What is the COVID-19 Multi-System Inflammatory State?

Are kids with COVID-19 developing symptoms of Kawasaki disease?

Breaking News – The CDC reports at least 1,000 confirmed cases of MIS-C and 20 deaths in the United States. (see below)

Kids aren’t supposed to get serious COVID-19 symptoms, right?

As we are learning more and more about SARS-CoV-2, that seems to be holding true most of the time.

That doesn’t mean that kids are unaffected though.

Remember, it is still thought that kids get asymptomatic infections that they can spread to everyone else. And tragically, they sometimes get life-threatening infections.

What is the COVID-19 Multi-System Inflammatory State?

What else are we seeing when kids get SARS-CoV-2?

As they reassure parents that “serious illness as a result of COVID 19 still appears to be a very rare event in children,” the Paediatric Intensive Care Society issued a statement discussing an NHS England email alert about kids presenting with a type of multi-system inflammatory disease.

“The alert indicated ‘the cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children. Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation’.”

PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease

This statement followed the release of a study in Hospital Pediatrics, COVID-19 and Kawasaki Disease: Novel Virus and Novel Case, that discussed a similar case.

“We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease (KD), who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And an alert of more frequent cases of Kawasaki disease in France and Italy.

“In several Italian centers, where the incidence of Covid-19 was higher – Professor Ravelli told ANSA – more frequent cases of Kawasaki disease have occurred than we have observed before the arrival of the coronavirus.”

Coronavirus: Prof. Ravelli, investigation of Kawasaki disease report (google translated)

And New York.

“The NYC Health Department contacted PICUs in NYC during April 29-May 3, 2020 and identified 15 patients aged 2-15 years who had been hospitalized from April 17-May 1,2020 with illnesses compatible with this syndrome (i.e., typical Kawasaki disease, incomplete Kawasaki disease, and/or shock).”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Following a report of 15 cases in New York City, the New York State Department of Health issued an advisory to healthcare providers about 64 potential cases throughout the state.

As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.
As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.

And next came an alert from the CDC on what they are calling multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).

MIS-C case definition

Most people will find the MIS-C case definition more helpful than the new name.

Also helpful is a recommendation to “report suspected cases to their local, state, or territorial health department.”

“This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness.”

Health Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated With Coronavirus Disease (Covid-19) in Children

So what does this mean?

It may means that we can add SARS-CoV-2 to the list of possible viruses that can trigger Kawasaki disease.

“Various studies have described an association between viral respiratory infections and KD, ranging from 9% to as high as 42% of patients with KD testing positive for a respiratory viral infection in the 30-days leading up to diagnosis of KD.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And continue to be reassured that “serious illness as a result of COVID-19 still appears to be a very rare event in children.”

“If the above-described inflammatory syndrome is suspected, pediatricians should immediately refer patients to a specialist in pediatric infectious disease, rheumatology, and/or critical care,as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications. Patients meeting criteria for Kawasaki disease should be treated with intravenous immunoglobulin and aspirin”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Still, everyone should be on the alert for MIS-C, especially as COVID-19 cases once again surge.

More on COVID-19 in Kids

Are Kids Dying With COVID-19?

How many children have died with COVID-19?

Breaking News – A young child in Allegheny County, Pennsylvania with underlying medical conditions died of COVID-19. (see below)

You have likely heard that COVID-19 is not supposed to make children sick, so what’s with the reports that kids are dying with COVID-19?

“Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group.”

Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020

So far, while only about 5% of cases in the United States have occurred in children and teens who are less than 18 years old, some of those “pediatric COVID-19 cases were hospitalized.”

The American Academy of Pediatrics reports at least 138 child deaths from COVID-19.
The American Academy of Pediatrics reports at least 138 child deaths from COVID-19.

Some were even admitted to the ICU and tragically, some have died.

Are Kids Dying With COVID-19?

How many kids?

So far, as of mid November, there have been over 1,349,000 COVID-19 deaths worldwide (all ages), including over 249,000 deaths in the United States (all ages).

“In China, the novel coronavirus has claimed the lives of a 10-month-old and a 14-year-old, at least.”

The coronavirus pandemic has claimed the lives of an infant and a teenager

And some of those deaths have been in children.

