With the COVID-19 pandemic forcing doctors and public officials to make many tough decisions, the Kansas COVID Workgroup for Kids came together in May to ensure children's needs weren't forgotten and provide information and counsel to medical colleagues and state and local leaders.

"This is a disease that has been found to primarily affect adults clinically, so a lot of the focus, stay-at-home orders and such, are adult-centric," said Stephanie Kuhlmann, D.O., associate professor and pediatric hospitalist division director at KU School of Medicine-Wichita. "We felt we needed a core of pediatricians and family medicine physicians and other advocates for children to address the impact on kids from the pandemic."

Founded by Kuhlmann and pediatrics colleagues at the medical school, group members knew the medical school and its network of alumni and programs provided a good avenue for sharing expertise and advocating for children's mental, social and physical health at a time of isolation and disruption. About 20 physicians, school nurses and psychologists across the state are members of the steering committee for the work group, called KCWK for short.

The group hosted a webinar in early July at which local health, education, child services and other officials shared "Lessons Learned in Finney County," where COVID-19 cases surged in Garden City and other communities in May. Over 50 people took part in the webinar, and other online sessions via Facebook or other formats are planned. The group will take part in a July session by Engage ICT - community conversations sponsored by Wichita radio station KMUW - on back-to-school preparedness.

The should-they-open, shouldn't-they-open debate and other questions involving schools has been at the forefront for the KCWK.

"Work group members from all over Kansas were getting questions - good questions - from county health departments and school districts about what to do if a child has a fever, what does reopening look like, whether there should be a mask requirement," said Paul Teran, M.D., assistant professor at KU School of Medicine-Wichita and a pediatrics hospitalist at Wesley Children's Hospital. "We collected all these questions that had to be answered for communities."

The group used those questions and others to assemble 20-plus pages of recommendations endorsed by the Kansas Academy of Pediatrics, the Kansas Academy of Family Physicians and KU Wichita Pediatrics. They shared the document with school districts across the state, and the Kansas Department of Education included them in its recently released 1,000-plus-page "Navigating Change: Kansas Guide to Learning and School Safety Operations." About the same time that guide was released, the governor delayed the start of school until after Labor Day, which has since been rejected by the Kansas Board of Education.

Work group members have revised their recommendations several times as the science develops and circumstances change and expect to continue doing so. Their report includes advice on screening students for illness, staff training, schooling for children with special needs, participation in sports and extracurriculars (contact sports and vocal/band carry a higher risk of spread), transportation and a host of other matters.

The recommendations advocate an extended winter break, possibly from late November to mid-January, to prevent overloading hospitals and minimize transmission at a time the regular flu and other respiratory illnesses are usually doing just that. Early on, it recommended masks for students in sixth grade and above, a stance since embraced by the American Academy of Pediatrics.

Illustrating the collective impact of the effort, Teran said the group obtained input from a detective at the missing and exploited child unit in Wichita, who noted online exploitation had increased with more kids at home, some alone. That input was incorporated into the recommendations.

Teran, for one, has long had an awareness of education issues, a natural interest since his father was a school superintendent, his wife a teacher and his brother a principal in the Kansas City area. Teran, along with other group members, have met with Wichita-area superintendents and provided counsel to others across the state.

"Their response has been amazing, and they are thankful for our input," Teran said of educators. "They say our virtual meetings are some of the most useful they do. The feedback is they want to keep the dialogue open and meet on a regular basis."

"Right now, teachers feel like clinicians did in March," Kuhlmann said. "The medical team has been there, and the educators are now feeling that uncertainty of the frontline. We can certainly sympathize."

Lindsay Byrnes, M.D., MPH, is a KU School of Medicine-Wichita graduate board certified in internal medicine and pediatrics. Living in Garden City but working as a hospitalist in Wichita, she's medical director of the Finney County Health Department, giving her a good view of the challenges urban and rural communities face with COVID-19. The upsurge of COVID-19 cases in April and May in southwest Kansas put the health care system and providers under great pressure.

A member of KCWK, Byrnes helped pull together a panel of fellow health providers, school and public officials, and children's services professionals to share their experience and some lessons during the July 7 webinar, which was facilitated by Brian Pate, M.D., chair of KU Wichita Pediatrics, and drew 51 participants from across the state.

Planning ahead, which the county health department had done, was valuable. "An overarching theme is that you have to have a plan in mind where you run through those scenarios of what's the worst case," Byrnes said. "We went from zero to 60 really quickly and having that process was great. Because all of a sudden you're going to need to bring in extra people and you're not going to be able to just plug people in and figure it out in the moment."

Byrnes said the experience in her county brought some positive changes, such as the child development center serving 19 southwest Kansas counties going to virtual visits for the first time and realizing that engagement with families actually increased.

After the webinar, the Garden City manager told Byrnes this: "Ninety minutes of talking about how communities respond to disease without making it a political issue or blaming it on anyone. What a treat and super therapeutic."

"It's a time where we have to step up and care about public health because it will directly affect what we do in the hospital as well," Teran said of the group's efforts. "I'm impressed by KU and just the relationships we have in our work group. With that network, we can really have a big impact."

"We can't work in bubbles," Byrnes said. "We need to share resources. And a part of those resources is knowledge."