Start your question with one of the **5 W’s**: **W**ho, **W**hat, **W**hen, **W**here, **W**hy, or ho**W**? * Important criteria for a good question include: * Can be researched and tested. * Can be proven one way or the other. * Needs to be complex. Not a yes/no or right/wrong type question. * Example: “What medicine can treat coronavirus?” * **Do background research.** * This means using reliable sources\* to learn more about that topic. Here are some [reliable sources](https://sites.google.com/bostonpublicschools.org/virtuallearningcommons/research-information/research-grades-6-8?authuser=0) that are perfect for middle-schoolers! * Example: Read about medicines that are used to treat other viruses, such as the yearly flu. * **Create a hypothesis.** * This is what you think the answer is. * Example: Our prediction is that flu medication could help people with coronavirus. * Now it’s time to test our idea! * **Test with an experiment.** * Here comes the creative part – come up with a way to test your hypothesis and see if it is correct. * Example: Our experiment is going to test whether flu medication helps people recover from the coronavirus by comparing how sick patients with coronavirus who take flu medication were versus patients who did not take flu medication. * **Analyze data and draw conclusions.** * Time to figure out what the results of your experiment mean. * Example: In our experiment, we found that people who have coronavirus who take flu medicine do not feel less sick and do not get better faster. Thus, our study suggests that flu medication does not help treat people who have coronavirus. * **Share your results.** * Scientists then share their findings with everyone else so that we all can learn from their work. * Example: You could make an online presentation to share with your classmates, teachers, and friends/family. **Your turn!** Use your worksheet to come up with your own question about coronavirus and work through the scientific process. **Possible questions include:** * How does the virus spread to other people? * Are there long-term effects of the virus on people’s health? * Why do older people and people with lung/kidney/heart problems get more sick? * Think about what you learned at the beginning of this module about the immune system to help you form a hypothesis. * Come up with your own question; the possibilities are endless! **\*Reliable Sources:** 1. Government agencies or universities usually use websites that end in .GOV, .EDU, or .ORG. 2. The website will tell you who the author is, so you can check if they're qualified to write about the topic. Usually, qualified authors will have relevant university degrees or job experience that make them experts on a topic. 3. They are evidence-based. This means that the source uses proper scientific methods and data to draw conclusions. The evidence should come from repeated experiments with many people in different places that all come to the same conclusion. It is important to check that the experiments were done correctly and responsibly. 4. The information in the reliable sources will match information from other sources that you already trust, like textbooks. 5. Information will be presented in an unbiased way, meaning that they do not insert their own opinions or exclude certain viewpoints. ## **I’m worried about what this means for me and my friends and family.** This is a new and uncertain time for all of us. It is normal to feel worried. Take a few moments to **write out your feelings** about the virus and physical distancing on your worksheet. How do these changes to your life make you feel? What are you most worried about? What has coronavirus made you realize you miss? You can use sentences, bullet points, pictures, whatever helps you express your feelings -- be creative! ### **I’m worried about my parents or grandparents getting sick.** In order to avoid older people getting sick, it is important for all of us to do our part by keeping clean and safe. Follow the safety tips we shared to help limit the spread of the disease. Remember that there are a lot of nurses and doctors all across the country and around the world working hard to help everyone stay safe and to help people who are sick get better! ### **I miss my friends. When will I be able to see them again?** It’s hard not to see your friends as often as you usually do. You may miss hanging out with them at each other’s homes, the park, or at school. You will be able to spend time with them as soon as it is safe to do so again. Unfortunately, we do not know exactly when that will be. Which is tough. In the meantime, you can talk on the phone, have video chat hangouts, play online games together, or consider becoming email pen-pals to keep in touch! ### **When will I go back to school?** We do not know when exactly it will be safe for us to resume our normal activities. Once it is safe, schools and businesses will reopen. Until then, there are great websites such as [KhanAcademy](https://www.khanacademy.org/) where you can find videos to learn about new topics. ### **I am feeling worried and/or stressed. What can I do to manage my feelings?** It’s normal to feel worried during this time. Taking a break and doing a [4-7-8 breathing exercise](https://www.youtube.com/watch?v=PmBYdfv5RSk) can help you feel more calm. You may also find that talking to your friends or parents, writing a daily journal about your thoughts, or being creative (such as drawing or painting) helps calm your mind. Exercising safely away from others (by walking or running around your neighborhood, or trying yoga or another at-home workout) can be another great way to manage stress. You can also read about these [Self-Care Tips](https://www.mghclaycenter.org/parenting-concerns/11-self-care-tips-for-teens-and-young-adults/). Take a few minutes to **develop an action plan** on your worksheet. What helps you feel better when you are stressed? Some ideas could be arts & crafts, dancing, listening to music, or meditation. Make a list of these activities, and you can reference this list when you are feeling uneasy. If you found this activity helpful, you can learn about more stress-reducing strategies in the [Coronavirus Anxiety Workbook](https://thewellnesssociety.org/wp-content/uploads/2020/04/Coronavirus-Anxiety-Workbook.pdf) from The Wellness Society. # COVID-19 High School and College Student Curriculum - Start Here Welcome! Please review this introduction to the high school/college materials. **Author:** Jessica Laird, MS3 \[1] **Faculty Reviewers:** Ned Palmer, MD \[2], Gene Beresin, MD \[3], Ms. Livia Rizzo \[4], Ms. Erin Martin \[4] **Student Reviewers:** Chandler Moore \[1], Katie Kester \[1], Kendall Carpenter \[1], Priya Shah \[1], Rachel Reardon \[1] *\[1] Harvard Medical School, \[2] Boston Children’s Hospital, Division of Medical Critical Care, \[3] Massachusetts General Hospital, Department of Psychiatry, Child Psychiatry Service, \[4] Teachers, Harvard Medical School MEDScience* ## Who is this curriculum for? This curriculum is for high school and college students interested in learning more about COVID-19, science, medicine, and more! You don’t need any previous medical experience to work through this session -- just make your best guesses, use what you know, and you will do great. ### How to use this lesson: This lesson is a simulated patient case, where you will meet an imaginary patient coming into the hospital. You will go through the process of diagnosing and treating the patient like a doctor would. The case is meant to be interactive and includes quiz questions throughout to keep it interesting and make you think critically. We do not expect that you will know all the answers to these questions as they would be difficult for even many first year medical students. Just answer the questions to the best of your ability, and the correct answer with information on how to proceed will be revealed to you. More information on medical simulation and telehealth is included in the introduction. If you come across terms that are unfamiliar to you, jot them down on a piece of paper. They will likely be addressed later in the curriculum but if they are not, you can do a quick Google search to find the answer. \ The Case Part 1 introduces you to your simulated patient and has you begin the process of diagnosing and treating the patient. Then, there is a Learning Point lesson on the disease COPD. The Case Part 2 brings you back into the case of the simulated patient to complete the diagnosis and treatment. The Case Wrap Up does a deep dive into the patient’s disease and teaches you about the disease COVID-19. Finally, the section on Caring for Yourself and Others is meant to address another vital topic -- the social, psychological and emotional impact of the COVID-19 that you may be experiencing and how to build resilience and take care of yourself in this challenging time. ### How long will this curriculum take? This curriculum should take 2-3 hours to complete if you go through it completely. It is divided into sections so that you can split up completing the lessons over time. ## Goals: *Students who complete this lesson should:* * Develop familiarity with the epidemiology, basic virology, presentation, and treatment for COVID-19 * Understand the basic biology and features of Chronic Obstructive Pulmonary Disease (COPD) * Gain a general understanding