“Three deaths were reported among the pediatric cases included in this analysis; however, review of these cases is ongoing to confirm COVID-19 as the likely cause of death.”

Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020

It’s important to note that some these recent COVID-19 deaths in children are still being investigated, but according to reports they include:

The latest reports of COVID-19 deaths include:

Experts have still not confirmed that COVID-19 caused all of these deaths.

Kids are dying with COVID-19.
Kids are dying with COVID-19.

Still, the AAP reports that there have been at least 138 COVID-19 deaths in children in the United States and cases are on the rise in many areas.

“During February 12–July 31, 2020, a total of 391,814 cases of COVID-19 and MIS-C (representing approximately 8% of all reported cases) and 121 deaths (approximately 0.08% of all deaths) were identified among persons aged <21 years in the United States.”

SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020

While there are far fewer COVID-19 deaths in children than in adults, since fewer kids are reportedly getting infected, the number of deaths is concerning.

“Among the 121 decedents, 30 (25%) were previously healthy (no reported underlying medical condition), 91 (75%) had at least one underlying medical condition, and 54 (45%) had two or more underlying medical conditions.”

SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020

And that’s why it is important to continue to encourage your kids to follow all social distancing recommendations.

Keep in mind that there have been an additional 20 deaths in children from multisystem inflammatory syndrome in children (MIS-C), which is associated with COVID-19.

More on COVID-19 Deaths

The Best Milk for Kids – Does It Still Come from a Cow?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut.

You wouldn’t think that the idea that kids should drink milk would be controversial.

Of course, it is…

The new joke seems to be that you can turn anything into milk.
The new joke seems to be that you can turn anything into “milk,” even peas.

The controversy is more over the type of milk now and not so much over the amounts though.

Few people disagree with the American Academy of Pediatrics 2014 clinical report on Optimizing Bone Health in Children and Adolescents, in which they recommended that “Children 4 through 8 years of age require 2 to 3 servings of  dairy products or equivalent per day. Adolescents require 4 servings per day.”

Which Kind of Milk You Got?

While you used to have to go to Whole Foods to get soy milk, nearly every grocery store now has every type of “milk” you can think of, and some you haven’t.

So in addition to raw milk and pasteurized cow’s milk, it is possible to buy:

  • almond milk
  • cashew milk
  • coconut milk
  • flax milk (flax seeds)
  • goat milk
  • hazelnut milk
  • hemp milk
  • lactose free milk (cow’s milk without lactose)
  • oat milk
  • potato milk (as powdered milk)
  • quinoa milk
  • rice milk
  • ripple milk (peas)
  • 7 grain milk (Oats, Brown Rice, Wheat, Barley, Triticale, Spelt and Millet)
  • soy milk
  • sprouted rice milk

Complicating matters even more, once you decide on the type of milk to give your kids, you will have a lot of other options to choose from – organic, hormone free, sweetened vs unsweeted, enriched vs original, and a long list of flavors, etc.

The question is no longer simply Got Milk?

Best Milk for Kids

So which milk is best for your kids?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and most importantly, which he is going to drink.

What about the idea or argument that cow’s milk is made for baby cows?

Following that logic, if you weren’t going to give your kids cow’s milk, then you probably wouldn’t give them most plant based milks, as they are commonly made from seeds. Almonds, peas, and soybeans, etc., aren’t “made” to make milk. They are produced to make more plants. But just like we pasteurize and fortify cow’s milk so that we can consume it, we have learned to use these other foods.

Best Milk for Kids with Food Allergies

While the wide availability of so many different types of milk is confusing for many parents, it has been great for pediatricians and parents of kids with food allergies and intolerances. Having more of a variety has also been helpful for vegan families.

In general, you should breastfeed or give your infant an iron fortified formula until they are at least 12 months old, avoiding milk or other allergy foods as indicated if you are breastfeeding and your child develops an allergy to that food, or switching to a hypoallergenic or elemental formula if your child develops a formula allergy.

