Back-to-school and the Delta variant with Dr. Steve Silvestro

5 minute read


This blog post is based on a video interview with Dr. Steve Silvestro about going back to school during the Delta variant outbreak. You can listen to the full interview here.





What are your priorities for your own kids and family as school starts? And what would should What do you think we should all be focused on as parents?


“Three things patience, empathy, and openness to reflection.”


  • Patience - expect big ups and downs the first weeks of school. Try to hold off on big celebrations or events to give your child time to decompress.

  • Empathy- know that there will be lots of big emotions and adjustments as things go back to being more “normal”. There will be lots of things that kids have to get used to again.

  • Reflection - lots of families had slower routines and are now going back to normal activities. Know that it’s okay to reflect on what works and what doesn’t work for your family.


What’s your perspective on the Delta variant as we head back to school?


“So I think it's really important to start by explaining why the Delta variant is such a big deal. You know, we hear a lot, it's more contagious, it spreads more easily. I've always found that understanding why helps a ton. So the real superpower that the delta variant has and why kids, part of why kids are a bit more of a risk right now is that it multiplies, it replicates a lot faster than the original strain that we all faced early on….we were just at the county fair, a week ago, right, you know, that county fair game where you shoot the water pistol into the hole, and it blows up the balloon, right? So I got suckered into paying the extra $5. So that I would play to the guy kind of I had my two kids and their cousin. And the guy said, Well, if you play too, I’ll close it off, and one of the four of you will be guaranteed to win. And that way, somebody else won't get the prize. Alright, fine, I'll do it. Well, of course, you know, wise old adult gets in there. Didn't think about the fact that I shouldn't let a kid win, but just shot right into the hole...the balloon filled up, and I won before the kids were even half full. And that's what the Delta variant actually is. So it fills up the balloon, it multiplies so quickly, compared to the other variants, that now you have tons of virus or cells burst just like that balloon, more viruses and other cells, and you end up building up a lot more virus inside your airway at a much faster rate than you did with the previous versions. Okay. So that then means that it's really easy to spread because you have a lot more virus to spread around. Just like that balloon filling up faster, you build up a lot more virus faster than you would have with the other ones. It also then means that you're contagious at an earlier stage. And so, you know, these are reasons why it's spreading a lot more easily in the community. It's also a reason why people who are vaccinated might still get it, although we think that they are contagious for a much shorter window than somebody who wasn't vaccinated. You know, essentially your body after the vaccine is stepping in front of that water pistol and blocking it from point to balloon too much. But the problem with the Delta variant is it's filling up so many balloons so fast that your body has to catch up from so you get a little window when you're vaccinated where you're still contagious. So that is why this is the big deal.


Luckily, the things that will really help are still the same things that helped out throughout this whole pandemic. All those same precautions, masking, distancing, and great ventilation. Okay, the problem is that we've removed a lot of those safety precautions, right, we pulled off the masks early this summer, distancing is kind of non-existent, schools are going back a full capacity. And so we're not going to have half classroom size for many locations. Luckily, many schools really worked on ventilation early in the year, so hopefully, those places that really need that work have had that work done. So we're left now going into the school year, really, ideally, with masks, and hopefully, with Improved Ventilation. And so I would really try to focus as a parent that even if it's not mandated by your school system, you're really trying to convince your kids to wear masks in the classroom. You can work at a bigger level with the school, or even the teachers to try and get as much outdoor time as possible. There has been a push in my community to try and get lunch outside. Which I think would be a huge win. Because that's the time when kids' masks are off. If they're wearing masks, then they're right across each other and talking. And so that's probably their greatest risk, actually, in my mind would be lunchtime.”


What kinds of things should we as parents be looking at as far as stats and numbers on the Delta variant in our areas to inform our decisions about things like extracurriculars?