of how medical teams care for patients with COVID-19 * Learn the basics of ventilatory support for patients with respiratory failure * Understand the basic biology, features, and treatment of Acute Respiratory Distress Syndrome (ARDS) * Appreciate the emotional, social, and psychological toll of the COVID-19 pandemic and have an understanding of the skills and resources students can use to support themselves and others ## Objectives: *At the end of simulation, students should be able to:* * Discuss the appropriate use of different types of personal protective equipment * Describe how smoking damages the respiratory system and leads to COPD * Explain how novel viruses emerge and what features of a virus enable it to cause a pandemic * Describe the signs and symptoms of a patient with COVID-19 and what complications may emerge * Explain how ventilators and their various settings help patients breathe * Discuss the different public health strategies (quarantine, isolation, contact tracing, physical distancing, flattening the curve) to contain the spread of and reduce mortality from COVID-19 * Name the emotional, social, and psychological impact that the COVID-19 pandemic may be taking on individuals, families, and communities * Describe positive coping skills and know of resources to help people get through the emotional, social, and psychological challenges of the COVID-19 pandemic ## Are you interested in a medical student tutor? COVID-19 Classes for Kids (CCFK), spearheaded by medical students at the University of California, San Francisco (UCSF), is mobilizing health professions graduate students across the USA to teach these modules to children who are currently “sheltering in place” at home. If you or your child/student are interested in working through this curriculum with a medical student tutor, please [fill out this form](https://docs.google.com/forms/d/e/1FAIpQLScw9HAE9FDWLBmEbcC3DSrSABlKuJ6rGaoO6rA-6abwQ-LflQ/viewform). ## Table of Contents [**Caring for Yourself and Others during COVID-19**](/high-school/covid-19-high-school-and-college-student-curriculum/caring-for-yourself-and-others-during-covid-19) [**Case Introduction:** Simulation, Telehealth, and PPE ](/introduction-simulation-telehealth-and-personal-protective-equipment-ppe/introduction-simulation-telehealth-and-personal-protective-equipment-ppe) [**Case Part 1:** The Man who Lost His Breath](/introduction-simulation-telehealth-and-personal-protective-equipment-ppe/untitled) [**Learning Point:** What is COPD?](/introduction-simulation-telehealth-and-personal-protective-equipment-ppe/learning-point-what-is-copd) [**Case Part 2:** The Iron Lung](/introduction-simulation-telehealth-and-personal-protective-equipment-ppe/case-part-2-the-iron-lung) [**Case Wrap Up:** What Happened to the Man who Lost His Breath?](/introduction-simulation-telehealth-and-personal-protective-equipment-ppe/wrap-up-what-happened-to-the-man-who-lost-his-breath) # Lesson Plans for Teachers Teachers and parents are encouraged to use these guides to plan a class session. **How to use these lesson plans:** Below is the case manual and case lesson plan for you to download if you want to teach this class to your students virtually. We suggest having 2-3 people teaching the simulation if possible -- one to act as a consult, and one to act as the patient. The powerpoint is included so that you can display different lab values, images, or vitals throughout the case. Even if you are unfamiliar with clinical medicine, walking through this curriculum yourself with the guides provided should help you to guide students through the materials as well. Encourage them to research questions that you may not know the answers to, and remind them that learning is a lifelong process - especially during this pandemic! A key part of implementing this curriculum is offering students support and space to process their emotional reactions to this pandemic. We recommend assigning a reflection exercise upon completion of the case and giving students the handout “Caring for Yourself and Others during COVID-19.” This lesson has been taught over Zoom with multiple schools in the Boston area, typically taking place over two one-hour sessions, with one teacher acting as a consulting attending, one teacher acting as the patient, and one teacher acting as classroom manager, utilizing the chatbox to engage students, manage breakout rooms, etc. However, it can be taught in as little as one hour if you need to condense it. If you would like to discuss the optimal way to implement this curriculum in your classroom, reach out to ****. If after reviewing the materials you still feel uncomfortable moderating the case, medical students across the country have been side-lined from clinical duties and are looking for ways to get involved. Consider reaching out to a local medical school and see if they have students who would be interested in guiding this case for your students. Contact **** for more info and visit to connect with other medical student-led outreach groups. **Case Manual:** [**https://docs.google.com/document/d/1eOvd4jhiHxkQv4yUMGrzY73YwlbG0HdJYIoBWAnep10/edit?usp=sharing**](https://docs.google.com/document/d/1eOvd4jhiHxkQv4yUMGrzY73YwlbG0HdJYIoBWAnep10/edit?usp=sharing) **Case Lesson Plan:** [**https://docs.google.com/document/d/1IpufysRX\_qRYnYmSeDSNymn5Dj9LcsFUsQ\_tgWXlWxQ/edit?usp=sharing**](https://docs.google.com/document/d/1IpufysRX_qRYnYmSeDSNymn5Dj9LcsFUsQ_tgWXlWxQ/edit?usp=sharing) (these files are available for viewing on Google docs, as well as download to Word Doc or PDF) **Powerpoint:** {% file src="/files/-M5UlepXY8At3e9E2rYg" %} High School Case Module Powerpoint {% endfile %} Link to blank virtual whiteboard for students to fill out as they complete the case (use as google doc link sent to students participating, shared on screen during part 1 of case, available for download): [**https://docs.google.com/document/d/1wGxtsR2S8eWQIY\_r2z553eiyn7KzMvpWMdSwymOvMak/edit?usp=sharing**](https://docs.google.com/document/d/1wGxtsR2S8eWQIY_r2z553eiyn7KzMvpWMdSwymOvMak/edit?usp=sharing) Link to example completed virtual whiteboard (completed by students in Boston-area school on Zoom):\ [**https://docs.google.com/document/d/12vHnKnAMGfrpStgGrelwOUKgMD8lM0Flglc1aOa8tlA/edit?usp=sharing**](https://docs.google.com/document/d/12vHnKnAMGfrpStgGrelwOUKgMD8lM0Flglc1aOa8tlA/edit?usp=sharing) [**Caring for Yourself and Others during COVID-19**](/high-school/covid-19-high-school-and-college-student-curriculum/caring-for-yourself-and-others-during-covid-19) [**GUESTBOOK LINK**](https://forms.gle/r9KRC4u89HDtCAJo7) [**FEEDBACK LINK**](https://forms.gle/CtWEwbS92x9qJVNP8)\
# Caring for Yourself and Others during COVID-19 This section was written by Rachel Reardon, Jessica Laird, and Gene Beresin, MD and adapted from the [Clay Center for Young Healthy Minds](https://www.mghclaycenter.org/parenting-concerns/11-self-care-tips-for-teens-and-young-adults/) and [UNICEF](https://www.unicef.org/coronavirus/how-teenagers-can-protect-their-mental-health-during-coronavirus-covid-19) ## Reflect It’s important to take some time to share your emotional reactions to this very unusual situation. Taking time to express your feelings and share your responses with your friends and classmates can help you realize that you are not alone in what you are experiencing. There are strategies that can help you cope with how current events are impacting you. This reflection and group expression is an important part of building your resilience, and helping those around you do the same. We want everyone to appreciate that we need to build resilience as it is helpful in managing stress, building our own immune system, and helping ourselves and others -- a key part of understanding the management of COVID-19 is taking care of yourself socially, psychologically and emotionally. While guidelines for physical distancing are important and effective, they have also disrupted our lives in profound ways. Losing your daily routine can be unsettling, and being separated from friends and family members can add another layer of stress to this experience. This pandemic is affecting everyone, and can bring up a wide range of different emotions in each person. All of these, from anxiety and worry to hope or optimism, are completely normal reactions, and may come and go in waves over time. Just as it’s important for us to understand what this virus is and how we can combat it, it is crucial to take stock of what we are experiencing during this time and be intentional about caring for our own well-being. Take a moment to express what you’re feeling. Some ideas for reflection to get you started may include: * **Frustration** at missing out on experiences you were looking forward to, like concerts, sports games, performances, parties, jobs, internships, and graduations * **Uncertainty** about what’s coming next - How long will this last? Will my summer job/internship be affected? What about college? How will my family’s economic situation be affected? How will my grandparents and older relatives be affected? * **Worry** about loved ones who are sick or out of work, concerns about our financial well-being, worry about grandparents and older relatives * **Annoyance** with family members * **Confusion** from all of the information and opinions being shared * Feeling **overwhelmed**, anxious, depressed, and/or lonely * **Missing** your friends, teammates, classes, practices/rehearsals, routines * **Gratitude** for certain people or resources that are supporting you * **Hope** that things will improve soon ## Self-care Once you’ve given yourself the space to express what you’re feeling, it’s important to identify strategies to care for yourself. This time can provide an opportunity both to return to practices that have been effective for you in the past, as well as try new tactics. Some ideas may include: 1. **Get scheduled.