And then, after your toddler is old enough to wean from breastmilk or formula, you:

  • should avoid cow’s milk, lactose-free cow’s milk, and goat milk if your child has a milk protein allergy
  • should avoid almond, cashew, coconut, and hazelnut milk if your child has a nut allergy (yes, even though almonds and coconuts are really stone fruits and not true nuts, they have been rarely known to cross react and trigger allergic reactions)
  • should avoid soy milk if your child has a soy allergy
  • should make sure your child’s milk is fortified with calcium and vitamin D

Most importantly, talk to your pediatrician and/or a pediatric allergist before switching to a plant based milk if your child has food allergies and before trying to switch back to cow’s milk after you think they have outgrown their allergy.

Other Things to Know About Kids Drinking Milk

Kids don’t necessarily need to drink any kind of milk.

They do need the nutrients that you commonly get from milk, including fat, protein, calcium, and vitamin D, etc.

You should also know that:

  • the American Academy of Pediatrics recommends that most toddlers drink whole milk until they are two years old, when they should switch to reduced fat milk.
  • switching to reduced fat milk can be appropriate for some toddlers who are already overweight or if their pediatrician is concerned about their becoming overweight or about their cholesterol, etc.
  • most cow’s milk that you buy in your grocery store doesn’t have any added growth hormone (labeled rBST-free), even if it isn’t organic
  • the AAP, in a report on Organic Foods: Health and Environmental Advantages and Disadvantages, states that “there is no evidence of clinically relevant differences in organic and conventional milk”
  • if a company makes more than one type of non-dairy milk, such as rice, almond, and soy, then cross-contamination could be a problem for your child with food allergies
  • most kids with a lactose intolerance can tolerate some lactose in their diet, so may be able to drink some cow’s milk and eat cheese, yogurt, and ice cream, even if they can’t tolerate a lot of regular cow’s milk
  • while plant based milks are lactose free and some are unsweetened, others might have added sugar, including cane sugar or cane syrup
  • reduced-calorie and no added sugar flavored cow’s milk often use artificial sweeteners
  • unlike cow’s milk, most plant based milks are very low in protein, so look to give other protein rich foods to make up for it, like eggs, peanut butter, beans, tofu, and of course meats
  • although they aren’t labeled as 1% or 2%, plant based milks typically have less fat than whole milk, so look to give other foods with healthy fats to make up for it, like avocados, hummus (provides protein and fat!), peanut butter, some fish (salmon), and use olive oil, coconut oil, and real butter when possible
  • phytoestrogens in soy milk are a concern for some people
  • most milk, even oat milk, is gluten-free, with the exception of 7 grain milk, which obviously contains wheat
  • UHT milk undergoes ultra-high temperature processing or ultra-pasteurization to allow it have a longer shelf life, even if not refrigerated, at least until the carton is opened
  • although some experts warn about cross reactivity, like between peanuts and green peas, the Food Allergy Research & Education website states that “If you are allergic to peanuts, you do not have a greater chance of being allergic to another legume (including soy) than you would to any other food.”
  • raw cow’s milk, in addition to being a risk for bacterial contamination and outbreaks of Escherichia coli, Campylobacter, and Salmonella, is very low in vitamin D and has no proven health benefits over pasteurized milk
  • some brands of almond milk contain only about 2% of almonds, which leads some critics to say that you should just eat a few almonds to get even more nutritional benefits

But don’t forget about cost. Plant based milk can be at least two to four times more expensive than cow’s milk.

So again, remember that while each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut, etc.

For More Information On The Best Milk For Kids:

Save

Where is COVID-19 Spreading Now?

Since SARS-CoV-2 is spreading wherever a lot of people are getting together, you must adapt to life with COVID-19 now, so that you will still be around when COVID-19 is finally gone.

As cases start to surge again and countries are reentering lockdown, you might be asking yourself just who is spreading COVID-19 around now?

Is it political rallies, protestors, or kids going to school?

Where is COVID-19 Spreading Now?

In addition to very large gatherings, like political rallies, some folks might be surprised to learn that COVID-19 is now spreading:

  • after religious events and holidays
  • in daycare centers and schools
  • among recreational, high school, and college sports teams
  • at very large gatherings (>50 people), including funerals and weddings, some of which turn into superspreading events
  • at large gatherings (>10 people) of family and friends

Not surprisingly, SARS-CoV-2 is spreading wherever a lot of people are getting together.

Hopefully, understanding that can help us all avoid getting sick with COVID-19!