“So there are three to focus on. There's a really wonderful website called COVID act now.org that I've loved since last year and they really focus on these three. So it's a great way to find out the most important information. The three stats to focus on are:

  • The number of daily infections per 100,000 people in your area. Okay, the reason we use per 100,000 people is to standardize so in the small town where I grew up, if we had 10 infections a day, that's a much bigger deal than if New York City has 10 infections a day. Okay, there's very little that means in New York City, but there's a whole lot in my small town. So we've standardized to 100,000 people per day, when it comes to number of dealing infections per 100,000 per day, the ideal number is four or less. Most places in the country aren't there right now, it doesn't necessarily mean that you can't do things...But the real hope is that four or less, if you have 10 or less, you know, that's great too but four or less ideal.

  • The second number is the test positivity rate. You want to have 5%, or lower for your test positivity rate. The reason is that when the number is higher than 5%, then we worry that we're not catching enough positive tests, we're not catching enough people with COVID. Which then would mean that number per 100,000, might not be reliable. Okay, so if your test positivity rate is less than 5%, that means your number per 100,000 is a good solid estimate of how much is out there.

  • And then finally, what we'll see is our T or R zero, that's the effective transmission rate or the infection rate, you'll see people describe it in different ways. What that is, is when it's one, each infected person infects one other person, if it's two, each infected person infects two other people. If it's zero, each infected person doesn't infect anybody else. So it's usually like one point something or 0.8. So you ideally want to see that it is less than one, because that tells you that in your area, the infections are on the way out, when it's over one, then you're likely to continue to see it, your daily infection rate is getting higher over time.”


So, kids stayed home a lot last year, whether they were going in person or virtual, and parents may have started to notice some things maybe they're concerned about ADHD, ADD or other learning differences. Is the physician's office somewhere we should bring this up?


“The physician's office is absolutely the place to discuss those things. Now, I will say that last year and virtual learning being home was such a new experience that had so many challenges for almost everybody. I mean, there were some kids that really thrived with it. But it was a brand new experience on both sides, on the teacher side, and on the student side. And so there is certainly the possibility that some of those things that you saw, I may have been worried about may not be something that persists, or that truly is an issue with how your child learns in a typical school year. That said, it's worth keeping these things in mind. And you can bring them up with your pediatrician or family doctor.


Typically, the standard approach is, especially for ADD, or ADHD, there is a screening survey called the Vanderbilt survey that teachers and parents fill out, you can find it online, too, if you're curious about the sorts of things that it looks at. And it essentially gives you an idea that, okay, ADD/ADHD, is the path that we should be pursuing, versus something else. Because there are many other issues that might be going on, it can give you those same types of symptoms, especially last year, when we were worried about mental health of many kids. And depression, anxiety, can present as challenges with focus and concentration and other ADD, ADHD, typical symptoms, do that survey teachers digs in and teases out. Attention problems, different types of learning issues, your reading and math, processing disabilities. And so can really hone in on, on what's going on. So it's a big ordeal to do it. But it's well worth it if you have the concern. But again, it may be worth having a discussion with the doctor early on. But giving a little bit of wiggle room to see how the start of the square goes just because it's closer to a typical school year, this year than last year was for most kids.”


If your child is falling behind this school year, a highly qualified online tutor can help. Schedule your free consultation call today.


Dr. Steve Silvestro is an award-winning pediatrician, multimedia healthcare communicator, bone marrow harvesting physician at Georgetown University Hospital, mindfulness educator to parents and children, and consultant to parenting- and health-oriented startups.

His primary mission—to distill complex health information into memorable content that resonates, producing behavior change and positive social impact.


Dr. Silvestro is the founder of The Child Repair Guide, a multimedia child health education platform utilizing video, podcast, and written content designed to help parents take ownership over their kids’ health by providing accurate, engaging information that resonates. His most impactful content has reached millions of readers and influenced policy decisions by schools and communities. His work has been highlighted by multiple national media outlets, including The Washington Post, Axios, Salon, Consumer Reports, Readers Digest, and more.


Dr. Silvestro is a consultant to companies that set out to advance child & family health access and education through innovation. A frequent speaker, he has delivered presentations and workshops to audiences that range from university and medical students to parenting groups and professional organizations, covering parenting challenges, the science and benefits of mindfulness, nuances of COVID decision-making, and more.


He currently works as a medical content manager at Ro Health, and is a bone marrow harvesting physician at MedStar Georgetown University Hospital, collecting bone marrow for transplant in adults and children worldwide.





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