** Dedicating even 15-20 minutes a day to engage in activities that help you check-in with yourself can make a huge difference. You might try doing this first thing in the morning, just before you go to bed, after you take a shower, or at some other specified point in your daily routine. 2. **Get creative.** Have you always wanted to try drawing? Do you have an instrument that’s starting to gather dust? Do you enjoy writing but can never find the time? Whatever form of expression you like, commit to engage in practicing it regularly. Now is also the perfect time to learn a new art or skill, and you can find countless free tutorials on YouTube or online. Or, ask a family member to teach you their favorite knitting stitch or dinner recipe! 3. **Get active.** Keeping your body moving is amazingly beneficial to both your physical and mental health. Though gyms might be closed, there are many ways to get exercise at home! Go for a walk or run outside, try an [online yoga class](https://www.youtube.com/user/yogawithadriene), practice [bodyweight exercises](https://www.fitnessblender.com/videos), have a dance party with your family or over FaceTime with a friend - or come up with a brand new movement practice of your own design! Exercise is an incredibly effective way to reduce anxiety, strengthen your immune system, and boost your mood. 4. **Get connected.** Though physical distancing means that you can’t see many loved ones in person, there are lots of ways to keep in touch! Phone calls, group FaceTime/Zoom parties, and social media can all be great ways to maintain relationships while you’re apart. Though this isn’t the same as being together in person, everyone is going through this together. Sharing your feelings with people you trust, and giving them the opportunity to do the same, can help you both feel supported. Be sure to also take time to have fun! Try virtual board games, watching a movie at the same time, gaming together, or starting an online book club. 5. **Get quiet.** While staying connected with others is important, knowing when to turn the screens off is just as valuable. Consider setting aside time everyday away from your phone and computer to share a meal with your family, focus on homework, read a book, or settle into the flow of the creativity and exercise practices that you love most. You can also start keeping a journal. Fill it with your thoughts, reflections, news clippings, photos of where you are and what you’re up to. This is a profound moment in history, and keeping a personal record of what you’re experiencing can be very therapeutic. 6. **Get mindful.** Now is also a great time to engage in meditation - check out [this article](https://www.mghclaycenter.org/hot-topics/mindfulness-a-practical-guide-toward-personal-peace-and-resilience/) to learn about all of its brain-boosting benefits! Many people find that phone apps like Calm and Headspace make it easier to adopt a regular meditation practice. There are many different types of meditation, but all can help you feel more grounded and present, especially when the world around you feels tumultuous. Which of these strategies have you found helpful in the past? What are some new ones you want to try? How will you make these activities a priority in your life? Come up with your own action plan, and keep it somewhere that you can refer to regularly to hold yourself accountable. As you write, consider what obstacles you might face: Do you share a limited physical space with others? Can you find a private place at home? How much time do you have to spend on studying, contributing around the house, or caring for others? What resources are readily available to you? Come up with how you will address each of these potential challenges. Can you compromise with family members on dedicated quiet time? Would setting up a schedule help you stay on track? Are there friends/family members in your life who might want to try some of these activities with you? You can visit [https://www.mghclaycenter.org/self-care/](https://urldefense.proofpoint.com/v2/url?u=https-3A__www.mghclaycenter.org_self-2Dcare_\&d=DwMGaQ\&c=WO-RGvefibhHBZq3fL85hQ\&r=XqKKuOynfAI9fTQssVMFXMKYXiAQMX0mHeVfLlhZ-H0\&m=ki2_Qslt3JBgHQHcMYUFIU0wJPbM1UO966yOb46Z1e8\&s=MCzXV8QPmnDXWBhTTiTCNWvP3iFHVG42Mhvo_xDINdY\&e=) for more ideas to build your resilience through self-care. You might consider working through the self-care videos and Activity Toolkit at home or with your teachers. ## Cultivate resilience Taking care of yourself in these ways is a springboard for you to cultivate resilience within yourself, your family, and even your community during this pandemic. * **Reach out** to people in your life who may feel isolated or alone. * **Contribute** to chores around your house, and consider planning fun dinners or special game/movie nights for everyone to enjoy together. * **Contribute** to your community. See if your school district would be interested in having volunteers virtually tutor younger students while they learn from home. Find out if there are donation efforts in your community to help provide PPE to medical workers. Write/email thank-you notes for front-line workers in healthcare, grocery stores, delivery trucks, pharmacies, and other industries. * **Limit** your news media viewing, and be mindful about the media you consume and share with others - look for information from sources like the [WHO](https://www.who.int/), [CDC](https://www.cdc.gov/), and medical institutions (like [Mayo Clinic](https://www.mayoclinic.org/coronavirus-covid-19) or [Harvard Health Publishing](https://www.health.harvard.edu/)). * **Use humor!** During times that are dark, sharing a joke, comedy video, or favorite funny story can lift spirits and help you and your loved ones through this pandemic. * Above all, be sure to wash your hands, follow physical distancing guidelines, and be kind to yourself and others. Though there is still a lot of uncertainty, remember that this is only temporary! Researchers are hard at work developing treatments and vaccines, and we will be back in school, at work, and with our loved ones in the not too distant future. ## Reach out Change can be very difficult and take a large toll on our mental health, our relationships, and our coping mechanisms. Needing some extra help to deal with this unprecedented and stressful time is absolutely normal and there are many opportunities to talk to a professional while maintaining social distancing, such as video-chatting or talking on the phone with a therapist or psychiatrist. If you don’t know how to find someone you can talk to, you can reach out to your pediatrician, who can connect you to professionals in your area. It is especially important to reach out for help: * **If you have thoughts of hurting yourself**: It's not unusual for young people to have suicidal thoughts or feelings. The [Youth Risk Behavior Survey from the CDC](https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trendsreport.pdf) reveals that about 20% of high school students seriously think about suicide. This is normal in times that feel desperate. However, it's one thing to have fleeting thoughts about harming yourself and actually consider or plan action. If you have these thoughts or feelings, it's super important to reach out for help. If you or someone you know is struggling, please call the Crisis Hotline at 1-800-273-8255 or Text "HOME" to 741741. * **If someone is hurting you**, including physical violence, sexual violence, psychological aggresion, or stalking: Intimate partner and domestic violence can look like many different things, from being hit or kicked, to receiving unwanted sexual advances online such as sexting, to using words to exert complete control over another person. The [CDC](https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html) estimates that 26% of women and 15% of men experience intimate partner violence for the first time before turning 18. Some experts worry that if you experienced violence at home in the past, the fact that we are all in isolation at home may make some kids and adults fear danger -- perhaps a repeat of the past. If you feel that you or others are at risk, please be sure to contact someone for counselling or home help at the Hotline. If you or someone you know is being hurt by another person, please call the Domestic Violence Crisis Hotline at 1-800-799-7233 or go to to chat with a live representative. * **If you are turning to alcohol or drugs to cope**: During stressful times, people often use substances as a way of controlling or quelling negative feelings, however it ends up doing more harm than good. Alcohol and drugs may act as a temporary escape from your problems, but will not help you deal with them and may take a negative toll on your physical and mental health and your relationships. For those of you who struggle with an addiction: