Tagged Children’s Health

Your School Assignment For The Day: Spelling And Specs

DELANO, Calif. — Daisy Leon struggles to sit still and read the letters on the eye chart. Her responses tumble out in a quiet, confused garble.

“You know your letters?” asks optometrist Jolly Mamauag-Camat. “Umm, ya,” says Daisy, almost inaudibly.

The 6-year-old kindergartner had her eyes examined for the first time on a recent Thursday morning. Although she hadn’t complained about headaches or blurry vision, her grandmother noticed she’d been inching closer to watch television.

After Daisy’s failed attempts at reading the eye chart, Mamauag-Camat inspects the little girl’s eyes through a phoropter and writes her a prescription for glasses.

At least 20% of school-age children in the U.S. have vision problems. But according to the Centers for Disease Control and Prevention, fewer than 15% of children get an eye exam before entering kindergarten. Because vision problems tend to worsen the longer they go undetected, many children suffer even though there are often simple, relatively inexpensive solutions such as prescription glasses.

Half of the states plus the District of Columbia require screenings or exams for preschoolers, according to the National Center for Children’s Vision & Eye Health. But California has no such requirement, said Xuejuan Jiang, an assistant professor of research ophthalmology at Keck School of Medicine of USC. California does require them for older children.

“The system in California is not as good as it can be,” Jiang said.

In much of California’s Central Valley, where roughly 1 in 5 people live in poverty, two school districts are working with two nonprofits, the Advanced Center for Eyecare and OneSight, to provide vision care to Kern County’s underserved and uninsured children.

Many of the neediest are the children of farmworkers.

“We are an agriculture-based community,” said Linda Hinojosa, coordinator of health services for the Delano Union School District. “Most of our families harvest table grapes 12 hours a day, with very limited time to take their children in for an eye exam.”

The program, funded by the nonprofits and the school districts, operates five school-based clinics in Bakersfield and Delano. Students receive comprehensive eye exams and glasses, along with free transportation. And breakfast.

Most of the children who visit the clinics have coverage through Medi-Cal, California’s Medicaid program for low-income people. There is no out-of-pocket cost for the eye exams and glasses for them, or for children who are uninsured, said Alexander Zahn, chief business development officer for the Advanced Center for Eyecare.

Almost half of the students examined need glasses.

“The need was very apparent” in the Central Valley, Zahn said. “Sixty dollars for an eye exam and $80 for glasses might be the difference between eating dinner a couple days a week.”

Daisy was among 12 students who were bused to the Delano Union School District Vision Center, adjacent to Pioneer School, an elementary school with about 1,000 students. Almost all the students at Pioneer are Hispanic and about three-quarters qualify for free lunches.

Students from throughout the Delano Union Elementary School District visit the clinic. Since it opened in 2018, the clinic has performed 961 eye exams and prescribed 517 pairs of glasses.

For Daisy, whose parents are farmworkers, the clinic has been a tremendous help.

“They prune out in the fields,” said Guadalupe Leon, Daisy’s grandmother. “They can’t afford to take days off.”

The Delano Union School District Vision Center is funded by multiple sources: OneSight, a nonprofit organization dedicated to increasing access to vision care in underserved communities around the world, donated the ophthalmic equipment and provided grant funding for the first year of operation. The Advanced Center for Eyecare provides staff and supplies. And the school district provides the facility, furnishings and transportation. (Heidi de Marco/KHN)

Twelve students from Nueva Vista Language Academy and Fremont Elementary School arrive by bus for their eye exams and follow-ups. Linda Hinojosa, a registered nurse for 20 years, says lack of transportation is a major barrier to vision care. “Parents a lot of times don’t have a car, or it can be a one-vehicle family,” she says. (Heidi de Marco/KHN)

Students are offered breakfast before their appointments with optometrist Jolly Mamauag-Camat. About three-quarters of students in the district are eligible for free/reduced-price meals. (Heidi de Marco/KHN)

Daisy Leon, a kindergartner at Nueva Vista Language Academy, takes a test to check for color blindness. Before beginning, the optical technician asks Daisy if she understands English. Because of the region’s large Spanish-speaking population, clinic staff members often act as interpreters. (Heidi de Marco/KHN)

