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

How Long Are You Contagious When You Have COVID-19?

There are strict rules that dictate how long you are contagious and when you are most contagious when you have COVID-19.

Why is it so important to know how long you are contagious when you have COVID-19?

There are strict rules that dictate how long you are contagious when you have COVID-19.
There are strict rules that dictate how long you are contagious and when you are most contagious when you have COVID-19.

Of course, it is so that you don’t expose anyone else and get them sick too!

How Long Are You Contagious When You Have COVID-19?

Fortunately, knowing how long you are contagious when you have COVID-19 isn’t as confusing as it might seem.

Those people with severe symptoms or a severely weakened immune system might be contagious for a much longer period of time though, up to 20 days.
Those people with severe symptoms or a severely weakened immune system might be contagious for a much longer period of time though, up to 20 days.

In general, you are contagious until 10 days have passed since your symptoms first appeared, as long as you are free of fever and your other symptoms are improving.

But what if you never had any symptoms of COVID-19?

“If you continue to have no symptoms, you can be with others after 10 days have passed since you had a positive viral test for COVID-19.”

When You Can be Around Others

If you had a positive COVID-19 test, but no symptoms, then you will continue to be contagious until 10 days after the test.

Other things you should understand about COVID-19 include that:

  • although you are generally contagious for 10 days after your symptoms start or you had a positive test, you can be contagious even earlier, up to two days before you develop symptoms (presymptomatic transmission)
  • you are most contagious in the first days when your COVID-19 symptoms start when viral load peaks
  • it is possible that you could continue to test positive for up to three months, even though you are out of the range of time when you are considered contagious (viral load is too low to cause disease), which is why most experts don’t recommend retesting after someone is diagnosed with COVID-19, especially as a method to figure out when to end home isolation
  • you should start making COVID-19 antibodies within 5-10 days of getting sick, which is thought to make you less contagious
  • while you are likely contagious for at least 10 days (how long you should stay in isolation) when you are sick with COVID-19, if on the other hand, you are exposed to someone with COVID-19, you need to quarantine for 14 days – that’s the incubation period for COVID-19 – how long it might take to develop symptoms after being exposed

Don’t want to deal with any of this?

Wear a mask, practice social distancing, wash your hands, etc., and work to avoid getting COVID-19!

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

Are Kids Spreading SARS-CoV-2 in School and Daycare Centers

If kids aren’t spreading SARS-CoV-2, then why are three percent of the students at a high school in Texas sick with COVID-19?

Why are people starting to think that kids are spreading SARS-CoV-2, the virus that causing COVID-19, in school and daycare centers?

There have been over 500,000 cases of COVID-19 in children in the United States.
There have been over 500,000 cases of COVID-19 in children in the United States.

Probably because we are seeing more and more cases in kids, especially kids in daycare centers and schools in states with spiking cases.

SARS-CoV-2 in School and Daycare Centers

For example, let’s take a look at what’s going on in Texas…

“As of Friday, 410 total cases of coronavirus — 267 staff members and 143 children — had been reported at 318 licensed child care operations across the state, according to the Texas Health and Human Services Commission.”

Texas child care centers see sharp increase in coronavirus cases after months of relative calm

So far in Texas, 83% of child care centers (12,196 facilities are open) haven’t reported a COVID-19 case.

But 17% have…

Either in a child or adult.

Altogether, since March, there have been 1,271 cases in children and 2,416 cases in adults in 2,034 different daycare centers in Texas.

So far the largest cluster was in a Houston daycare, in which 17 adult staff members and 6 kids tested positive.

In another large cluster, in Pleasanton, 11 kids, but only 2 adult staff members tested positive.

COVID-19 has also already led to several school closures in Texas, just weeks after the start of the fall semester.

In one high school in East Texas, the number of active COVID-19 cases has already reached 3%. The school was only open for about three and a half weeks before having to move to online only education.

Are Kids Spreading SARS-CoV-2 in School and Daycare Centers?

A rise in cases in daycare centers doesn’t necessarily mean that it is the kids that are doing the spreading though.

Are staff members getting exposed and bringing SARS-CoV-2 to work with them, exposing the children? Or are the children acting as the spreaders?

A new study, Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020, provides some answers.

Children who likely got COVID-19 at two Utah daycare centers spread it to other family members at home.

These outbreaks all started with an infected staff member, but quickly spread to other staff members and children.

“Analysis of contact tracing data in Salt Lake County, Utah, identified outbreaks of COVID-19 in three small to large child care facilities linked to index cases in adults and associated with transmission from children to household and nonhousehold contacts. In these three outbreaks, 54% of the cases linked to the facilities occurred in children. Transmission likely occurred from children with confirmed COVID-19 in a child care facility to 25% of their nonfacility contacts.”

Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020

Not surprisingly, cases then spread outside the daycare centers, to some of the parents of these children and other family members at home.

Of course, that this study found evidence that children can spread SARS-CoV-2 isn’t surprising because it isn’t the first to make this claim.

“These findings demonstrate that SARS-CoV-2 spread efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission. Asymptomatic infection was common and potentially contributed to undetected transmission, as has been previously reported.”

SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020.