smoking, vaping, or using substances, please contact your counselor or primary care physician to obtain resources to help you through a potentially very rough time. It is not safe to go out and obtain drugs, nor have them brought to you. Learning to become abstinent is tough! However, counseling and AA groups are available online. Reach out for help if you need it! One resource is the Substance Abuse and Mental Health Services Administration (SAMSA) at 1-800-662-4357 to get connected to services that can help. * **If you are smoking or vaping**: Vaping or smoking cigarettes marijuana can [more than double](https://www.massgeneral.org/children/vaping/smoking-vaping-and-covid-19) your chance of developing serious complications from COVID-19 by weakening your body’s natural defenses against disease. It is important to make every effort you can to quit smoking or vaping. The nicotine patch, gum, and other prescription medications can be prescribed by your doctor and many find them very helpful in quitting. Two common quit lines for coaching and support are 1-800-784-8669 and SmokefreeTXT. Text the word “QUIT” (7848) to IQUIT (47848) for free help. * **If you are having a lot of conflict with your parents**: Self-isolation can be an opportunity to spend time and reconnect with your parents, however, it can also be a time where there is more conflict with your parents. It is normal for there to be more conflict when you have fewer things that you can be doing outside of the house, are spending more time together, and are feeling more stressed. Make sure that you are able to have some alone time, whether that be having time in your room or other private space in your home, going on a walk by yourself, using meditation or relaxation apps, or watching a movie or listening to music. Both you and your parents should do what you can to communicate and reduce conflict. There are resources for individual and family counseling online if you want to consider getting some professional advice. Your parents can contact your primary care physician for a referral. # Summer Activites **Student Authors:** Margaret Irwin, Katie Kester, and Allison Fialkowski *(Harvard Medical School)* **Contact:** **Faculty Reviewers:** Jennifer Pitt-Lainsbury, *High School and Middle School Administrator, University of Toronto Schools* Donna Fialkowski, M.Ed., *Special Education Teacher, Atlanta City Public School System* Juliana H. Chen, M.D., *Child and Adolescent Psychiatrist, Massachusetts General Hospital/Harvard Medical School and Newton-Wellesley Hospital* Rachel Conrad, M.D. *Child and Adolescent Psychiatrist, Boston Children’s Hospital, Harvard Medical School* **Student Reviewers:** Mengting Qiu, Chandler Moore, Rachel Reardon *(Harvard Medical School),* Toke Odimayomi *(Harvard T.H. Chan School of Public Health)* ## The Tournament of the Summer! During this time of uncertainty, we need **resilience,** or the ability to recover from difficulties. This summer, you will begin the Tournament of the Summer - a challenge to invest in yourselves to develop resilience. Pick one challenge a day. When you complete the daily challenge, give yourself a point. If you forget to do a challenge one day, don’t worry- just pick a challenge the next day. Compete against friends, family, or just try to see how many tasks you can complete. When you earn 14 points, give yourself a reward! **Step One: Pick a reward.** My reward for winning 14 points is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Ideas for rewards:* Picking dinner out for the family that night, having a movie day, or buying yourself a present you have been saving up for. If you can’t think of a reward, try asking your parent/guardian to see if they may be able to think of something. **Step two: Pick a different challenge each day.** ![Click the chart to print it out and track your progress!](https://lh5.googleusercontent.com/5hAM4kv4CTOZJNXQOfv8RTQOmp-O_xiKoxTUNLVHC0QWdeQe18TQCkRb8_D6g_j9cU9ZULw3qH0XXnJpJqtoB3iYntG1Hhy0Y0-s7cqWen2sQjIm6cN3XQ6vKjO7fVWoiI1UfKbZ) **Domains of Care:** * **Personal Self Care:** * **1 point**: Spend some time off social media (30 minutes). * Spend time without social media, off of your phone, and away from friends or family. * You can read, take a walk, or sit outside--just take some time for yourself. * Want to learn more about why being alone may be helpful? Click here: * **1 point**: Find a “junk drawer” in your house or a messy closet, and clean it out. You could also organize the photos on your phone or files on your computer. If you can’t think of a space, try asking a parent/guardian if they have an idea in mind. This may be a small space, but starting a task like this and then finishing it will mean that you have completed something that is pretty difficult in one day - that’s pretty cool! * Need some inspiration? Try Marie Kondo: * **Physical Self Care:** * **1 point**: Get enough sleep, but wake up at a reasonable time. * Today: pick a bed time, and stick to it. Put your phone away from your bed, and set an alarm to make sure you get at least eight hours of sleep. Set your bedtime for tonight as a time that will allow you to get up early and enjoy the next morning. * Sleeping can be hard when your routine has changed so much. One app that may help is the app “Calm,” which has sleep stories and meditation that are available for free: * If you want to get better at tracking your sleep, here are some apps that may help: * * **1 point**: For a whole day, make half of your plate fruits and/or vegetables. * Fruits and vegetables can often be expensive, but canned or frozen fruits and vegetables are more affordable and can be just as yummy. Plan this challenge ahead of time with your family to be ready to have a healthy day! * For more ideas of inexpensive and healthy food options: * **1 point**: Set a SMART goal to improve your physical activity or self care. SMART goals () are Specific, Measurable, Actionable, Realistic, and Time-Specific. Post the goal somewhere that you see regularly, like your fridge or the door to your bedroom, and try working towards that goal. * Here are some examples: * In order to take better care of my teeth and avoid having a cavity, I will floss my teeth at least five nights a week at night before I go to bed for the next two weeks starting tonight. * To make sure I keep my body healthy, I will go on a walk for fifteen minutes a day after lunch everyday for one week starting this Sunday. My mom wants to stay healthy too, so we can do this goal together. * Here is a worksheet to get you started: * **Emotional Self Care:** * **1 point:** Positive self talk. You are an incredible person with so many talents and great traits. Today, write a list of ten things that you like about yourself, such as how kind you are to your siblings or how good you are at video games. Put this list somewhere safe, so that you can remind yourself of all the ways you are special when you are feeling down. * **Psychological Self Care:** * **1 point:** Journal. You are living through an important moment in history right now. Write one page about your daily life and the emotions you are feeling during this time. You may want to look back at this time and reflect on this when you are older, so try to keep this somewhere special. * **1 point:** “Happiness” list. It is so important to know what makes you happy. Make a list of five simple, inexpensive things that make you happy. Do you feel happy when you curl up in a chair and read? Or when you play videogames with your sibling or friend virtually? Or make a pot of tea for yourself and a family member? Save your list so that when you are feeling down, you can pick an item that may lift up your mood. Do not forget to add the people who you can talk to or call and who make you feel happy, such as relatives or friends! ![Today I'll be happier than a bird with a french fry. | Typographic ...](https://lh5.googleusercontent.com/ZGcA0-y3EI9q4PWi93PpEYI8kIxsOTJ1QaaJPe8rVfB7mknBNO4wtz8WNk1plGbklUj19w6FT7PfoJ4EivKlBoXjNzdwaMOWgaIuV0AcUqQnLX7LpAx9XnJpM_3ofz8-Iu4Xwad8) * **Spiritual Self Care** * **1 point:** Practice mindfulness. There is no one best way to practice mindfulness. Some people practice mindfulness when they are mindful of their body during yoga. Other people practice mindfulness when they savor a meal and slowly enjoy each bite of food. Pick one way that you would like to be more mindful, and try it out- then give yourself a point for it. * Here are some more ideas of how to practice mindfulness: * The app “Calm” also is helpful to practice mindfulness: * **Academic Self Care:** * **1 point:** If you were able to travel anywhere in the world right now where would you go? Plan your perfect trip to a country you have never been to and try to learn as much as you can about it for twenty minutes. You can use videos, the computer, your phone, or a book around your house. You can even learn about a country by asking a family member or friend who has traveled there. Then tell a family member or friend about what you learned. * **1 point:** Read something for twenty minutes: * You can read or listen to a book if you have access to one, or you can read an article on the computer or phone. Don’t forget to check out your local library for access to books, ebooks, and articles as well. Below are links to some interesting articles to read! * * * **Care for Others:** * **1 