Daisy looks into an auto refractor as part of her eye exam. (Heidi de Marco/KHN)

Daisy and Jonathon Castro watch a movie as they wait for their eyes to dilate. This is the first eye exam for both of them. (Heidi de Marco/KHN)

Daisy sits on her knees to see through a phoropter, a device to help determine eyeglass prescriptions. Mamauag-Camat says children often can’t tell if they have vision problems because they don’t know any differently. “They can fall through the cracks,” she says. “They don’t know the difference between what’s clear and not clear.” (Heidi de Marco/KHN)

About 45% of Kern County’s population is on Medi-Cal. Medi-Cal covers vision care, including an eye exam and glasses every two years, but in communities like Delano, access is a problem. “We live in an area with a big shortage of providers, particularly specialty care providers like optometrists and ophthalmologists,” says Alexander Zahn, of the Advanced Center for Eyecare. (Heidi de Marco/KHN)

Daisy picks out glasses right after her exam, a pink pair that she had been admiring all morning. “We need to go where students are,” says Hinojosa. “Vision is absolutely vital.” (Heidi de Marco/KHN)

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Watch: One Father’s Fight Against ‘Predatory’ Drug Price

Dr. Sudeep Taksali tells “CBS This Morning” about his efforts to get a cheaper version of a drug commonly known as a hormone blocker for his daughter, who has central precocious puberty. The report is the latest collaboration between CBS, NPR and Kaiser Health News on the “Bill of the Month” crowdsourced investigative series.

KHN Editor-in-Chief Elisabeth Rosenthal described how one active ingredient is sold by Endo Pharmaceuticals as two different drugs — the one for children has a price tag of $37,300, while one used in adults goes for $4,400.

Taksali said the discrepancy signals a type of “predation on parents who have that sense of vulnerability, who will do anything within their means to help their children.”

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Hormone Blocker Shocker: Drug Costs 8 Times More When Used For Kids

Dr. Sudeep Taksali, an orthopedic surgeon, became worried that his 8-year-old daughter had already grown taller than his 12-year-old son. And sometimes she had an attitude more befitting a teenager. Something seemed wrong.

Taksali and his wife, Sara, realized their daughter had grown 7 inches in two years and was showing signs of puberty. They took her to the doctor, who referred her to a pediatric endocrinologist for a work-up.

Eventually, their daughter was diagnosed with central precocious puberty. It’s a rare condition that meant she would go through sexual development years earlier than her peers and would likely stop growing prematurely, too.

Adopted two years ago from India, she’s a bright, avid reader who loves to do kettlebell workouts with her dad and Zumba with her mom. Still, moving across the world and learning a new language is no easy feat.

“Having one more thing for her to deal with … where there might be maybe some negative attention drawn to her changing body,” Taksali said. “That was one of my big concerns.”

On the advice of their daughter’s doctors, the Taksalis decided to put her early puberty on hold. The recommended treatment is a product commonly known as a hormone blocker. Implanted beneath the skin in her arm, it releases a small dose of a drug each day that increases the body’s production of some hormones while decreasing others. The result is the child’s progression toward adulthood slows.

Taksali’s 8-year-old daughter recently underwent treatment for central precocious puberty, or early puberty. Her father, an orthopedist, worked with her doctor and their health insurance provider to get the less expensive of two nearly identical drugs with vastly different price tags.(Kristina Barker for KHN)

The doctors told them there were two nearly identical drug implants — each containing 50 milligrams of histrelin acetate — made by the same company, Endo Pharmaceuticals, an American drugmaker domiciled in Ireland. But one was considerably cheaper.

Taksali wanted his daughter to get the less expensive option, but his insurer said it would cover only the more expensive option. Resigned, he asked the hospital how much it would charge for the expensive drug he had been hoping to avoid.

Then the estimated bill came.

The Patient: Sudeep Taksali’s daughter, 8. She is insured through her father’s high-deductible UnitedHealthcare plan.

Total Estimated Bill: The hospital told Taksali the insurer wouldn’t cover the cheaper version of the drug, Vantas. After that, he spent hours trying to get an estimated bill ahead of the scheduled implantation. Supprelin LA would cost around $95,000 plus the cost of implantation, the hospital’s billing department told him. Under his health plan, he has a $5,000 deductible and 20% coinsurance obligation, so he was worried how much he might owe.