“Regardless of the origin of superspreading, we emphasize the particular fragility of a disease in which a major part of infections are caused by the minority. If this is the case, the disease is vulnerable to mitigation by reducing the number of different people that an individual meets within an infectious period. The significance is clear; Everybody can still be socially active, but generally only with relatively few – on the order of ten persons. Importantly, our study further demonstrates that repeated contact with interconnected groups (such as at a work-place or in friend groups) is comparatively less damaging than repeated contacts to independent people.”

Superspreaders provide essential clues for mitigation of COVID-19

Remember, the pandemic isn’t over yet.

If anything, we are heading into another big wave in most parts of the world.

And although COVID-19 vaccines are on the way, they won’t be hear quick enough to stop it.

A positive COVID-19 rapid test.
A positive COVID-19 rapid test.

Only you can stop it by social distancing from others as much as possible (stay at least 6 feet away), wearing a mask (yes, masks still work despite the new study some folks are talking about), and washing your hands regularly.

Most importantly, understand that:

  • someone can be contagious for up to two days before they develop symptoms of COVID-19 or they test positive and will continue to be contagious for at least 10 more days, their isolation period
  • if exposed to someone with COVID-19, you should avoid others and go into self-quarantine for at least 14 days after your last contact, as that is the incubation period (the time from exposure to when you might develop symptoms)
  • in addition to those who are sick before they develop symptoms (pre-symptomatic), some are contagious even though they never develop symptoms (asymptomatic transmission)
  • you can’t test out of your quarantine after being exposed
  • there are no good treatments and there is definitely no cure for COVID-19

And know that COVID-19 can be life-threatening, especially for folks who are in high risk groups, including those who are elderly and anyone with chronic health problems.

What does all of this mean?

That you have to adapt to life with COVID-19 now, so that you will still be around when COVID-19 is finally gone.

More on the Spread of COVID-19

Does Your Child Have Dyspraxia?

Could your clumsy child with delayed milestones have dyspraxia?

Have you ever thought that your child might have dyspraxia?

“Developmental dyspraxia is a disorder characterized by an impairment in the ability to plan and carry out sensory and motor tasks. Generally, individuals with the disorder appear “out of sync” with their environment. Symptoms vary and may include poor balance and coordination, clumsiness, vision problems, perception difficulties, emotional and behavioral problems, difficulty with reading, writing, and speaking, poor social skills, poor posture, and poor short-term memory. Although individuals with the disorder may be of average or above average intelligence, they may behave immaturely.”

Developmental Dyspraxia Information Page

Probably not, as most people have never even heard of it.

Confusing things even more, dyspraxia has also been known by other terms, including clumsy child syndrome, sensory integration disorder, and developmental coordination disorder.

Does Your Child Have Dyspraxia?

Dyspraxia is a disorder of movement coordination, but it can also affect your child’s language, speech, and learning.

You might think about getting your child evaluated for dyspraxia if they have delayed early motor development. More common in boys, it is thought that at least 5-6% of children could have dyspraxia.

“In the preschool child, common features reported by parents include a history of delayed developmental milestones, particularly crawling, walking and speech, difficulty with dressing, poor ball skills, immature art work and difficulty making friends.”

Dyspraxia or developmental coordination disorder? Unravelling the enigma

Does your child:

  • have poor balance
  • have trouble pedaling a tricycle or bicycle
  • have bad handwriting because they have difficultly gripping their pen or pencil
  • avoid playing with toys like Lego blocks and jigsaw puzzles

Is your child:

  • clumsy, often falling or bumping into people and things
  • a messy eater because they have trouble using spoons and forks, etc.
  • delayed in learning to button clothes or tie their shoes, etc.

Was your child extra fussy as a baby? That’s another sign of children with dyspraxia.

Dyspraxia isn’t just about these motor issues though.

Childhood dyspraxia is included in the DSM-V manual, with clear diagnostic criteria.
Childhood dyspraxia is included in the DSM-V manual, with clear diagnostic criteria.

Either because dyspraxia can also be associated with ADHD, learning disorders, or autism, or just because the signs and symptoms occur as a part of dyspraxia, these children might have many other signs and symptoms, including speech delays, sensory issues, and problems with concentration and comprehension.