point:** Make a list of classmates who you have not talked to since school let out, but who you liked saying hi to. Text or call one of them to check in and see how they are doing. It is okay if this feels awkward or if they do not reply, but in only one or two minutes, you could brighten their day by just saying “hi!” * **1 point:** Call a family member who may not have many people visiting as often due to coronavirus (or write a letter!). * **1 point:** Ask your parent/guardian if you can help with a chore today. When you help your family, you are giving back to your community in a really great way. Thank you for taking care of the people in your life! Below are some suggestions for possible things you can help with (from ). ![](https://lh3.googleusercontent.com/P6nBhHXTakWQl_bh0PqWsg5jWT66T9J_n6llgT0KMjhzfMci55qOgTYi0MCWFjjttCm_Mm0ryM8kzcZBBU5A_kG9rSC5hT3PEGSIKJqkZSmXwCB-dMhJ1OLc16RyDcvmsgNwie8S) * * **1 point:** Write a letter or email to a teacher or coach saying how much you appreciate them! If you are writing a letter and do not have a specific address, you can send it to your school, and they will likely be able to give it to the teacher when they go back to school. This person will be so happy to hear from you! # High School and College Learning Modules You are about to learn some of the basics of clinical medicine and meet your patient, Bob. We encourage students to take notes as you go, and record your answers to the check-in quizzes as you work through them. The quiz questions are intended to help you learn, and there are extra resources included in some of the answers for you to explore if you are interested. You are welcome to repeat the quizzes more than once to assist you in your learning. **Let's get started!** # Introduction: Simulation, Telehealth, and Personal Protective Equipment (PPE) ## **What is telehealth?** * Telehealth is a way to provide medical care using the phone or other technology. It allows patients and providers to connect and provide care while being physically separate. * In this case, you will be a telehealth provider, interacting virtually with this patient who is in a remote clinic. **What is medical simulation?** ![](https://lh4.googleusercontent.com/JuuKhFWRrpQfjjpyzDCqmsWHqdPb42TyXC6Ns7rkIEJKVr0zUcuQtYasy9FDF_VG6HrAZW_8vaEkj3AiKSwcBLH1daWmPUdXlbKHFHm2HUFIjJgGSXWgPBUK6AFCPTxgOZhcELCc) Source: [Feinberg School of Medicine](https://www.feinberg.northwestern.edu/sites/simulation/images/homepage-images/clinical-sim-550-310c1.jpg) * Medical simulation is a way to train healthcare providers using simulated patients (either mannequins or actors) to practice essential skills, such as taking a medical history, doing a physical exam, or delivering news to a patient. It allows healthcare providers and/or students to learn in a safe zone where no real patients can be harmed. It does require some suspension of disbelief (or pretending like the case is a real-life situation) in order to get the most out of the scenario. * You will be part of a medical simulation case by completing this curriculum, where you act as the student-doctor to diagnose and treat this patient. * In this scenario, the patient is reporting to a hospital emergency room. To limit the exposure of hospital staff to the patient, only the nurse and attending doctor will interact with the patient, but they are very busy taking care of many patients. You are a team of doctors-in-training who will interact with the patient over telehealth and will be key to diagnosing and treating the patient. ### **What is personal protective equipment (PPE)?** PPE is equipment meant to protect the wearer from illness or injury due to occupational hazards -- for example, protect hospital workers from infectious diseases, construction workers from falling objects, or factory workers from dangerous chemicals. It is important to keep people safe and healthy. ### **What are examples of PPE?** ![](https://lh4.googleusercontent.com/WMQ1KNhSGYlm2XxUP_nuJVDXSKkyPxB86Iub258Ewiv373taR_h4yuPaliCpgsEVnbIn_fjPCOVwLM0LueM8cvT9eKGlI284lRQLyK82__Spjrl_eIVIwNvQ3rHz9z1TlRqDRcM0) Source: [CDC](https://www.cdc.gov/coronavirus/2019-ncov/images/COVID-19_PPE_illustrations.jpg) [**Masks**](https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf)**:** * **N95 mask** - protect yourself * Able to filter 95% of aerosolized virus particles from the air - protects wearer from airborne viruses * Tight fitting * Needs to be professionally fitted (e.g. cannot wear with beard) * **Surgical mask** - protect others * Protects wearer from large airborne droplets and splashes * Protects others from the wearer’s respiratory emissions * Loose fitting * Does not filter small viral particles and air is able to leak in around edge of mask * When user inhales, may still contract airborne viruses * **Cloth mask** - protect others * Similar function to surgical mask with less information known about its effectiveness ### **Other Types of PPE for Hospital Workers:** * Gloves * Gowns * Goggles * Face shield * Shoe covers * Full body suits * Respirators ## **Why has PPE been in the news a lot recently?** There is currently a shortage of personal protective equipment around the world. It makes healthcare workers nervous that they will not be able to keep themselves safe when working with patients who are sick. However, there are a lot of efforts to increase the amount of PPE available to healthcare workers -- for example, in Massachusetts, the governor and New England Patriots teamed up to bring [1.2 million N95 masks](https://www.wsj.com/articles/a-million-n95-masks-are-coming-from-chinaon-board-the-new-england-patriots-plane-11585821600) into the US for healthcare workers to use. You can help by donating any surgical or N95 masks that you have to hospitals and first responders and helping to make cloth masks for others. ### **Who is the ideal wearer of each type of mask during the COVID-19 pandemic?** ![](https://lh4.googleusercontent.com/K_VdfAFSdiz7jB0t3fBUwoQlM0MlB_rhU4UQtL-5fNiMvBmdPI01ah-yM1a2hzsNivQzPKHlFwofR6aLWkZnSKqF9qNv88C6OSsA8UwQBHZuUFk0ATide6O23Y9NEIuw3zLHiZfz)![](https://lh6.googleusercontent.com/qALT90-WKEJs_Fa_HigG8JHCrj9nAqOLSqBAVeHNCSZfJIoaVNbObRmpKN6M4d1jRLVkfuSPWTwwoXIBxocnjz15Jzf6LdbhY2K4mwFm9Me2tXwU5eWx_HhQYE4eAiwr5BcvEw9_) **Source:** [**CDC**](https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html) * **N95 Masks:** hospital workers * Keep healthcare workforce safe from contracting COVID-19 as they work with patients * **Surgical face mask:** people who are sick * Keep the patient from spreading COVID-19 to others that they interact with * **Cloth masks:** general public * Slow the spread of the virus and help prevent people who may have the virus and do not know it from transmitting it to others * However, this does not serve as a replacement for physical distancing, handwashing and important safety precautions. * [**Info from the CDC on how you can make cloth masks at home.**](https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html) ## Check-in 1: Complete the quiz below before moving on to the next module. {% embed url="" %} # Case Part 1: The Man who Lost His Breath ## **Instructions:** It’s time to meet our patient, Bob! Below is the transcript of your interview with him in the Emergency Department. You’re going to be asked to think like a doctor here to help diagnose and treat this patient! ## **The Interview** When you are interviewing a patient, you need to collect a lot of key information: * **Who are they?** * Name, age, gender * **What is their overall health like?** * Past medical history -- any diseases or medical problems they currently have or had in the past * Past surgical history -- any surgeries they’ve had * Medications * Allergies * Family history -- any diseases that run in the family * Social history -- What is their life like? Do they work? Where do they live and in what type of conditions? Who do they live with? Do they drink, smoke or use drugs? * This helps us understand potential causes of their medical condition, as well as develop a treatment plan with the patient that is compatible with their lifestyle. * **Why are they here today?