Service Provider: OHSU Hospital in Portland, Oregon, part of Oregon Health & Science University.

Medical Procedure: Implantation of a drug-delivery device containing 50 mg of histrelin acetate, to stave off early puberty.

What Gives: Supprelin LA was approved by the Food and Drug Administration in 2007 for central precocious puberty and has a list price of $37,300. Vantas was approved by the FDA in 2004 for late-stage prostate cancer and has a list price of $4,400.

The main difference between the two medicines is that Supprelin LA releases 65 micrograms of the drug a day, and Vantas releases 50 micrograms a day. Each implant lasts about a year.

The 15-microgram difference in daily dose with Vantas is less than the weight of an eyelash, and the doctors who recommended the treatment said it has the same effectiveness for children with central precocious puberty.

The much higher price for the children’s version of the drug grated on Taksali. “From a parent standpoint, as a physician, as a consumer, it feels abusive,” he said. “There’s sort of a predation on parents who have that sense of vulnerability, who will do anything within their means to help their children.”

Taksali questions why Endo Pharmaceuticals makes two nearly identical drug delivery implants with vastly different prices.(Kristina Barker for KHN)

Drugmakers can use the same chemical compound to create different branded drugs with different disease targets ― and apply for FDA approval for each. FDA spokesperson Brittney Manchester said by email, “Generally, it is the sponsor’s decision.” Endo makes both Supprelin LA and Vantas.

Indeed, other drugmakers have used the maneuver: Pfizer makes two versions of sildenafil citrate: Viagra for erectile dysfunction and Revatio for pulmonary arterial hypertension.

When we asked Endo Pharmaceuticals why Supprelin LA and Vantas had such different price tags, the company said the implants aren’t identical and treat very different conditions. It didn’t respond to questions about why that meant the prices should be different and whether it was somehow more expensive to manufacture one versus the other.

Resolution: Taksali spent more than a month trying to make sure his daughter could use the cheaper drug and, finally, the week his daughter was scheduled to have the procedure, it was approved. The hospital submitted the request again and UnitedHealthcare said it would cover it.

“Our coverage policies are aligned with FDA regulations and Vantas is not FDA approved to treat central precocious puberty,” UnitedHealthcare spokesperson Tracey Lempner said in an email. “In this specific case, when the provider expressed concern over the cost of Supprelin LA, we worked with them to allow for coverage of Vantas.”

Taksali’s daughter got the Vantas implant in late January.

The hormone-blocking implant was placed on the young patient’s arm to treat central precocious puberty, or early puberty.(Kristina Barker for KHN)

When he got a breakdown of charges afterward, it listed $608 for the implantation and $12,598.47 for Vantas — about three times its list price. (Hospitals add markups to the list prices.) Still, that’s far less than the $95,000 the Supprelin LA bill would have been.

According to his explanation of benefits, after insurance, Taksali will owe $4,698.45 ― most of his high deductible. Because it is early in the year, the family had not yet spent any of its 2020 deductible.

Taksali said he fought for the lower cost drug on principle.

“Even if it is the insurance company’s money, it’s still somebody’s money,” he said. “We are still contributing to those premium dollars.”

On the day the Taksali family adopted their daughter from India, she and her brother were about the same height. Now she is about 5 inches taller than him despite being more than three years younger.(Courtesy of Sudeep Taksali)

The Takeaway: If you need an expensive drug, the first thing you should do is ask your doctor if there are cheaper alternatives. Often different formulations of the same chemical compound carry vastly different prices. In this family’s case, the version to treat prostate cancer patients was far cheaper than the pediatric version for a hormone imbalance.

More commonly, the different formulations relate to different dosages ― two 250 mg tablets may be cheaper than a 500 mg pill. Likewise, a pill you have to take three times a day may be far less expensive than the once-a-day extended-release version.

When a coverage denial leads to costly care, patients can ally with their health care providers or employers to appeal, though it can be time-consuming. Self-insured employers, in particular, won’t want to waste health care dollars either. For Taksali, using social media to direct-message UnitedHealthcare garnered prompt responses and some answers.

