♪ ♪ Welcome to this Week in South Carolina.

I'm Gavin Jackson.

For the last year and a half, many South Carolinians have dealt with challenges such as school closures and unemployment to mental health issues.

We talked about those challenges with Roger Williams of the South Carolina Department of Mental Health, but first, MUSC pediatrician, Dr. Annie Andrews looks to the latest medical news affecting children.

Dr Annie Andrews, thanks for joining me.

>> Thanks for having me.

>> So, Dr. Andrews, you're a pediatrician down at MUSC.

...let's talk about the top news of the week affecting children and this pandemic, and that's the U.S. Federal District Court here in South Carolina blocking that mask mandate prohibition that Republicans put in the state budget.

I want to get your thoughts on this, because... now schools can actually ...have the discretion to put in mask mandates in the classroom.

Do you think this is too little, too late, especially as we're kind of on the downward side of this Delta surge?

>> So, I think we all breathed, a lot of us breathed a big sigh of relief, when we heard this news this week, because, although numbers from this past week do look a little reassuring, we are still in the midst of this Delta surge, of this pandemic, and it is affecting a lot of children; and we know that masks in schools work.

There's been several studies that have been released recently that have shown that schools with mask mandates have significantly lower risks of outbreaks of COVID.

...so this is great news, because now school districts can do what they think is in the best interest of the children in that district.

>>...why do you think this has become so political when we're talking about safety measures that were in place last year in schools versus, ...people making it seem like these kids can't breathe or they can't function normally, even though again, like you're saying, studies show that they can.

>> Yeah, I mean as a doctor and a scientist, it has been really disheartening to see the injection of politics into this issue, especially when it comes to protecting kids, because I really do believe that all of us can agree that we want to do what's best for our kids.

We can all agree, we want kids in the classroom, and I think it's just one of the hardest things about this pandemic, for me, from my viewpoint, as a pediatrician to see how politics has gotten so mixed up into this sort of basic public health messaging about vaccines and masks.

>> I'm assuming your kids have been going to school with their masks on since day one.

>> Yes, absolutely.

..., but you were just before a Senate Medical Affairs Subcommittee hearing up here in Columbia.

They heard from credible medical professionals like yourself, ...then they had some other folks on there who maybe were not so credible, cited some studies that are not so valid.

What's the message that you wanted to convey to that committee too, while they were talking about therapeutics and some, ...unproven treatments?

...what was your message?

What was your take away from that meeting?

>> So, I think one of the messages I tried to get across was it is important for leaders to be able to identify expertise, and we live in a state with fantastic resources and experts in Public Health and critical care medicine and infectious disease.

...we need to be talking to those people, and it is so easy to get distracted by people who feel passionately about this issue, but don't have the expertise to really be needing to weigh in, ...I would hope that our elected leaders would see the difference between expert testimony and just passionate testimony, from people in the community...

...I think specifically the medical affairs committee, you know, there is a very real genuine need to find and...they want to find treatments that are going to be effective to help South Carolinians, and we all share that goal, but we were getting distracted by some of these sort of medical conspiracies that have been popping up online; and it was unfortunate that we had so many experts in the room on that second day ...and we spent so much time talking about some of these things that really don't deserve that air time right now.

>> ...to give it some air time right now, but not entirely, can you talk to us about what you say to people who kind of push these anecdotal research documents these studies that they look towards, especially...when we're talking about things like Ivermectin and you compare that to thoroughly researched therapeutics and other preventive measures that have been documented to work or at least help treat COVID-19.

>> Yeah, so I think, one thing is... science is complicated and we've spent years in school learning how to practice medicine and some of us learning how to interpret and conduct clinical research.

...so it's not as easy as just reading a post on Facebook, you really have to understand research methods to be able as a person to interpret these studies.

...that's why we have a scientific community, so that we can interpret these studies and then communicate that to the people of the state, but when you sort of take out that middle man and you have people without the training trying to interpret the studies it can get really messy.

...I think, the other thing that seemed like it was implied a little bit is that there are some treatments like Ivermectin that we somehow, we know that they work but we're not willing to give them to our patients, and that's just not how we practice medicine.