** * Chief complaint -- What is the #1 problem that brought them into the hospital today? * History of present illness -- the storyline behind this problem that brought them into the hospital ### **While you are reading through the interview, print this table or create a similar table to fill out with your notes to keep track of all of the information you learn:** | Interview Notes | | | --------------------------------- | - | | Name | | | Age | | | Gender | | | Chief Complaint | | | When did it start? | | | What other symptoms do they have? | | | Any other important information? | | | Past Medical History | | | Past Surgical History | | | Medications | | | Allergies | | | Family History | | | Social History | | **Student Doctor (You):** Hi, it’s nice to meet you! I am the student doctor who will be taking care of you today. What is your name? What is your age and what gender do you identify with? **Bob (Patient):** My name is Bob and I’m 65 years old. I identify as a man. ![](https://lh6.googleusercontent.com/GGDtrKZRHAn6DQmuPJbufXEyOjx2gLxOnWfGvgco5sZkiaHzygPV_LxGe6Z2aS0GZGEIvvKBT1m9M5b_1taeelHoVD_0Z7orlf7rsZxLMDLvBlmCAsVrvaiuiLkTMnBpGXRnax2U) Source: [Verywell Health](https://www.verywellhealth.com/thmb/LDL2WghLx8tDzhzOm7St4glApf0=/400x250/filters:no_upscale\(\):max_bytes\(150000\):strip_icc\(\)/hospitalstay-5a32aa7e0c1a82003633338b.jpg) **Student Doctor (You):** I heard you’re not feeling so well. What brings you into the clinic? **Bob (Patient):** I’ve been having a hard time breathing. **Student Doctor (You):** Can you tell me more about that? **Bob (Patient):** It started about a week ago and keeps getting worse. I also think I’ve had a fever. I’ve been coughing and feeling really tired. I don’t know how I got sick because I don’t know anyone around me who has been sick. **Student Doctor (You):** What is your health normally like? **Bob (Patient):** I have a lung disease called COPD (more on this in the next section) and it affects my life a lot. I usually get a little short of breath when climbing stairs or walking long distances, and cough every day because of my COPD. However, I noticed I am much more short of breath than normal and have been coughing a lot more. **Student Doctor (You):** Do you have any other health problems? **Bob (Patient):** I also have high blood pressure. **Student Doctor (You):** Have you ever had surgery before? **Bob (Patient):** I had my appendix removed 40 years ago. **Student Doctor (You):** Do you take any medications? **Bob (Patient):** I take a pill for my high blood pressure and use some inhalers for my COPD. I don’t know the names. **Student Doctor (You):** Do you have any allergies? **Bob (Patient):** No. **Student Doctor (You):** Do any diseases run in your family? **Bob (Patient):** My father had a heart attack and my mom had cancer. **Student Doctor (You):** Can you tell me about your day-to-day life? **Bob (Patient):** I am retired -- I used to work in construction but can’t anymore because of my breathing issues. I live alone in an apartment in Boston. In the last 2 weeks, I have had a few doctor's appointments and had to go to the pharmacy to pick up medications a few times, as well as go to the grocery store. I used to smoke cigarettes and smoked 2 packs of cigarettes a day for 35 years, but I quit 10 years ago. I do not drink alcohol or use other drugs. ## Check-in 2: Complete the quiz below before moving on {% embed url="" %} ## Physical Exam **Nurse Morgan:** Would you like me to perform a physical exam on the patient? **Student Doctor (You):** Yes please. Could you pay extra attention to how the lungs sound? ![](https://lh6.googleusercontent.com/Oy-aRKCDf8rWsKoze4E-shaArA6f0ovy82PPcn4cIs_EbwvsmrvDqYdAMBlJAVCMVVn94NjIr5jVbzUG7mLSSq6ZTbAje-oqCjRAxsgT598hZkPytJCItwhgz0bOWw87UNSZlT8d) Source: [UCSD](https://meded.ucsd.edu/clinicalmed/lungs_auscutation.jpg) **Nurse Morgan:** Most of the physical exam was normal, however, the lungs do not sound clear. Here are the sounds I’m hearing in the lungs: [**Crackles**](https://www.youtube.com/watch?v=LHqqvrm2j6g) **and** [**Wheezing**](https://www.youtube.com/watch?v=T4qNgi4Vrvo) **Student Doctor (You):** Thank you so much. What are the patient’s vital signs? **Nurse Morgan:** | | **Heart Rate (beats per minute)** | **Blood Pressure** | **Temperature** | **Oxygen saturation** | **Respiratory Rate (breaths per minute)** | | ------- | --------------------------------- | ------------------ | --------------- | --------------------- | ----------------------------------------- | | Patient | 95 | 120/70 | 102F | 85% | 25 | | Normal | 60-100 | 110-140/60-80 | 98.6F | 95-100% | 12-20 | ### **Key:** **Heart rate -** also known as the pulse. How many times your heart beats a minute. **Blood pressure -** the pressure in your blood vessels when the heart is squeezing (number on top= systolic blood pressure) and when the heart is relaxed (number on bottom= diastolic blood pressure). **Temperature -** body temperature **Oxygen saturation -** percent of hemoglobin (protein in blood that binds oxygen) that is currently carrying oxygen **Respiratory rate -** how many times you breathe in a minute ## Check-in 3: Complete the quiz below before moving on: {% embed url="" %} **Nurse Morgan:** I rechecked Bob’s vitals after I gave him the treatment, here they are: | | **Heart Rate (beats per minute)** | **Blood Pressure** | **Temperature** | **Oxygen saturation** | **Respiratory Rate (breaths per minute)** | | ------- | --------------------------------- | --------------------------- | --------------- | --------------------- | ----------------------------------------- | | Patient | 95 | 120/70 | 102F | 90% | 21 | | Normal | 60-100 |

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| 98.6F | 95-100% |

12-20
Check-in 4:

| ## Check-in 4: Complete the quiz below before moving on {% embed url="" %} # Learning Point: What is COPD? ### **Have you heard of COPD? What does it stand for? What is it caused by?** * COPD stands for Chronic Obstructive Pulmonary Disease. * COPD is a combination of emphysema (destroyed lung tissue) and chronic bronchitis (long-term lung airway inflammation). * COPD is almost always caused by smoking. #### **What is the anatomy of the respiratory system?** ![](https://lh4.googleusercontent.com/zorHQMJHoSWwdiRQ0Yp1d3rjmzqCAlE8zGYowXH9Y7ZaoZ74VjLW9EZxsFYI_uGa4KwkTI4iJU-E9ELf7BiLb3VZipvT6GpVFzOZhEy8Zkgon3knI3zciovpYT_XveIB_DVKfORK) Source: [El Camino Hospital](https://www.elcaminohealth.org/sites/default/files/2019-05/respiratory-system-1200x630.jpg) * Mouth/nose, pharynx, larynx, trachea, bronchi, bronchioles, alveoli * For more information, here is a [Khan Academy video reviewing the respiratory system. ](https://www.khanacademy.org/science/high-school-biology/hs-human-body-systems/hs-the-circulatory-and-respiratory-systems/v/the-lungs-and-pulmonary-system) ### **What is the normal function of the alveoli?** ![](https://lh6.googleusercontent.com/APzvW99fe-M-HmeYkaCGZ5gclAIUfYTWU5IgQhNWIVwoA-Tqt6MtdlycO3sw2eI8aQv9rlmcEV8dOhnux_hllaCFjhU4NjKQPNsSUmZJ72sANPQwjlj0aMNMfFOWYypqJgXfF9wN) **Source:** [**GEN**](https://www.genengnews.com/news/alveoli-finding-may-offer-new-opportunities-to-treat-lung-damage/) * Just like balloons, the walls of alveoli are stretchy and elastic so that they can expand when you inhale and then deflate when you exhale. They are gathered together like a bunch of grapes and are surrounded by blood vessels. They have thin walls that allow gas to pass into and out of the bloodstream. This is how you get oxygen (O2) into the body and carbon dioxide (CO2) out. ![](https://lh4.googleusercontent.com/tWOkspa8BGV3Dl4pN-MF_KfU4RZFSeUBJHLgmp0CBPQryClm1uRpmbUAgO1zSkOAsaltwLkCZvh4WIXEWSn_rpnRC3SMFxk5LcvOv3OPtYOKpnqYXxjdEdx8eSPWV-MU95s8-1qA) Source: [Lumen Learning](https://courses.lumenlearning.com/boundless-ap/chapter/gas-exchange/) ### **How does smoking affect the alveoli? (Emphysema)** ![](https://lh4.googleusercontent.com/Gzdbi7js5iPjYJ5ALV6Z-Rf8ugaf0oTmNq4MrFSQPWG25RwFphe_N89bMCuajDGxUhbQNu6EF6Y8pTZBDZbG5xcExs93SwYWTqI4tVB2WSo9y3Lc5wBJgqZhunhUyDhcTHuLr0fN) Source: [Palo Alto VA](https://www.paloalto.va.gov/images/emphysema.jpg) * The toxic chemicals in cigarette smoke destroy the alveoli. * Smoking makes the alveoli less stretchy, causing air to get trapped. * Inflammation from the smoke destroys the protein in the alveolus that makes it stretchy and elastic, called “elastin.” Since the alveoli can no longer spring back after being filled with air, air gets trapped in the alveoli. This traps CO2 in your lungs, and when you take your next breath, you can’t bring in as much new oxygen. * Smoking makes the walls of the alveoli thick, so oxygen cannot travel across them well. * Smoking eventually destroys the alveoli so the lung is made up of large holes rather than healthy lung tissue. ![](https://lh6.googleusercontent.com/zoRaYwCwpKyuRNBLOMPtNKm5SZzoqvmjHtrY_K6KmTClr__RnPgMzafWXgEjtU9H3k-yvmMX2kZZ5eelRq1MRqxbcGbWmvILmdI4TvlntsdciAX4uYxnaaHkR7NRYNvaqOrcfkZX) Source: [MedicineNet](https://www.medicinenet.com/smokers_lung_pathology_photo_essay/article.htm) ### **How does the body prevent bacteria and dust that you normally breathe in from infecting your lungs?** ![](https://lh5.googleusercontent.com/_j24dyX_rJmGW-jn5LcGOvjxM0dOvF--nhDZ7PeJuZUw5K9mi5-imO_m2hT7KxvpWKkLSMcazTMLKwyMMpZnOBUubwHTtigIVtQzyUstTwRPKmdqYRGmshm4gsGMZhqsgfgETfUY) Source: [Frontiers](https://www.frontiersin.org/files/Articles/458896/frym-07-00106-HTML-r1/image_m/figure-1.jpg) * Your body produces sticky mucus that can trap invading bacteria or inhaled dust and prevent it from getting deeper into your lung tissue. * It then has to get rid of the mucus. One group of airways, called the bronchi, have little finger-like projections, called “cilia,” that move the mucus up into the trachea so that you can swallow it or cough it up. This system of mucus + cilia is sometimes called the “mucociliary escalator” (see the picture above!) ### **How does smoking affect the bronchi? (Chronic Bronchitis)** ![](https://lh5.googleusercontent.com/l9cHmcs0x9DqqHaKsDe0GZFQdWUai4RzLxW9CctnDM0_jJnasgpXM-ktPgeOxVfsRD_ziCbcBYC0K_KSssMHWRY6Kfi_8Ln7nnTlrxgvaHxteGghG3NIk6xpq9sdi_7zz6GRjJKP) Source: [CDC](https://www.cdc.gov/antibiotic-use/community/images/bronchitis-lg.jpg) * Smoking destroys the cilia and increases mucus production. This is why one of the symptoms of COPD is coughing with mucus. It’s harder to clear bacteria and easier for them to get into the lungs, which is why patients with COPD have frequent lung infections (pneumonias). * Smoking also decreases the diameter of the bronchi so that it’s harder to get air in. This is a combination of increased mucus inside the bronchi as well as inflammation causing the walls of the bronchi to thicken, so there is less room for air to flow to the alveoli for gas exchange. ### **Why is our patient more susceptible to a severe lung infection?