If there aren’t other options, drug manufacturers often offer coupons to help patients with their copays. You can find some using GoodRx or by visiting the drugmaker’s website directly.

KHN senior correspondent JoNel Aleccia contributed to this report.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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Distritos escolares lidian con cuarentenas, mascarillas y miedo

En un distrito escolar, las familias están sacando a sus hijos de la escuela. En otros, los estudiantes aparecen con mascarillas.

Los distritos escolares a lo largo del país, y en particular aquellos con grandes poblaciones asiático-americanas, se han apresurado a responder al brote del nuevo coronavirus, que ha matado a más de 2,000 personas (al 19 de febrero) y ha enfermado a decenas de miles más, casi todas en China.

Hasta el momento, se han confirmado 15 casos en los Estados Unidos (además de los 14 pasajeros del crucero Diamond Princess que arribaron enfermos), principalmente en California, hogar de aproximadamente un tercio de los inmigrantes chinos de la nación.

Los distritos pisan territorio desconocido cuando aplican reglas federales a sus cuerpos estudiantiles. Y, en algunos casos, están tomando decisiones para abordar los temores de los padres, no la enfermedad real, sin orientación oficial. Están sopesando si permitir que los estudiantes trabajen desde casa, incluso si no han viajado al extranjero recientemente, o si les permiten usar mascarillas en clase.

“Estamos haciendo todo lo posible para cumplir” a medida que evolucionan las reglas y el brote, dijo Jenny Owen, vocera del Distrito Escolar Unificado de Duarte, unas 20 millas al noreste del centro de Los Ángeles y donde aproximadamente el 6% de los estudiantes se identifican como asiáticos.

Los síntomas de la enfermedad por coronavirus, denominado COVID-19, varían desde tos leve o secreción nasal hasta neumonía grave y dificultad para respirar. Los científicos estiman que el período de incubación abarca hasta 14 días y aún están investigando si puede propagarse cuando las personas no tienen síntomas visibles.

Para evitar la diseminación del virus en los Estados Unidos, el gobierno federal ha emitido reglas para los viajeros que regresan: los ciudadanos estadounidenses y los residentes permanentes que estuvieron en el epicentro del brote en la provincia de Hubei, en China, en los 14 días anteriores deben someterse a una cuarentena obligatoria de dos semanas en una instalación administrada por el gobierno. Aquellos que visitaron otras partes de China deben quedarse en casa, en “auto-cuarentena” durante dos semanas.

Estas normas entraron en vigencia el 2 de febrero y, como resultado, un programa de intercambio que traía a niños de China a las escuelas de Duarte se canceló temporalmente para evitar que los estudiantes fueran puestos en cuarentena, dijo Owen.

Las nuevas normas ayudaron a aclarar la confusión, especialmente para las familias que habían viajado recientemente desde China y se preguntaban si debían o no enviar a sus hijos a la escuela, dijo Don Austin, superintendente del Distrito Escolar Unificado de Palo Alto en el Area de la Bahía, de casi 12,000 estudiantes y en el que aproximadamente el 36% de los estudiantes se identifican como asiáticos.

“Cuando escuché por primera vez sobre el concepto de auto-cuarentena, mi primer instinto fue que esto podría ser problemático si estamos solos, tratando de crear algunas de estas políticas y prácticas sobre la marcha”, agregó.

Pero los distritos escolares y los departamentos de salud locales aún tienen que tomar decisiones rápidas en casos que caen fuera de las pautas federales.

Los funcionarios de salud del condado de Ohio, en West Virginia, pidieron a una familia que retirara a un niño de la escuela el 3 de febrero para someterse a una cuarentena de 14 días, a pesar que las pautas federales no se aplicaban al historial de viajes del estudiante, dijo Howard Gamble, vocero del Departamento de Salud del condado de Wheeling-Ohio. El niño acababa de regresar de Hong Kong, que no es parte de China continental. Pero un miembro de la familia que había viajado informó síntomas similares a los de la gripe al regresar.

Los Centros para el Control y Prevención de Enfermedades (CDC) respaldaron la decisión del distrito, dijo Gamble. Los CDC no respondieron a una solicitud de comentarios.

Falta orientación federal sobre otras preguntas que los distritos escolares están considerando.

