Voice 1: Our grandchildren call me Pap Pap, and grandmother, Grandma.
Mr. Rogers: Pap Pap and Grandma.
Voice 2: I have five terrific grandchildren, some of them call me Bubbe, some of them call me Gram.
Mr. Rogers: Bubbe and Gram.
Gupta: My kids call their grandparents Dada and Dadi. But since this pandemic began, my daughters have only been able to call them on the phone and see them on video chats. No family dinners, no birthday parties, no hugs. And I know that's the case for many of you listening.
Grandparents can be incredibly influential in kids' lives. That's why it's so painful that those over 65 are especially vulnerable to Covid-19. Many grandparents have not been able to see their families for months, and they're desperate to know when and how they can safely change that.
So today I'm going to ask that very question to my friend of more than 30 years, Dr. Preeti Malani. She specializes in infectious diseases and geriatrics and is the chief health officer at the University of Michigan.
I'm Dr. Sanjay Gupta, CNN's chief medical correspondent. And this is "Coronavirus: Fact vs. Fiction
I have to tell you, one of the most common questions I get, you know my family well. So this is the questions asked of my own family a lot. My parents have five granddaughters, three of my daughters and my brother Suneel, who lives up in Michigan where you are, has two daughters.
And we're constantly asked by my parents, when can they see the grandchildren again? What should I tell my parents? What should people tell their grandparents about when they might be able to see them again?
Dr. Preeti Malani, chief health officer, University of Michigan: I get asked this question a lot, too. And there is no love that is more genuine than the love between grandparents and grandchildren. It's so important. It's not just love. It's this social, emotional well-being.
And, it's this idea of: Can you get to a point where there's acceptable risk? Because frankly, the — the least risky thing is to not see them. But that's also not without risk. We focus so much on the risk of Covid that we forget that there's also a social emotional well-being piece for the grandparents and the kids, and that loneliness, social isolation, are not good, particularly for older adults.
So what would I tell them? Sort of depends on what's happening in other people's lives. Like, I know you have been pretty much staying at home and recording and, and I'm sure Suneel's also probably been staying home and, you know, your parents would require them to travel. But to me, that's an acceptable risk. Everyone's kind of been in place.
The differences might be is if you have young kids that are going to day care, you know, that introduces a different kind of risk. Certainly, if anyone has any symptoms, there shouldn't be any visiting.
Gupta: When we, when we think about viruses, if you go back to the last pandemic we dealt with, H1N1, people may not remember, but that seemed to affect children more than it affected adults or certainly elderly people. As it turns out, it wasn't that lethal. But what is it about this virus, do you think, that puts elderly people at higher risk of these, these more severe complications?
Malani: The reasons why this affects older people is speculative. You know, in general, there's been a lot about comorbid conditions and diabetes and obesity and hypertension. The question is, is that just what people look like demographically, who are older? But it's a very interesting thing, particularly as we think about opening up day cares and K through 12 that kids seem to get infected from adults, not vice versa. And I don't understand why that is. And that's one of the many mysteries of this pandemic.
Gupta: I mean, I think about that part of it a lot. I think about my kids. You know, God forbid that they spend time with grandparents and then their grandparents get sick. I think it would be very hard psychologically for them. So we've been very careful.
I mean, even — even — there's been times when we could have used the extra help just in terms of helping manage three teenage, almost teenage girls', you know, lives and it's been really challenging. And I know for you as well, Preeti, Dr. Malani, your own grandmother passed away at the age of 97. I was sorry to — sorry to hear that. It wasn't Covid related, it sounds like. But how did you, how did you handle that as a family? I mean, what happened?
Malani: Yeah. Thank you, first of all, for your condolences, Sanjay. Yes. So my grandmother had a very long and healthy life. And she had been asking me to come because her health had been declining a little bit and she wanted to talk to me. And it was quite urgent.
And so I, I made the decision to go and see her in April. And, you know, just be careful. I knew that I wasn't ill and I had been doing a pretty good job at that point of not really being in any, any kind of patient care environment for several weeks.
So, again, of the parallel tragedies of this pandemic is also that even without Covid, it if you end up in the hospital, visitation, just ability to, to advocate for your older family members is very limited. And I think it's, it's hard on families. It's hard on patients. I don't know that people have thought about all those things and how different the world is if you, if you have a routine illness right now.
Gupta: Life is a series of risk/reward decisions. But I do run into the scenario a lot, it hasn't happened with my own parents, but with my mother-in-law a little bit where it's this idea, I guess the best way to describe it is that, she's like, "Look, I'm old, you know, this is my life. The only thing that gives me meaning in my life is to spend time with my kids and grandkids. And I get it. I'm not, I'm not being ignorant to what's happening in the world. But for me, I don't have many years left. Am I going to lose my meaning in the few years that I have?" Is that a fair decision, do you think, for them to make or is that being a little insensitive to the current situation?
Malani: I feel it is a very fair assessment. And again, it is a risk/reward and there's a difference between the reckless and then taking an acceptable risk. And we don't know what the risk of Covid is for most people. We assume sometimes that it's really big and that all of us are asymptomatic carriers and we're going to infect everyone. But the truth is, is that that's probably not the case.
And, you know, there's a way that we can sort of balance risk. Like you can stop at the rest area, do your business, wash your hands and get out of there. And I don't think that that is going to put you at risk of Covid. So somehow we need to, like, learn how to estimate risk in a situation where you truly can't estimate it.