** * COPD * Lungs are not able to clear infection as well. * Lungs at baseline are not working well. A person with healthy lungs can have a lot of their lung tissue temporarily not work, but still be able to breathe and maintain a normal oxygen saturation. This is because the rest of their lungs are working well and are able to bring in enough oxygen for the body. A person with unhealthy lungs does not have the reserve to take on this extra challenge, and may need mechanical help to continue breathing. * Age - our immune system is not as strong as we get older. # Case Part 2: The Iron Lung Here is a summary of our patient Bob, who we met in Part 1 of the case. * Bob is a 65-year-old man with past medical history (PMH) of COPD and hypertension, presenting with one week of worsening shortness of breath, fevers, cough, fatigue, and loss of appetite. * Vitals showed high fever, as well as low O2 saturation and a high respiratory rate (which partially improved after being given an oxygen mask). * Labs showed normal white blood cell count and he was negative for the flu. * CT scan of his chest showed bilateral, diffuse ground glass opacities in his lungs, consistent with fluid in his lungs. * Bob was admitted to the hospital for supplemental oxygen and close monitoring. It’s been a few days since Bob was admitted to the hospital and you are going to virtually check in with him. Before you talk to Bob, you check in with his nurse, who has some test results for you. **Nurse Morgan:** The test you ordered for COVID-19 for Bob came back, and it’s positive. ![](https://lh6.googleusercontent.com/ohsqWinf4Q0yHmL0jCW3fR3wX2QwAZFhiiskHAUXyL9TnpdySRTqD3i7aW0sa__IzEhDAhwtmbTptZ2YnHat13WKqfyMNMtyNUBRCWEwhUwhlg-AFIqfLwp-10AuP1Ad7OW41qF1) **Source:** [**Baycare**](https://baycare.org/newsroom/2020/march/baycare-to-launch-drive-thru-covid-19-testing-sites) ## Check-in 5: Complete the quiz below before moving on: {% embed url="" %} **Bob (Patient):** Thank you for telling me about my diagnosis, doctor. I have been having a really hard time breathing for the past few minutes, even though I’m still using the oxygen mask. Can you help me? ![](https://lh6.googleusercontent.com/az8jGrnfUHPkVNpDWa8SetH9gt-Kidye4NP5b9p0VRsrJI-hTPLWPUvIkY-RR7M4bP79Js9lAs3nyMfWYtXFE1-4xJp6W1rVMmpew4UeiOWmmDiuhanU_hQdPRJZn-v6a1Z0zn6A) Source: [Alamy](https://c8.alamy.com/comp/JAWFYG/unconscious-male-patient-lying-on-a-bed-with-an-oxygen-mask-in-a-hospital-JAWFYG.jpg) **Nurse Morgan:** The patient told me he has been having a hard time breathing so I retook his vitals. Here they are: | | **Heart Rate** | **Blood Pressure** | **Temperature** | **Oxygen saturation** | **Respiratory Rate** | **O2 flow rate** | | ------------------ | -------------- | --------------------------- | --------------- | --------------------- | -------------------- | ---------------- | | Patient (now) | 110 | 90/50 | 103.2F | 72% | 35 | 6 L/min | | Patient 2 days ago | 95 | 120/70 | 102F | 90% | 21 | 6 L/min | | Normal | 60-100 |

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| 98.6F | 95-100% | 12-20 | -- | ## Check-in 6: Complete the quiz below before moving on: {% embed url="" %} ## **What is intubation?** Intubation is the process of inserting a breathing tube (also called an endotracheal tube) through the patient’s mouth and into the trachea to assist with breathing. A patient can then be placed on a mechanical ventilator to breathe for the patient during severe illness or anesthesia for surgery. ![](https://lh4.googleusercontent.com/82pUwZEOXWSMDJjoAyFVsCuczcT19wxtTy_Q4sjZHv3N9_xbgiOAhD_IbtaSWL4XNamMCqs53javsPz1s1hxLnWfiJZo8PSWBV-otIAB2MoMzNHphduEnSxTx5GfkoMEzYLJB-98) Source: [VeryWell Health](https://www.verywellhealth.com/what-is-intubation-and-why-is-it-done-3157102) **Watch this** [**video from Covenant Health**](https://www.youtube.com/watch?v=FtJr7i7ENMY) **from 3:28-4:29 to learn about the intubation:** {% embed url="" %} ## **Check-in 7:** Complete the quiz below before moving on: {% embed url="" %} ## **What is a mechanical ventilator?** ![](https://lh5.googleusercontent.com/mCVix_IjHnC2MI1hd6OPT6EeAOcW-35kYeE8KwfbsQ0isg91_9BQ7_T7KnLf41SQLIA14JxjXoEqMy_rLIPTGJzH8GsoZpYB-xfsq7FgtJWbRUZk_A4cD_ta7t76JfstDh6vaqkq) Source: [Hackaday](https://hackaday.com/wp-content/uploads/2020/03/Ventilators_feat.jpg?w=475) Once the patient is intubated, he will be attached to a mechanical ventilator. A mechanical ventilator is a machine that helps patients breathe when they are unable to breathe on their own due to severe illness or anesthesia. The ventilator is attached to the breathing tube in the patient’s trachea. ### **How does a ventilator compare to an oxygen mask?** * An oxygen mask is worn on the outside of the body and requires the patient to keep breathing spontaneously on their own. The oxygen flows through the mask at a steady rate that is set by the healthcare providers. The main purpose of the oxygen mask is that the air the patient is breathing has a much higher percentage of oxygen than room air, which is 21% oxygen. For example, if a patient is on a mask receiving 4 L O2 / min, the air she is breathing is about 35% oxygen. * A ventilator can do the work of breathing for a patient. As shown in the video, the breathing tube is in the trachea. The ventilator uses pressure to push air into the lungs to simulate inhalation. Patients usually exhale on their own because the lungs are like a spring; the spring is stretched during inhalation and wants to recoil back after being stretched with air. You can also adjust the percentage of oxygen in the air you give the patient through the ventilator. ### **Controlling and Monitoring Ventilation** ![](https://lh3.googleusercontent.com/fkayLz5xayWBpFPLUMO1NvQzj65cPpypsCRE4yhNfJn34CmudG1JWXd47ZDiExyuTjQDgaNu3p7f8XUYFjed50n3xtd2YfHov9iRb5KHjbYr2XCC5RlVgPaEdhtoJddeWWZPZ7nr) **Source:** [**Osmosis**](https://www.youtube.com/watch?v=j_9MUsF77Jw) These graphs are produced by the ventilator as it breathes for the patient. The shape of the curves helps healthcare providers know how to adjust the settings. ### **Here are some of the different variables that you set on the ventilator to help the patient breathe:** | | **What is it?** | **Example Ranges** | | ------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------- | ------------------- | | **Tidal volume** | How big of a breath do you want the patient to take? | 4-6 mL/kg | | **Respiratory rate** | How fast do you want the patient to breathe? | 12 - 20 breaths/min | | **FiO2** | What percentage of oxygen is in the air flowing through the tube? | Up to 1 (100%) | | **PEEP (Positive End Expiratory Pressure)** | This keeps the alveoli from closing at the end of a breath which helps decrease the amount of work it takes to continue breathing. | 3-5 cm H2O | If you want to learn more about ventilators and practice controlling the ventilator settings on different patients, check out this great [Ventilator Simulator by OPENPediatrics](https://www.openpediatrics.org/assets/simulator/ventilator-simulator). ### **What are the patient’s vital signs now?**
| | **Heart Rate** | **Blood Pressure** | **Temperature** | **Oxygen saturation** | **Respiratory Rate** | **O2 flow rate** | | ------- | -------------- | --------------------------- | --------------- | --------------------- | -------------------- | ---------------- | | Patient | 100 | 105/60 | 103F | 92% | 12 | 100 | | Normal | 60-100 |

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| 98.6F | 95-100% | 12-20 | -- | The patient’s vital signs look a lot better thanks to your intervention, great job! ## **Check-in 8:** Complete the quiz below before moving on: {% embed url="" %} You have successfully treated a patient with COVID-19 and he made a full recovery! Proceed to the wrap up to learn more about COVID-19 and ARDS. # Wrap Up: What Happened to the Man who Lost His Breath? ## **How did COVID-19 emerge as a new virus in December 2019?** ![](https://lh3.googleusercontent.com/9GrL9yUV709qEdWkINsoici4MNTYcHmdcGVL_3pybBxJJAfsNhg5wYt385gpgHYSKymo61WcbwpHsjvyVrBnpO2UD-gVuThwg5c5i6D71en2SIkEb9oRHmeLljQiNLttefc_z84j) Source: [National Institute on Drug Abuse](https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/animated-graphic-2019-ncov.jpg) * COVID-19 stands for COronaVIrus Disease 2019. Coronavirus is the family of viruses that this new virus belongs to. Other viruses in the coronavirus family include many of the viruses that cause the common cold, Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS). * The virus was thought to be transmitted from a bat to a human and has features that allow it to spread well from person-to-person. * Viruses that spread from animals to humans are called “zoonotic viruses” and include the flu, Ebola, Zika, and HIV. * Since it is a virus that humans have not been exposed to before, we don’t have immunity to it, which is why so many people around the world are getting sick. ### **How is COVID-19 spread?** The virus is spread by respiratory droplets, such as when someone with the virus sneezes, coughs, or talks and you breathe it in, or when you touch a surface that a droplet was on and then touch your mouth, nose, or eyes. It is important to know that COVID-19 can infect anyone, regardless of where they’re from or what they look like. ### **How does COVID-19 replicate in the body?