En el Distrito Escolar Unificado de San Ramón Valley, en el Área de la Bahía, casi el 40% de los 32,000 estudiantes se identifican como asiáticos. Algunas familias sacaron a sus hijos de la escuela y pidieron al distrito que disculpe sus ausencias mientras completan el trabajo escolar desde casa, a pesar que no han viajado recientemente a China o no han estado en contacto cercano con viajeros de China, dijo Christopher George, vocero del distrito.

El distrito dijo que sí.

“Queremos que nuestras familias tengan la opción, incluso para las que tienen miedo de enviar a sus hijos a la escuela”, dijo.

El Distrito Escolar Unificado de Palo Alto ha recibido solicitudes similares, y el superintendente Austin dijo que está permitiendo que, por ahora, las escuelas decidan.

A diferencia de las cuarentenas que terminan después de 14 días, quedarse en casa para evitar la exposición al coronavirus no tiene fecha de finalización, dijo.

“Si este virus continúa propagándose por todo el mundo durante X cantidad de meses, ¿en qué momento diríamos que tienes que volver a la escuela?”, se preguntó George. “La intención no es que todos los estudiantes que no están expuestos se queden en casa como medida de precaución”.

Otra área gris para los distritos escolares es el uso de mascarillas.

Los CDC no recomiendan el uso de máscaras para el público en general porque no son una forma efectiva de prevenir infecciones. Pero en algunos países asiáticos, usar una máscara facial para protegerse contra la contaminación del aire o los gérmenes se considera normal.

Algunos distritos escolares, incluido el Distrito Escolar Unificado de Arcadia, en el condado de Los Ángeles, permiten que los estudiantes y miembros del personal vayan a la escuela con mascarillas si lo desean, siempre que las usen por razones preventivas y no porque estén enfermos.

“Fue una decisión bastante fácil para nosotros”, dijo Ryan Foran, portavoz del distrito, donde cerca del 66% de los 9.400 estudiantes se identifican como asiáticos. “Usar máscaras no es nada nuevo en nuestra comunidad”.

En el cercano Distrito Escolar de Garvey, los maestros y el personal les preguntan a los estudiantes con mascarillas si se sienten bien, pero no los excluyen de las actividades escolares, dijo Anita Chu, superintendente del distrito, donde cerca del 60% de los estudiantes son de ascendencia asiática.

En el Distrito Escolar Unificado de Alhambra, donde aproximadamente la mitad de los estudiantes se definen como asiáticos, los administradores desalientan el uso de máscaras y tratan de explicar a las familias que no protegen contra la enfermedad, dijo Toby Gilbert, vocero del distrito.

Eso es un buen consejo científico. Sin embargo, los esfuerzos del distrito se han encontrado con una petición en línea de change.org pidiendo a los administradores que permitan a los estudiantes usar mascarillas y que cancelen las clases por temor al virus. La petición tiene más de 14,000 firmas electrónicas, pero no está claro cuántas son del distrito.

Funcionarios de salud pública del condado de Los Ángeles “nos dijeron que las máscaras dan una falsa sensación de protección y se suman a un clima de alarma sin ayudar”, dijo Gilbert. “Siempre hemos permitido las máscaras, pero queríamos que los padres supieran que no estaban protegiendo”.

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School Districts Grapple With Quarantines, Face Masks And Fear

In one school district, families are pulling their kids out of school. In others, students show up in face masks.

Educators in one Southern California community agreed to suspend an exchange program to keep visiting Chinese students out of quarantine.

School districts across the U.S., particularly those with large Asian American populations, have scrambled to respond to the outbreak of the novel coronavirus, which has killed more than 2,000 people and sickened tens of thousands more, almost all in China.

So far, 15 cases have been confirmed in the U.S., mostly in California, home to about one-third of the nation’s Chinese immigrants.

The districts find themselves in uncharted territory as they apply new federal travel rules to their student bodies. And, in some cases, administrators are making decisions to address parental fears — not actual disease — with no official guidance. They’re weighing whether to allow students to work from home, even if they haven’t traveled abroad recently, or let them wear face masks in class.

Balancing these requests against broader public health needs often leads to different conclusions.