...those of us who have been on the front lines and many of my friends and colleagues have been more than me, all we want is for these patients to get better and if there were treatments that we truly believed and that the evidence supported, we'd help these patients, of course we would be prescribing those medications.

>> "...so then maybe why not?

...when it comes to trying to save a child's life, another some 30 kids in the hospital, right now why not throw everything at them, including some unproven or anecdotal drugs like Ivermectin... ...what's stopping you guys from doing that?

>> ...we are an evidence based profession and we can do that with any diagnosis.

You know.

We have kids in the hospital with cancer or heart failure or you know overwhelming infections and there's a million things in our pharmacy we could throw at them, but that's not how you practice medicine.

...you let the evidence guide you.

...and particularly when you're talking about children, we have to weigh the potential harms of unproven treatments, before we just throw anything at them.

...and so we will eagerly await any research that directs us to additional effective treatments for COVID in children and when that research arrives, we will be happy to, ...adopt it into our clinical practice, but what we know now is that masks work.

Social distancing works.

Vaccines work, and we need to be focusing on our messaging around those things to protect our kids.

<Gavin> ...messaging seems to be a big issue, too.

Especially, when talking about all the different facets of this pandemic.

Do you think some people just... they hear from the medical community, they hear from the science community.

One thing, one day and a couple months later, things change.

Obviously, everything always comes with a caveat, too during a pandemic, but do you think that there's some distrust because of that, even though that's part of the... scientific method and that's how things get proven over time not just immediately based on someone saying, "Oh, that cured me.

This must work for everybody."

>> Yes, I think sort of, a lack of - really understanding of the scientific process.

And also, the vast majority of us have never lived through a pandemic before.

So...science rapidly evolves, but never more so than in a pandemic when all the greatest scientific minds in the world are focusing on understanding this disease, identifying treatments and prevention methods.

...so we have to understand that science isn't as clean cut as someone might think it is.

..it will change over time; and sometimes we ...make missteps and we think one thing is the answer, and it ends up not being the answer.

We're trying to work as quickly as we can to help save as many people as we can, but I think people need to understand that the nature of science is that it evolves over time and our understanding of science evolves over time, as well.

>> Yeah, it's definitely not set in stone for any long period of time.

...doctor tell me what it's like, right now on the front lines.

You're a pediatrician.

You practice in the hospital.

You just mentioned some your colleagues on the front lines, as well.

What's it like?

I think there's around 29 children hospitalized across the state right now with COVID-19.

Those numbers really jumped up again like we were seeing this fall, because of the Delta surge.

What's it like out there?

>> Yeah, so, you know, I work in the hospital based setting and I have cared for a lot of children with COVID over the past month or so, far more than I did in the beginning of this pandemic.

...it is hard, because prevention is really the cornerstone of the practice of pediatrics.

We talk about preventing diseases, like infectious diseases through vaccines.

We talk about injury prevention and it's hard to watch children suffer from preventable illness, and I think one point that's really important for people to understand is throughout the entire pandemic, all of the children who have been hospitalized at my institution for COVID have been unvaccinated.

So, we have not had one vaccinated child hospitalized for COVID, because vaccines are effective.

...so again, when we see these patients that I'm caring for on the general inpatient unit or the patients my colleagues are caring for, down in the pediatric ICU, it really is just tragic because these illnesses are by and large preventable.

...I've talked to parents who are sort of grappling with watching their child hospitalized, knowing... potentially they could have made a different decision and they could have avoided hospitalization or severe illness in their child.

So, it really is heartbreaking.

I'm optimistic that we are going to continue to pound the pavement and get this message out there that vaccines for children are safe and our state has a lot of work to do to bump up the vaccination rate in those kids who are 12 years of age and older.

>> ...some of those children that you're talking about some of those families, were those children eligible to be vaccinated?

Or are you talking about them being basically victims of people who could be vaccinated?

>> ...Yeah.

So, it's both.

I would say just on average about half of these kids have been eligible.

So they've been 12 years of age and older.