More common in infants who are born premature, dyspraxia is thought to be caused by immaturity in neuron development.

Talk to your pediatrician if you suspect that your child has dyspraxia, as early intervention with occupational therapy and speech therapy can be helpful. A pediatric neurologist can also be helpful in getting your child evaluated for dyspraxia.

More on Dyspraxia

Mask Exemptions for Kids During the COVID-19 Pandemic

If your child doesn’t want to wear a face mask, your pediatric provider might be able to offer more help than just an exemption.

Some parents who don’t want their kids to wear a mask at school might think about asking their pediatrician to write a mask exemption for their kids.

You can easily spread what you don't know you have... Remember, you can be contagious a few days before you have symptoms of COVID-19, which is why mask exemptions for kids aren't a good idea unless they are medically necessary. #BeInformed
You can easily spread what you don’t know you have… Remember, you can be contagious a few days before you have symptoms of COVID-19, which is why mask exemptions for kids aren’t a good idea unless they are medically necessary. #BeInformed

Before they do, they might understand that there are very few real medical reasons for these types of exemptions for wearing a mask.

Masks Control the Spread of SARS-CoV-2

More and more, we are learning that masks can help prevent the spread of SARS-CoV-2, the virus that causes COVID-19, protecting both the person wearing the mask and the people around them.

“The prevention benefit of masking is derived from the combination of source control and personal protection for the mask wearer. The relationship between source control and personal protection is likely complementary and possibly synergistic, so that individual benefit increases with increasing community mask use.”

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2

Still, that doesn’t mean that everyone has gotten used to wearing them…

Hopefully, most folks do now understand why they are important though.

Wait, why are they important, especially if you are healthy and the people around you don’t have COVID-19?

Mostly it is because people with COVID-19 can be contagious:

  • up to two days before they start to show symptoms
  • up to two days before they test positive, even if they don’t have any symptoms

So if you are waiting to put on a mask until people around you have symptoms, then you will eventually get exposed, probably without even knowing it, and you might get sick, ending up in isolation, not being able to go to school or work.

And if you wait to put on a mask until you start to show symptoms, then you will likely eventually expose other people to the SARS-CoV-2 virus.

The alternative, if you want to reduce your risk of getting sick, is to just wear a mask any time that you can’t social distance (stay at least six feet apart) from other people.

Mask Exemptions for Kids During the COVID-19 Pandemic

So what are the medical reasons that kids, like adults, can’t wear a mask all day while they are at school?

In general, a child over age two years should wear a face mask unless:

  • they have a physical or intellectual condition that would keep them from being able to remove their face mask by themselves
  • they can’t tolerate wearing a face mask because they have a condition such as autism spectrum disorder, intellectual disability, or a mental health disorder
  • they have a physical or intellectual condition and wearing a cloth face mask gets in the way of their ability to communicate

But shouldn’t these kids just do virtual school if they can’t wear a mask, instead of getting an exemption?

While that might be an option for some kids, others need the extra services that they get at school, which they can’t get with at home schooling.

In addition to a face mask exemption, some things that might work in some situations when a child won’t wear a mask include:

  • a face shield
  • a transparent face mask
  • using different fabrics for the mask
  • trying a bandana or gaiter
  • try to desensitize your child to wearing a mask

What about asthma?

In general, most kids with well controlled asthma should be able to wear a face mask. If your child’s asthma is so severe that it is made worse by wearing a face mask, then they likely need an evaluation by a pulmonologist and it might be best to avoid being around others during the pandemic.

If your child can wear a face mask, but just doesn’t want to, then it might help to allow them to pick their own mask, with a comfortable fabric and fit, maybe even getting a mask with a favorite character on it.

“Model it! Make it familiar by wearing a mask too.”

Getting Your Child to Wear a Mask

And don’t expect your child to want to wear a mask at school if you don’t wear a mask when you go out or if you don’t believe that wearing a mask is necessary.

More on Mask Exemptions

Health Supervision Guidelines for Children With Extra and Special Needs

In addition to the routine recommendations for preventative pediatric health care that all kids need, there are specific health supervision guidelines for children with special needs.

In addition to the routine recommendations for preventative pediatric health care that all kids need, there are some extra things that kids with special needs should get at their well child check ups.