“We’re just doing our best to comply” as the rules and outbreak evolve, said Jenny Owen, spokesperson for the Duarte Unified School District, about 20 miles northeast of downtown Los Angeles and where about 6% of students identify as Asian.

Symptoms of the coronavirus disease, dubbed COVID-19, range from a mild cough or a runny nose to severe pneumonia and difficulty breathing. Scientists estimate the incubation period spans up to 14 days and are still investigating whether the illness can spread when people have no obvious symptoms.

To prevent the virus’s spread in the U.S., the federal government has issued rules for returning travelers: U.S. citizens and legal permanent residents who visited the epicenter of the outbreak in China, Hubei province, in the previous 14 days must undergo a mandatory two-week quarantine at a government-run facility. Those who visited other parts of China must stay home and “self-quarantine” for two weeks.

The policies began Feb. 2, and as a result, an exchange program that brought children from China to Duarte schools has been temporarily halted to prevent the students from being quarantined, Owen said.

State public health departments are using the federal rules to draft guidelines for school districts.

The policies made a “night and day” difference in clearing up confusion, especially for families who had recently traveled from China and were wondering whether or not to send their kids to school, said Don Austin, superintendent of the nearly 12,000-student Palo Alto Unified School District in the Bay Area, where about 36% of students identify as Asian.

“When I first heard of the concept of self-quarantine, my first instinct was, this could be problematic if we’re alone on that and trying to create some of these policies and practices on the fly,” he said.

But school districts and local health departments still have to make quick decisions in cases that fall outside federal guidelines.

Health officials in Ohio County, West Virginia, asked a family to retrieve a child from school on Feb. 3 to undergo a 14-day self-quarantine, even though federal guidelines did not apply to the student’s travel history, said Howard Gamble, a spokesperson for the Wheeling-Ohio County Health Department. The child had just returned from Hong Kong, which is not part of mainland China. But a family member who made the trip reported flu-like symptoms upon return.

The Centers for Disease Control and Prevention supported the district’s decision, Gamble said. The CDC did not respond to a request for comment.

Federal guidance is lacking on other questions school districts are weighing.

At the San Ramon Valley Unified School District in the Bay Area, nearly 40% of 32,000 students identify as Asian. A few families have pulled their kids out of school and asked the district to excuse their absences while they complete schoolwork from home, even though they have not traveled to China recently or come in close contact with travelers from China, said Christopher George, spokesperson for the district.

The district said yes.

“We want our families to have the option, even for the families who are afraid to send their kid to school,” he said.

Palo Alto Unified School District has received similar requests, and superintendent Austin said he’s allowing individual schools to decide — for now.

Unlike the quarantines that end after 14 days, staying home from school to avoid coronavirus exposure has no end date, he said.

“If this virus continues to spread around the world for X number of months, at what point would we say that you have to come back to school?” he said. “The intent is not for every student who has no exposure to stay home as a precaution.”

Another gray area for school districts is the use of face masks.

The CDC doesn’t recommend the use of masks for the general public because they aren’t an effective way to prevent infections. But in some Asian countries, wearing a face mask to protect against air pollution or germs is considered normal.

Some school districts, including the Arcadia Unified School District in Los Angeles County, allow students and staff members to come to school with face masks if they wish — provided they’re wearing them for preventive reasons and aren’t sick.

“It was a pretty easy decision for us,” said Ryan Foran, spokesperson for the district, where about 66% of the 9,400 students identify as Asian. “Wearing masks is nothing new in our community.”

At nearby Garvey School District, teachers and staff “respectfully and gently” ask masked students if they are feeling well but don’t exclude them from school activities, said Anita Chu, superintendent of the district, where about 60% of students are of Asian descent.

In the Alhambra Unified School District, where about half of the students identify as Asian, administrators discourage the use of face masks and try to explain to families that they don’t protect from disease, said Toby Gilbert, a spokesperson for the district.

That is sound scientific advice. Yet the district’s efforts have been met with an online change.org petition asking administrators to allow students to wear face masks and cancel classes over fears of the virus. The petition has more than 14,000 electronic signatures, but it’s not clear how many of those are from within the district.

Los Angeles County public health officials “advised us that masks give a false sense of protection and add to a climate of alarm without being of help,” Gilbert said. “We have always allowed masks but wanted parents to know they weren’t providing protection.”

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