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COVID-19 update: Exposures, Testing, Daycare, School

by |  June 27th, 2020
  

June 26 COVID-19 UPDATE

Hello again!

We’re back with a long overdue (and lengthy) update about the pandemic to help guide your decisions and plans for the near future. Please note: we offer evidence-based information and our collective experience as pediatricians. We have great respect for infectious diseases and our job is to help you keep your kids healthy. Germs do not play politics!

  1. Office updates
  2. COVID-19 surging in Austin
  3. Daycare and school decisions
  4. What to do when exposure occurs
  5. What is a quarantine?
  6. Testing options
  7. Does my child qualify for testing?
  8. Where to get tested in Austin
  9. What to do if your child has symptoms of infection
  10. What is herd immunity?
  11. Opening up does not mean giving up

 

  1. Office updates: We are open!! Currently, we are scheduling as many well checks as possible before the fall begins. Please do not wait. We anticipate having to shift to more telehealth/sick visits as COVID-19 cases go up (and our usual respiratory viruses like croup, RSV, and flu start showing up). We updated our office policies on scheduling appointments and new charges in March 2020 and those are listed on the website.

 

  1. COVID-19 is surging in Austin. This is not an artifact of increased testing. It is true that more people are being tested, but the number to follow is the PERCENT of people testing positive. In April 2020, Austin had a 7% positive test rate, in May a 4% positive test rate, and currently, it is up to 10%. Hospitalization rates are also on the rise. If you want a deeper dive on what may lie ahead for Austin, we recommend watching this Travis County Medical Society video featuring Lauren Ancel Meyers, PhD, the executive director of the University of Texas COVID-19 Modeling Consortium. Spoiler alert: We are in this for the long haul and we are likely to have several openings and closings over the next several months.

 

  1. Daycare and school decisions. Many parents are weighing the pros and cons of sending children back to daycare and school. We know it is not an easy decision! The good news: children seem to have milder cases of illness and do not seem to spread this virus as readily as other viruses, like flu. The bad news: just this week, we have had patients in three different daycare centers in Austin with COVID-19+ teachers and the children are now on a 14-day quarantine. Even with measures in place, we know it will be difficult for children under age 5 to socially distance. So, you will have to decide what is a reasonable risk for your own family, and have a Plan B for childcare should your child have a COVID-19 exposure, become ill, or the daycare needs to close temporarily for positive cases. For school aged children, the American Academy of Pediatrics just released return to school guidance that encourages students to be physically present, if possible. The AAP’s goal is to “mitigate, not eliminate risk,” and with proper precautions, they view the benefit of in-person learning and socialization outweigh the risk of disease transmission based on the current data on COVID-19 in children. However, school aged children should be more compliant with social distancing measures than toddlers and preschoolers. So, it may be an easier decision for older kids than little ones. Whatever you decide to do, be prepared for a Plan B for the possibility of online learning and childcare.

 

  1. What to do when exposure occurs:

If your child has had close contact (within six feet for 15 minutes or more, within 48 hours prior to the onset of symptoms) with someone who is COVID-19 +, here is the CDC guide:

1) Get tested if possible*

2) If unable to get tested—> Quarantine for 14 days and monitor symptoms daily

3) If COVID-19 negative —> Quarantine for 14 days and monitor symptoms daily

4) If COVID-19 negative but then develops symptoms —> Retest**

5) If COVID-19 positive —> Quarantine until 10 days after symptoms appeared, symptoms are improved, and fever free without fever-reducing medication for 3 days

 

* Testing is more accurate at least 5 days after exposure or when a person has symptoms so you do not need to run out to get tested immediately unless your exposed child is in contact with a high-risk individual (e.g. a grandparent, underlying health condition)

**Testing is not 100% accurate and a child can develop symptoms and become ill up to 14 days after the exposure.

>See below for testing options in Austin

>Parents of children who are exposed, but were not themselves exposed to the infected person, are considered secondary exposures. The parent does not need to be tested unless their child becomes ill/tests positive. The parent does not need to strictly quarantine but should socially isolate as much as possible until 14-day period passes.

 

 

  1. What is a quarantine?

>Monitor your child’s symptoms and check his temperature twice daily in the morning and at night before bedtime.

>Avoid any contact with family members who are considered high-risk for more severe disease.

>Person in self quarantine should isolate in his own room and bathroom in the home, if possible.

>Avoid contact with family pets.