But I agree with your mother-in-law a bit that, you know, at some point you have to take some risk because maybe next summer you're not going to be in good enough health to have that visit. Is there a way that you could do it that balances risk? And I think especially if it's a local grandparent, you know, visiting outside, going to the park with your grandkids, sharing a meal outdoors at a picnic. Those are things that are very low risk in my mind, especially right now.
Gupta: What about hugging? Hugging OK?
Malani: I think, I think a quick hug is OK. I really do. But, you know, some people would say, "Well, there's high risk." But, you know, I don't know what's a downside in some ways. I don't know that you want to have ongoing close contact and, you know, little kids can't really distance themselves.
Gupta: What about a — what about a grandma helps out by picking up from it and doing a car ride with one of the kids, being in a car with your grandparent for a short ride?
Malani: Again, I think it's reasonable. If you're worried, stick a mask on and open up the window.
Gupta: I bring it up because I think people are having these decisions all the time. And you live in this world of both infectious disease and geriatrics. You're navigating this as well. So it's good to hear your thoughts on this and along those lines. I want to — I want to play a couple of questions that we've gotten from our, from our listeners, just to see if you can help them as well.
Lindsay Hintze: Hi, Sanjay, I'm a mom of three kids ages 7, 5 and 2 in Phoenix, Arizona. If we, as well as my parents and in-laws had been carefully, socially distancing for weeks, can we allow our kids to spend time with their grandparents? And if not, what kind of things should we look for to decide if and when this is safe again?
Gupta: What would you tell her?
Malani: I would tell her to visit with the grandparents. The key that I heard was that everyone's been careful about socially distancing. And although Arizona, as a whole, is seeing an upswing in cases, the key is what your risk is, and if you really have a good sense of your own behavior and particularly kids that are 2, 5, and 7, you know what they're doing. They're not like teenagers or young adults where their risk may be a little bit unknown. I wouldn't have any qualms about it.
Gupta: I want to play another question again, this this time more from a grandparent perspective.
Jim Beile: I'm a grandparent. One of my grandchildren is co-parented. We don't always know where she's been when she's with my daughter's ex or where he's been. So what guidance can you give us so we can be with her and still be safe?
Gupta: So now you're adding another variable here, right, Dr. Malani? You don't know the whereabouts always of the child. How would you handle that?
Malani: That does make it a little more complicated, and the listener didn't offer an age. But let's just say it's a teenager, which is kind of a little bit higher risk than a younger child. You know, one of the things that's really important is to make sure that the kids don't have any symptoms. And I think mild symptoms are also important. Sore throat, headache, cough, paying attention to that. And that's something that parents can do and really think about. Also certainly encouraging kids to wash their hands and be as safe as possible.
But the truth is, is the child's risk is probably pretty low. You know, it's hard without knowing what they're doing. But, you know, assuming this is a minor child and these days a lot of the outlets are limited for young people. This is a case in which maybe you want to try to have lower-risk interaction. So outdoors, if possible, socially distance as much as possible, maybe within the same room, but kind of across the room. And this might be a situation where, just having everyone masked. That's something to consider.
Gupta: The idea of masks, Preeti, is interesting. Because there was a lot of back and forth, talking not just about the protection for those around you, but for the mask wearer him or herself. But the reason that so much of the guidance change seemed to be when there was clear evidence that there was asymptomatic transmission, that even without symptoms, you could spread the virus. How likely is an asymptomatic young person to spread the virus to their grandparent?
Malani: Early in the pandemic, I was probably one of those folks who really felt like maybe this whole asymptomatic spread was overblown, as well as environmental spread. And I still think people worry a little bit too much about what tennis ball they're touching and stuff, because by and large, most of that is symptomatic.
It's people coughing on you. It's respiratory secretions. But what has become very clear is that there is a great potential for spread, particularly right before symptoms develop and also for folks who are asymptomatic throughout.
But, you know, the masks to me are something that we can do. And it doesn't take the place of social distancing, but we know that kids, whether they're in day care or in college, they can't socially distance. So getting them to understand and buy into the masks, and I have no idea how this has become a divisive issue because it really is about kindness and about caring for everybody around you.
Gupta: Let's take one more question, because we get a lot of questions about this particular issue.
Ann Parker: My husband and I are healthy and in our 60s. We would like to drive thirteen hundred miles each way to see our grandchildren, and think this summer may be our best window. Are we being foolish?
Gupta: First of all, drive versus fly. Does it make sense for them to drive thirteen hundred miles each way to see their grandkids versus flying?
Malani: Well, they didn't say where they're traveling from. Obviously, that's going to take a few days, several days probably, and it'll require multiple stops, so. I think it's, I think it's OK. I think you could do it in a way that, that, limits risk of travel, could be careful depending on where you're going to stay along the way with friends or family or in a hotel or Airbnb.
Gupta: Would you stay in hotels now?
Malani: If I needed to, I would. But I would be pretty careful about things. Personally, thirteen hundred miles, if it was feasible and if it was, like, a place that you can easily fly to and from, I might consider flying because that's probably three or four nights of travel. I would say you should try to go see your grandkids.
Gupta: Yeah, you know, I know my parents. They obviously know you since you were a kid. They live in Florida. I mean, they have been good. They do a lot of virtual bridge with their friends, card games and things like that. What would you tell them in terms of protecting themselves over the next several months?
Malani: Well, you know, Sanjay, your parents are, are welcome to call me if they want.