So, they certainly were eligible for the vaccine and for lots of different reasons had showed their parents had chosen not to get them vaccinated and then we're seeing those younger kids and...I think about, you know, - specific, a baby that I took care of - that ...baby was relying on us to do what was right and to get as many adult and eligible adolescents vaccinated.

...because we failed to do that, these vulnerable children are at risk and it's really out of their control, and they are suffering, because of it.

>> ...so far - We have about three minutes left, doctor.

...I want to talk to you about vaccines, especially since up through this pandemic up until September 23, about 20 children have died from ages up to 20 years old.

... it does affect them.

Of course, it's a very small portion of those children who have gotten diagnosed and of course even smaller portion of the overall death toll in our state.

...Pfizer just announced this week that it had submitted data to the FDA, regarding its COVID vaccine for use in children 5 to 11 years old, like we're talking about here.

A dosage is about a third of that of what an adult would receive.

...Kind of tell me what this would mean if we can get these vaccines rolling out later this fall for that demographic.

>> I'm really excited and hopeful with this news and I think that vaccines are the key to us getting out of this pandemic.

...so the fact that we're going to be able to offer vaccines to another demographic is really exciting, particularly because we're in the midst of this Delta surge and we know that children are more susceptible to the Delta variant.

The Delta variant is more highly contagious.

Children are in the classroom.

Some of them are unmasked, and so until we can get enough of those kids vaccinated.

That's going to continue to be a source fueling this pandemic, and so I eagerly await the official approval of the vaccine for kids 5 to 11.

I have two, almost three kids in that age range, and I will be the first in line to get them vaccinated as soon as it's approved.

<Gavin> We have about a minute left, doctor there, and I just want to ask you about potential side effects, maybe what parents should be worried about when it comes to getting the vaccine and the rare ability to have a side effect from it.

>> Mmm Hmm.

So, I think first, ...nothing we do in medicine is without potential side effects, I would just encourage parents to go back to their trusted source of health information for their children.

...parents rely on their pediatricians or their family medicine doctors to make these decisions with them, and, you know go back to when your children were infants and you trusted your pediatrician with those routine vaccinations, at the two month, four months, six months check up.

...you probably trusted them and didn't really ask any questions at all, because that's just what we do when we trust our pediatrician.

...nothing has changed about the patient and physician relationship; and the pediatrician is such an important part of that.

So, go back to your pediatrician, ask them what they think about vaccinating your children for COVID and use that trust that you've built with that person over time to help you make the decision for your child.

>> Well, we'll leave it there Dr. Annie Andrews.

She's a professor at MUSC and a pediatrician at MUSC down in Charleston.

Thank you so much.

>> Thank you.

>> Roger Williams is the Director of the Spartanburg Area Mental Health Center and he's joining me now to discuss mental health issues during the pandemic.

Roger, thanks for joining us.

>> Thank you for inviting us and giving an opportunity to talk about this important topic.

<Gavin> Most definitely.

We're now 18 months into this pandemic, Roger and self reported symptoms of anxiety and depression among American adults has more than tripled according to the CDC.

Are we nearing those trends in South Carolina?

What are you seeing right now up in the upstate?

>> Oh absolutely!

We're seeing the same thing here.

Not just here in Spartanburg but, you know, we do have 16 mental health centers that cover the entire state and I'm in regular contact with all the other center directors, as well and we're seeing that same national trend is here.

...it's primarily anxiety and depression.

it seems to be weighing most heavily on young people and for this definition, young people they break them into different age groups, but the 13 to 17 year olds, the 18 to 25, ...age groups that ...quite frankly, in kind of normal times, if there ever are normal times, kind of coast through life and, you know, obviously all of them have individual difficulties, but we're just seeing a major increase in young people.

We're also seeing the stress of the pandemic on women more than men, because I think many of the challenges dealing with not just the pandemic, but with everything in terms of childcare and the classroom, many times those are falling more heavily on women.

So, we see a particular spike in younger working age women.

>> ...we always talk about these demographics of specifically young people and I want to talk about that in a moment, but ...are we doing enough to tackle these issues?