 

  1. Testing options: Here are the types of tests and what they mean.

Tests for active or current infection:

  • PCR Test: The most accurate test. Looks for the virus genetic code (RNA). Test is sent to a lab to analyze and takes 1-4 days for results. Test accuracy depends on quality of a deep nose swab (nasopharynx) and the amount of virus present (early in illness, a person without symptoms may be infected but test will be falsely negative).
  • Antigen Test: The quicker test. Looks for protein fragments of the virus. Test is done in doctor’s office with a nose swab and take 15-60 minutes for results. Test is less accurate than PCR test in detecting virus but a positive result confirms diagnosis. Patients with symptoms and a negative antigen test should get a PCR Test. (Brand names: Abbott ID Now, Quidel Sofia). These tests were recently approved and difficult to obtain due to high demand. WE ARE TRYING TO GET THEM 

Test for prior infection or immunity:

  • Antibody test: Blood test looks for body developing immune response to the virus. It takes at least two weeks AFTER an acute infection for antibodies to form. Some children will mount antibodies and still be shedding the virus, so having antibodies does not mean the period of contagiousness is over. Antibodies may or may not be positive even when a person was infected with COVID-19. And, even with antibodies there is no guarantee for duration of immunity. So, the utility of this test is questionable.

 

  1. Does my child qualify for testing?
  • Yes, if your child has symptoms of COVID-19 infection.
  • Yes, if there is a known exposure to someone with a confirmed case of COVID-19.

 

  1. Where to get testing in Austin?

Testing for Acute Infection (PCR or Antigen Testing)

Austin Public Health

  • PCR Testing, nasal swab for acute infection
  • gov/COVID19 self-assessment online, notified of drive through location
  • Free
  • Results back in 3-4 days

Pixel by Labcorp

  • PCR Testing, self-administer nasal swab for acute infection
  • Labcorp.com self-assessment online, test kit sent by FedEx overnight to home
  • Billed to your insurance
  • Mail back to lab by FedEx, result time varies

Remedy Urgent Care

  • PCR Testing, nasal swab for acute infection
  • Requires telehealth visit with their provider first then drive up testing
  • com
  • Insurance accepted, result time varies

 

Testing for Prior infection (Antibody Testing)

  • 411 Pediatrics can order antibody testing, which requires a blood draw at either Clinical Pathology Labs (CPL) or Quest Diagnostics

 

  1. What to do if your child has a fever (or other symptoms that might be COVID-19).

We are developing protocols and working with local school nurses so there is some uniformity in managing illness in children in this new world. Once we formalize these protocols we will share them with you on 411pediatrics.com. The general idea is this:

  • Fever of 100 F or greater

—> send home from daycare or school

—>contact 411 Pediatrics; set up telehealth visit

—>telehealth visit determines if testing at our office is indicated (e.g. COVID-19*, Strep, Flu, RSV, Urine, blood count)—*presuming we acquire COVID-19 tests for our office

—> decide if child needs in-office visit (babies under 3 months of age need in office visit)

—>treat illness/symptoms as indicated

If COVID negative—>return to school once fever free x 3 days without fever-reducing medication.

If COVID positive—> return to school 10 days after symptoms appeared, symptoms are improved, and fever free without fever-reducing medication for 3 days.

  • We will develop protocols for other symptoms related to COVID-19 because many children with COVID-19 will not have fever or cough initially. Other symptoms include vomiting, diarrhea, cough, shortness of breath, runny nose, fatigue, chills, body aches, sore throats, loss of smell or taste, poor feeding or appetite, and headaches. A child with any new symptom without a diagnosis to explain it should stay home. Contact our office to review next steps.

 

  1. What is herd immunity?

Herd immunity or “community immunity” occurs when enough people are immune to an infection that it makes it difficult to spread. This allows the entire community to be protected, even people who are not immune. Experts believe 60-70% of the population needs to be immune to COVID-19 to reach herd immunity. (That’s about 200 million people in the United States—and we are at 2.5 million right now.) This protection can occur naturally as people become ill, but with that also comes death and significant morbidity as we learn more about possible long-term health consequences of surviving this infection. So, having a chicken pox/COVID-19 party is NOT the way to achieve herd immunity! Ideally, we will achieve community immunity through vaccination, when available.

 

11. Opening up does not mean giving up. Please be vigilant to help reduce the spread of illness. Our greatest defense right now is protecting each other. It’s pretty simple and it’s on us.

 

We are here for you and your family. We will keep sending you updates—feel free to share these with other Austin families. Please stay healthy!

|, , , , , 411 Pediatrics

About

Dr. Ari Brown is a pediatrician and a mom. Dr. Brown is Board Certified and a Fellow of the American Academy of Pediatrics. She has been in private practice for over 20 years. Her passion to advocate for children and educate families extends beyond the office setting. She is the co-author the bestselling "411" parenting book series including Expecting 411: Clear Answers and Smart Advice for your Pregnancy, Baby 411, and Toddler 411. Dr. Brown has received several professional awards including the Ralph Feigin, MD Award for Professional Excellence, the prestigious Profiles in Power Award by the Austin Business Journal for her service to the community, Austin's Favorite Pediatrician by Austin Family Magazine, and Texas Monthly Magazine's Super Doctor.

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