There is also the report about children at the overnight camp in Georgia in June, which found an overall attack rate of 44% among the campers.

And the report about the Rhode Island COVID-19 daycare outbreaks.

“A total of 101 possible child care–associated COVID-19 cases were reported during June 1–July 31. Among them, 49 (49%) symptomatic persons were excluded after receiving negative laboratory test results, 33 persons (33%) had confirmed cases, and 19 (19%) were classified as having probable cases.”

Limited Secondary Transmission of SARS-CoV-2 in Child Care Programs — Rhode Island, June 1–July 31, 2020

Fortunately, community transmission of SARS-CoV-2 was lower in Rhode Island than many other states at the time, which is likely why “possible secondary transmission was identified in four of the 666 programs that had been allowed to reopen,” and not more.

Of course, these results stand in contrast to early reports in other countries which found that children didn’t seem to be spreading SARS-CoV-2.

“These data all suggest that children are not significant drivers of the COVID-19 pandemic. It is unclear why documented SARS-CoV-2 transmission from children to other children or adults is so infrequent.”

COVID-19 Transmission and Children: The Child Is Not to Blame

Early reports that were maybe flawed because children simply weren’t being exposed to SARS-CoV-2 at the time because of school closures and other factors.

“Here, we report that replication of SARS-CoV-2 in older children leads to similar levels of viral nucleic acid as adults, but significantly greater amounts of viral nucleic acid are detected in children younger than 5 years.”

Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19)

So with conflicting reports, what are we to believe?

What to Know About Kids Spreading SARS-CoV-2

We will have to see more research, but with cases continuing to increase in daycare centers, schools, and colleges, it is very hard to believe that kids aren’t spreaders of SARS-CoV-2.

Not that they have to be…

There is an easy way to keep kids from spreading SARS-CoV-2 at daycare, school, and college.

Even easier than making them wear masks.

A recent study in Germany found that child-to-child transmission of SARS-CoV-2 in schools/childcare facilities appeared very uncommon, but this was at a time of very low rates of community transmission.
A recent study in Germany found that child-to-child transmission of SARS-CoV-2 in schools/childcare facilities appeared very uncommon, but this was at a time of very low rates of community transmission.

Yes, that’s keeping the COVID-19 case count down in your community!

More on Kids Spreading COVID-19

Returning to Sports After Having COVID-19

Review the guidelines on returning to youth sports during the COVID-19 pandemic.

While many of us are simply concerned about kids returning to school, there is an added concerned for other parents, whose kids play sports and have already had COVID-19.

Many kids are returning to playing sports as they return to school during the COVID-19 pandemic.
Many kids are returning to playing sports as they return to school during the COVID-19 pandemic.

When can they go back to playing sports?

Returning to Sports During the COVID-19 Pandemic

What are the issues with returning to sports during the COVID-19 pandemic?

Well obviously, there is the issue of a lot of kids getting together during practice and games and the risk that they could get each other sick.

“Sports that require frequent closeness between players may make it more difficult to maintain social distancing, compared to sports where players are not close to each other.”

COVID-19 and Considerations for Youth Sports

There is another issue though.

If kids have been inactive for a long time because we have been worried about them getting together and playing sports, then they might be out of shape and not ready to jump back in at their usual high level of activity.

“Implement a two-week ramp-up period for conditioning—aerobic, interval and strength training to decrease risk of injury—without scrimmages or games.”

Return to Youth Sports after COVID-19 Shutdown: Reference Guides

A graduated return to play program will be necessary until their conditioning improves again.

Returning to Sports After Having COVID-19

But what if your child has already had COVID-19?

When can they start playing sports again?

“Returning to sports participation after a COVID infection will be a significant question posed to pediatric providers in the coming months”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Wait, weren’t you aware that returning to sports after having COVID-19 was an issue?

Well, it is…

“Most pediatric patients will be able to be easily cleared for participation without extensive cardiac testing, but pediatric providers should ensure patients have fully recovered and have no evidence of myocardial injury.”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Or at should at least be something to think about.

“The question of returning to sports is significant because of the propensity for COVID-19 to cause cardiac damage and myocarditis. While the incidence of myocarditis is lower in the pediatric population compared to the adult population, myocarditis is known to be a cause of sudden death during exercise in the young athletic populations.”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Fortunately, kids often have mild or asymptomatic infections when they get COVID-19 and shouldn’t be at risk for heart problems. Even if these kids don’t need further testing, they should likely wait at least 14 days until their symptoms resolved (or after they tested positive if asymptomatic) before playing sports again.

Experts do recommend that older kids, over age 12 years who had more moderate symptoms, especially prolonged fevers or who required bed rest, have an ECG before doing high intensity, competitive sports or physical activity.

Those kids who had severe symptoms, especially if they were hospitalized, should see a pediatric cardiologist and follow the myocarditis return to play guidelines, which include an ECG, echocardiogram, and exercise restrictions, etc.

And all will likely need a graduated return to play program once they are ready to play sports again, as deconditioning will be an issue after weeks or months of being inactive, with further evaluation if they develop chest pain, an abnormal heart rate or rhythm, or fainting during exercise, etc.

More on Playing Sports and COVID-19