** * COVID-19 uses a receptor we have on the cells that line our mouth, nose, and lungs to get inside our cells. * Once in the cell, it hijacks the cell’s machinery to replicate and then releases more viruses to go infect other cells. * The immune system is supposed to recognize these infected cells and kill them so that the virus can’t keep replicating. The older we get, the harder it is for our body to fight infection, which is why we think that older people are more susceptible to severe illness. ### **What are the symptoms of COVID-19?** ![](https://lh3.googleusercontent.com/aszFNkv354uMeMKm7LXKhkoBvhWzkPk0LzTdPeo9LBUZIpa5S8xDHMCpRbj2grBA7l-7yu3lm_XJ1VxLa4HkhQW6YDDKdpx3v1wIBDcHf7pD82k28J_uUZsVrK7ZdcKFAXIFq7F2) Source: Richterman and Meyerowitz, Partners ID Grand Rounds 3/25/20 * Fever * Fatigue * Cough (usually dry cough but can produce mucus/phlegm) * Loss of appetite * Myalgias (muscle pains) * Shortness of breath * Can be asymptomatic * Disease can range from asymptomatic to multiorgan failure ### **How do we diagnose COVID-19?** * Gold standard of diagnosis is the test for COVID-19: RT-PCR, which looks for genetic material from the virus on nasopharyngeal swabs. * Lab values are highly variable and not useful for making the diagnosis, but we often see low white blood cell count. * Chest CT typically shows ground glass opacities, consistent with appearance of viral pneumonia - however, chest CT not recommended as screen for COVID-19. * Lung exam often shows abnormal breath sounds as expected in pneumonia - crackles (faint popping sounds - like popping bubble wrap), wheezing (high-pitched whistling), egophony (more high frequency sounds). These all indicate the presence of fluid and inflammation in the infected lungs. #### Many people who get COVID-19 show minimal symptoms or have a mild flu-like illness where they can recover at home. What types of people are more susceptible to severe infection that requires hospitalization? * Elderly - immune system gets weaker as we get older * Immunocompromised - e.g. on cancer treatment, smokers, people with organ transplants, people with immune deficiencies, people with HIV/AIDS - immune system doesn’t work well to fight off viruses * People with chronic health problems * People with lung disease - asthma, COPD * People with other systemic comorbidities - diabetes, severe obesity, on dialysis for chronic kidney disease, liver disease * People with a history of smoking/vaping or current smokers - these inhaled agents damage lungs * People with obesity (those who are overweight) ### **What was happening in our patient’s lungs in part 2 when he suddenly had a really hard time breathing?** ![](https://lh6.googleusercontent.com/Ytmm6bFKqhD_F3nW-ZmF01sX2yak06zWmEYKH_NPMyp-GqX5iSQF5OlpB_vlGjgUCmkWTma0tFRuBc1uR-QfY7T5iyPZchqWpHOfpnnpEhAw_p0iL7nHiYl8zwVuvqrxpmIoJrR1) Source: [Medvizz](https://i.ytimg.com/vi/KXw8LXKcmrw/maxresdefault.jpg) When you have an infection, your body tells your blood vessels to be more leaky so that immune cells can leave the bloodstream to fight infections. However, when your body is fighting off a bad infection, your body can produce too much inflammation and make the vessels too leaky. In Acute Respiratory Distress Syndrome (ARDS), inflammation causes increased leakiness of capillary vessels in the lung, which fills the alveoli and area around the alveoli (the interstitium) with fluid. ARDS is sometimes colloquially referred to as “wet lung” for this reason. When the alveoli are filled with fluid, they cannot fill up with air and your body cannot get oxygen -- which is why it presents as low oxygen saturation and difficulty breathing. ARDS is a medical emergency since the patient is essentially drowning in their own lung tissue. ### **How does a ventilator help a patient with ARDS from COVID-19 recover?** In ARDS, there is fluid in the alveoli. The ventilator’s PEEP setting helps give extra pressure to push the fluid out of the alveolus so that it can be reabsorbed into the capillary and allow for air exchange. ![](/files/-M5UmnrGSdC2pluCMBiY) Source: Created by Jessica Laird ### **What other treatments do we have for COVID-19?** * Currently we do not have any specific treatments for COVID-19. * We help treat the specific symptoms each patient is experiencing -- monitoring them for complications, tylenol for fevers, intravenous fluids for hydration, giving oxygen or ventilatory support to patients with respiratory difficulties. * Many different treatments are being tested for efficacy in patients with COVID-19, but nothing has shown significant promise yet. The medications being tested out are ones that worked against MERS and SARS. * We are starting to have a few medicines (Remdesivir, dextamethasone) that may help certain people who are sick with coronavirus. Doctors are still studying how effective these medications are. * Now we have a mRNA vaccine for COVID-19 ### **What are we doing as a society to reduce the spread of COVID-19?** ![](https://lh3.googleusercontent.com/dHNybIuCVlKx7kALdleW52ylWh20yWpzcparrbbTjHsgZ5-q8Fda5sqKgu58aUW8S8TPfvAhzH9FiWwkTzaqoQSYx1c6OhnPM_6ZFDNLofEu51VFXNf7Ut8uc-WhEPZ18dHl4zIX) Source: [Vox](https://cdn.vox-cdn.com/thumbor/k-wYSoMv5Ay5VlDXDGBetXICM-A=/1400x0/filters:no_upscale\(\)/cdn.vox-cdn.com/uploads/chorus_asset/file/19874507/flattening_the_curve_2.jpg) * Contact tracing: Close contacts of a known case are identified, told of exposure, and encouraged or mandated to self-quarantine. Need to be able to test widely and use a lot of time and resources to find the people who may have been exposed. * Quarantine: Restricts movement of people exposed to contagious disease to monitor for development of disease. This principle is based on the idea that people can be infectious before they become symptomatic. * Isolation: Separating sick people from those who are not sick to prevent spread of disease. * Flattening the curve: Slowing the spread of disease in order to limit the number of people who are sick at once. The healthcare system can only treat a limited number of sick patients at once (due to a limited amount of staff and equipment). Slowing the spread of the disease prevents the healthcare system from getting overwhelmed so that it can provide care for those who need it when they need it. * Physical distancing: Minimizing contact between people in different households can significantly reduce spread of disease through asymptomatic people. ### **What do I need to know? What can I do to help?** ![](https://lh5.googleusercontent.com/szhQao5AOlL8oGXk4NpZo65yhZiOu2ZPhhG781tkPJUrFRsJTdgDCXNHkrfaE_bfinFEN3_q37A1wdOPAeJJOjbNdm9MLASvlXXVXUKr0RZj9v560EgIA7q_g9DGJ1R_bBqSqgk3) I worked with a group of medical students interested in pediatrics to create this sheet. It and many other fact sheets, including fact sheets in many languages, are available at [https://covid19healthliteracyproject.com/](https://covid19healthliteracyproject.com/#english). In addition, this [handout from CHU Ste-Justine](https://www.cps.ca/uploads/blog_uploads/Tips_and_tricks_adolescence_-_Ste-Justine_-_ENGLISH.pdf), Montreal, Quebec has great information on how to cope with COVID-19, specifically made for high school and college students. ### **Where can I find accurate information about COVID-19?** * [World Health Organization (WHO) ](https://www.who.int/emergencies/diseases/novel-coronavirus-2019) * [Center for Disease Control (CDC)](https://www.cdc.gov/coronavirus/2019-nCoV/index.html) The most important things we can all do to help include following guidelines of physical distancing as long as they are in place, washing our hands well, keeping in good virtual contact with loved ones (especially those living alone) and taking care of our mental wellness. While it’s good to seek out reliable information and guidance from trusted sources (like the WHO and the CDC), it’s also important to monitor your own emotional wellness. Engaging in activities like journaling, meditating, exercising, yoga, deep breathing, and talking to people you trust about how you are feeling are great ways to care for yourself during this tumultuous time. If you haven't already, proceed to \ the guide on "Caring for Yourself and Others during COVID-19" now:
{% content-ref url="/pages/-M5DTjmJLz7KjlMc5Zoz" %} [Caring for Yourself and Others during COVID-19](/high-school/covid-19-high-school-and-college-student-curriculum/caring-for-yourself-and-others-during-covid-19) {% endcontent-ref %} # Press Journal articles and media coverage of COVID-19 Classroom, and the larger COVID-19 Student Response Team at Harvard Medical School. Reardon R, Beyer L, Carpenter K, Irwin M, Kester K, Laird J, Moore C, Shah P, Conrad R. [Medical student development of K-12 educational resources during the COVID-19 pandemic.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266567/) Acad Pediatr. 2020 Jun 2; 20(6): 763-764. doi.org/10.1016/j.acap.2020.05.022 Shah PP, Diaz AA. [Creating multilingual COVID-19-related material: Expanding health literacy in vulnerable populations.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043278/) ATS Sch. 2020 Dec 7; 2(1): 9-12. doi.org/10.34197/ats-scholar.2020-0131CM [HMS COVID-19 Student Response Team Media Coverage](https://covidstudentresponse.org/news/)