...I feel like every time we see a tragic event or a mass shooting event, there's always this focus on, we need more mental health funding.

We need more attention on mental health issues.

We're in the middle of pandemic right now, ...we just talk about those numbers, how it's directly affecting people across the country, specifically, here as well.

Are we doing enough to reach out to get... in touch with these people who are reporting these symptoms of anxiety and depression?

>> Well, that's one of those, it sounds like a simple question, with a yes or no answer... unfortunately, it's not.

...I think the easy answer is ...we can never do enough, because enough would mean somehow we've met all the needs and we're not there.

We've put into place several different programs and activities to try and meet the needs.

There's something we call the SC hopes line, which is a phone number people can call just concerned about their mental health.

We...have a companion Spanish line called TU-APOYO.

Both of those lines and services are available ...and so that's a new response to the pandemic.

We are seeing... our mobile crisis teams have expanded their operation and that's been a major change that was happening, before the pandemic and... in many ways the pandemic accelerated trends we are already seeing in mental health.

So, for example, we've increased the number of services that are being provided by telehealth, by video.

It used to be we can only do those for psychiatric with the psychiatrist visits.

Now, we're allowed to provide therapy by telehealth.

So, are we doing more?

Yes.

Is it enough?

Not until everybody gets the help they need, and we're not there yet.

>> ...I know there has been some additional funding in the state budget too, for mental health counselors in schools to kind of bring them up to at least having one in every school district or neighboring schools at least.

What's the need there when it comes to children and what they're looking at?

And what they're dealing with...now with the pandemic, especially when we start looking at some worrisome suicide rates among that demographic?

>>...again it's important to recognize this was a trend that was in place before the pandemic and the pandemic just accelerated that.

We had actually hoped to be at that magical goal ...you said of one to one, one counselor in every school and obviously at some of the larger high schools.

I have one of the largest high schools in the state ...in my catchment area, and one counselor isn't enough, ...but the pandemic has really sadly slowed that process.

We had all hoped to - I have about 35 school based clinicians.

I need about 65 to meet that goal of one in each school and the pandemic... has really made that a little bit more challenging in terms of recruiting ...I know...your viewers will be aware of the labor shortages that are happening everywhere from the fast food joints to mental health centers to almost every other avenue of employment and we're unfortunately, not exempt.

So, we have the funding from the legislature, which we're very grateful for, from local sources.

We've got the funding to find those staff, but we are struggling to find enough staff.

>> Is it a matter of maybe going to the root cause of this and maybe getting to the schools or getting different programs in place in higher education or in technical schools to maybe get some sort of programs in place to really start feeding that pipeline, so that we can see more mental health counselors?

...obviously this isn't an issue that we've been seeing just in South Carolina, but nationwide.

>> ...I think that you know you're absolutely right.

We are talking to... colleges, looking at colleges in our area that perhaps have not yet (offered) a master's level, because We do need master's level, graduate level clinicians, and so talking to some universities, I have a college in our catchment area just has opened up a master's program, so we're very hopeful that will provide us with additional resources, but I think you're right to say starting in high school, and through undergraduate education saying, "Hey, have you thought about working "in public service, in community mental health?"

...we're working on that, but as you can well imagine, that's a long term...

It's six years to get from high school to a master's.

>> Yup...and the shortages we're seeing in all different kinds of fields, specifically medical fields, as well, when we're talking about nursing, as well.

...I found a number that was kind of startling to me when I was doing some research for this show, ...it's that, in South Carolina suicide is one of the top causes of death from people 5 to 44.

It's more prevalent among men.

We've even seen a 35 percent increase ...in suicides ...from 2010 to 2019.

Do you know what might be driving this or anything you can point to or what we can do to maybe stop what seems like an epidemic in it's own way?

>> You know, I think one way to think about the pandemic, a metaphor that at least works for me is sort of like daily life, before the pandemic was like working in a pool of about three foot of water, for some of us, we barely even noticed the water was there for those folks who my wife is under five feet tall, she might have noticed that a little bit more.

...now the pandemic, it's like it added a foot or two of water.