Health supervision for children with Down Syndrome.
The American Academy of Pediatrics has published health supervision guidelines for children with Down Syndrome.

There might also be extra things that need to be done for kids who have been diagnosed with various chronic conditions, from cystic fibrosis and diabetes to immunodeficiency syndromes and tuberous sclerosis.

Health Supervision Guidelines for Children With Extra and Special Needs

Being aware of and following these guidelines can help to make sure these kids get all of the screening tests, referrals to specialists, and other things that are necessary to keep them safe and healthy.

There are also AAP guidelines to help pediatric providers care for children in other special situations:

Guidelines that help pediatric providers care for all of their kids, no matter their needs.

More on Health Supervision Guidelines for Children

Why Can’t You Test Out of Your COVID-19 Quarantine?

You can’t test out of your 14 day COVID-19 quarantine after you have been exposed to someone with COVID-19.

Most people understand that they can’t test out of quarantine, right?

A quick reminder that close contacts of someone with COVID-19 need to quarantine for 14 days.
A quick reminder that close contacts of someone with COVID-19 need to quarantine for 14 days.

After all, if they are around others before their quarantine is over, they could end up exposing others to COVID-19!

Why Can’t You Test Out of Your COVID-19 Quarantine?

But why can’t you just test out of your COVID-19 quarantine?

Basically, if you have a negative COVID-19 test early in your quarantine period, it doesn’t mean that you can’t develop symptoms or test positive later on.

“If you are tested and the test is negative, do you still have to be quarantined?
Yes. Someone exposed to a person with COVID-19 needs a 14-day quarantine regardless of test results. This is because COVID-19 can develop between two and 14 days after an exposure.”

Coronavirus Questions and Answers

Testing negative doesn’t get you out of quarantine.

A negative test simply means that you don’t have an active infection. It doesn’t mean that the SARS-CoV-2 virus isn’t still incubating inside you. And no, we can’t test for that.

So why get tested?

“If you do not have symptoms, it is best to get tested between 5-7 days after you’ve been in a high-risk situation.  If your test is negative, get tested again around 12 days after the event. It can take 2-14 days for COVID-19 to develop, so even if you test negative once, you could still develop COVID-19 later and spread it unknowingly.”

Symptoms and Testing: COVID-19

Getting tested can be helpful because some people can test positive even if they don’t have symptoms, they can still be contagious, and this can help with contact tracing and can help you warn others that you exposed them to COVID-19.

Ideally, since you are in quarantine, you would not have exposed anyone else though…

And if you test positive?

Well, technically that does get you out of quarantine, but only to move you to a period of isolation, which is basically a stricter form of quarantine and lasts at least 10 days.

More on Testing out of Quarantine

7 Things to Know About COVID-19

Everything you need to know to reduce your risk of getting and exposing others to COVID-19.

We are far enough into this pandemic that there really is no excuse that folks still don’t know about the importance of going into quarantine after being exposed or why you should practice social distancing and wear a face mask.

As usual, Del Bigtree gets this one wrong. Hedrich wasn't the first to talk about herd immunity.
As usual, Del Bigtree gets this one wrong. Hedrich wasn’t the first to talk about herd immunity.

And yet, cases are once again surging all over the country…

7 Things to Know About COVID-19

In addition to knowing that the pandemic isn’t over and won’t be over for some time, you should know that:

  1. you could have been exposed to SARS-CoV-2 if you had close contact (less than 6 feet apart) to someone with COVID-19 (has symptoms or tested positive) for at least 15 minutes, even if you were both wearing masks (sure, there is much less risk if you were wearing masks, but to be safe, it still counts as an exposure). And with the latest guidelines, the exposure doesn’t have to for a continual 15 minutes, but rather “a cumulative total of 15 minutes or more over a 24-hour period.” So if you were close to someone with COVID-19 for 5 minutes each hour for three hours, then that counts as close contact.
  2. you can develop symptoms of COVID-19 from one to 14 days after you are exposed to someone with COVID-19. This is the incubation period for the SARS-CoV-2 virus and the time you should be in quarantine after your exposure.
  3. testing negative soon after you are exposed to someone with COVID-19 doesn’t mean that you can’t develop symptoms later in your incubation period! Although testing is a very important part of containing this pandemic, you don’t necessarily need to rush to get tested right after you are exposed. You can, but understand that a negative test doesn’t get you out of your quarantine early. A positive test will shift you into a period of isolation, but know that some COVID-19 tests, especially the rapid antigen tests, are more likely to give a false positive result if you don’t have symptoms. If you are going to get tested after being exposed and don’t have symptoms, the optimal time is probably about 5 to 7 days after your exposure and remember to continue your quarantine if it is negative.
  4. you can be contagious for at least two days before you develop any symptoms of COVID-19 or test positive and will continue to be contagious for at least ten days, the time you should be in isolation (a stricter form of quarantine). If you had severe symptoms or have a severely weakened immune system, then you might be contagious for a much longer period of time though, up to 20 days. And remember that you can continue to test positive for weeks or months, long after you are no longer contagious, which is why repeat testing is no longer routinely recommended.
  5. you can be contagious even though you don’t have symptoms, which is why you should try to always wear a mask and practice social distancing when you are around other people. You don’t know who has COVID-19!
  6. if you continue to be exposed to someone with COVID-19 in your home, your 14 day quarantine period doesn’t start until they are no longer contagious, as you will continue to be exposed that whole time. That’s why some folks end up in extended quarantine for 24 days- the 10 days that the COVID-19 positive person was contagious + 14 days of quarantine, which started once the person was no longer contagious.
  7. we can’t count on natural herd immunity to end the pandemic, as that would mean millions and millions of people dying. But understand that there is a middle ground between the extremes of total lockdowns and doing nothing. Wear a mask, keep six feet apart from other people (social distancing), and avoid crowds until we get safe and effective COVID-19 vaccines!

Most importantly, know that the more people you are around, the higher the risk that you will be exposed to and get sick with COVID-19.

Avoid crowded spaces, wear a mask, and practice social distancing to decrease your risk of getting COVID-19.
Avoid crowded spaces, wear a mask, and practice social distancing to decrease your risk of getting COVID-19.

Is it really essential that you have a family gathering with 25 or 50 people right now, as cases begin to surge in your area? Will you be able to keep everyone six feet apart? Will they be wearing masks the whole time?

Do you want to keep schools and businesses open, even if they aren’t at full capacity?

Then wear a mask, practice social distancing, wash your hands, avoid crowds, and stop acting like the pandemic is already over or never existed in the first place!

More on COVID-19

Screening Questionnaires in Pediatrics

These screening questionnaires can be a good starting point if you suspect that your child is having problems with anything from anxiety and depression to OCD and PTSD.

It’s no secret that the COVID-19 pandemic is having many effects beyond kids getting sick with COVID-19…

“Coronavirus disease (COVID-19) can affect children and young people directly and indirectly. Beyond getting sick, many young people’s social, emotional, and mental well-being has been impacted by the pandemic. Trauma faced at this developmental stage can continue to affect them across their lifespan.”

COVID-19 Parental Resources Kit

How we find these kids with social, emotional, and mental issues shouldn’t be a secret either.

Screening Questionnaires in Pediatrics

Of course, not all kids are having problems right now.

Are yours?

“Here are some quick ideas for how to get conversations started with children and young people about how they are feeling and what they are struggling with regarding COVID-19. You don’t have to use these exact words—you know best how to speak with your child, adolescent or youth. In addition, how we talk to children and young people varies depending on their age and developmental level.”

COVID-19 Parental Resources Kit

In addition to using some of the conversation starters in the COVID-19 Parental Resources Kit from the CDC and seeing your health care provider for a check-up, these screening questionnaires and checklists might help you discover issues that your kids are having.

You can't ask your kids (whether you are a parent or a pediatrician) these types of screening questions if you don't know these screening questionnaires exist...
You can’t ask your kids (whether you are a parent or a pediatrician) these types of screening questions if you don’t know these screening questionnaires exist…

Screening questionnaires?

While these aren’t necessarily designed for parents to use to screen their kids on their own, there are a large number of questionnaires and screening tools that your health care provider can use to make sure your kids are safe and healthy, including:

At the very least, these types of pediatric screening questionnaires can be a good starting point if you suspect that your child is having problems.

More on Pediatric Screening Questionnaires and Checklists