So, the person who was barely noticing it, is kind of struggling, but the person who was struggling, it's just, ...it's never one factor, but it could be the, what we're seeing with young people, of course, a major issue is the social isolation.

...I don't know about you, but you know, if I think back on my high school days, I'm not so sure I can recall all of my lectures in algebra and chemistry, but I probably remembered more talking to my friends, and so ...I don't think I'm unique in that regard.

So, that loss of connection the loss of activities, and the things that they're wanting to do.

...so ...we see that being in demand ...the stresses of just sort of daily life, ...even little things like - I went to the food store the other day ...and I'm wearing my mask.

Other people in the store are wearing your masks, but if you are prone to anxiety, if you are prone to depression, it isn't that that's what's causing it, but if you, if your body chemistry and your neurochemistry and all the neuro trans - all those fun things, are not perhaps as strong as they might be, you're going to just be adding and it's like the proverbial straw that broke the camel's back.

So, it isn't one thing or the pandemic, but it is going to affect those individuals who... had a tendency, perhaps to have some of those challenges.

So we're seeing that as a primary... driver of those higher numbers, and again we're seeing that stress is more prevalent in the younger population.

>> Roger, what can parents do to maybe, you know, stay involved with their children to make sure that, you know, they're not missing some sort of warning sign, or being aware of what their kids are maybe even doing online, and maybe teachers, as well ... especially in this new environment where they're doing virtual, or they're one day and they're doing in person the next day?

What can parents and teachers be doing to make sure that kids are ...safe and they're healthy and they're paying attention ...they're plugged in?

>> ...Spartanburg County - we have multiple school districts in Spartanburg County, but all of them have really worked together collaboratively to address the issue of suicide in the classroom.

They provided lots of training to the teachers and some of that report or that increase in reported suicide attempts is a reflection of the fact that it's being brought to attention more, which is certainly not a bad thing.

...I'll let the statisticians figure out how much of that is an increase in the reporting and how much is an actual increase.

...I think both of those are factors ...I really want to ... give a hats off to the good folks in the Spartanburg school systems who worked with our zero suicide project, which is the suicide prevention office in Columbia.

I work with them to provide training to teachers, to students, to help everybody sort of know.

...I would agree with you that parents are probably an area that we need to be paying a little bit more attention to in terms of providing some of that training.

...if I had sort of one piece of advice, it would be one that I'm sure we've all heard, talk to your kids.

....make sure that you ask them about whether or not they have thought about hurting themselves or thought about killing themselves.

...there was a myth and we won't say how old I am, but back when I started, that, somehow if you asked the question, you would, like, put the idea in somebody's mind, and when we know that's not true.

...so making sure that you give your children or your coworkers or people you're with permission to have that conversation to tell them, "It's okay.

", that doesn't mean you're going to be hospitalized.

Tell them that there's hope, that we have treatments that work, that we have effective interventions.

So, I think as a parent making sure that you ...have what might be an uncomfortable conversation ... that maybe none of us really want to have, but like so many - I'm the parent of six children, and...well, I have lots of uncomfortable conversations.

That's part of being a parent.

<Gavin> Very true.

...Roger, with about 30 seconds left ...I want to ask you about this new grant that the Spartanburg Area Mental Health Center received for 11 million dollars.

What do you see, doing with that money, how that's going to help, maybe, rural outreach in that area?

>> To be clear,...it's a state grant, but it is focused on the Spartanburg, Cherokee and Union Counties.

It's a system of care grant, meaning it's trying to find all those missing pieces that are so often absent in rural communities.

So, we want to work with all of our other partners with DSS, with the private sector, with the hospitals to try to make sure that kids have access to care, no matter whether they're one, and we're doing a safe baby court, or they're 17 and we're doing a peer drop in center.

<Gavin> ...Gotcha.

We'll have to follow up with you on that.

because it sounds exciting, and well needed and much needed up there.

...that's Roger Williams.

He's the Director of the Spartanburg Area Mental Health Center.

>> Thank you so much.

Thank you for having me.

For South Carolina ETV, I'm Gavin Jackson.

Be well, South Carolina.