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

Going Back to School During the COVID-19 Pandemic

What does going back to school during the CO pandemic look like?

For most parents, the ongoing COVID-19 pandemic has complicated their plans to send their kids back to school.

Going Back to School During the COVID-19 Pandemic

We can likely all agree that if it could be made safe for kids, teachers, and other support staff in schools, then kids should go back to school.

So what’s the problem?

Depending on where you live, the size of your school, and the number of cases, etc., it may not be possible to make schools that safe. After all, how much social distancing can you do in a classroom full of kids? And will kids, especially younger kids, really wear a face covering all day?

Sending Your Kids Back to School

On the other hand, if your community is doing a good job of keeping COVID-19 case counts down, then maybe it is safe, or at least, safe enough, to send most kids back to school.

Online or virtual schooling will be a safer option for higher risk kids.
Online or virtual schooling will be a safer option for higher risk kids. Fill out and review the CDC’s Back to School Decision Making Tool with your pediatrician if you aren’t sure what to do about school.

Going back to school might be a good option for:

  • kids who are healthy, without any high risk medical conditions, like diabetes or poorly controlled asthma
  • kids who have no high risk contacts at home, keeping in mind that in addition to having a chronic medical problem, the risk increases with age, especially once you reach age 65 years.
  • kids who have an IEP or get any kind of services or therapy at school that you can’t get at home
  • kids who did poorly with online school last spring
  • kids who are eager to go back to school

Most importantly, going back to school might be a good option for your kids if you are confident that your school has a good plan to keep your child and everyone else in the school safe.

Do they have a plan to cohort kids together, so that every kid in the school isn’t mixing with each other? What is their plan if someone gets sick? What is their plan if a lot of kids get sick?

It is also important to remember that virtual school isn’t a good option for everyone. Having a safe school to go to will be important for those kids who don’t have a parent or caregiver at home to help them with school or because they don’t have a reliable internet connection, etc.

Going to the School Nurse During the COVID-19 Pandemic

If your kids do go back to in-person school, what happens if they get sick?

“Immediately separate staff and children with COVID-19 symptoms (such as fever, cough, or shortness of breath) at school. Individuals who are sick should go home or to a healthcare facility depending on how severe their symptoms are, and follow CDC guidance for caring for oneself and others who are sick.”

Operating Schools During COVID-19

Should they go see the school nurse, if your school is fortunate enough to have one?

“School nurses are essential healthcare providers in the community working on the frontlines of the COVID-19 pandemic in schools.”

Considerations for School Nurses Regarding Care of Students and Staff that Become Ill at School or Arrive Sick

In addition to the problem with a bunch of contagious kids in the school nurse’s office, it is easy to see that it will difficult, if not impossible, for health care professionals at school to easily know if a sick child has COVID-19, strep throat, a cold, or the flu, etc.

“The overlap between COVID-19 symptoms with other common illnesses means that many people with symptoms of COVID-19 may actually be ill with something else. This is even more likely in young children, who typically have multiple viral illnesses each year.”

Screening K-12 Students for Symptoms of COVID-19: Limitations and Considerations

There is also the fact that a child who goes to the nurse’s office with a cough, runny nose, or headache, etc., might not have a contagious disease at all, as these symptoms can also be caused by asthma, allergies, and migraines.

“Remember that schools are not expected to screen students or staff to identify cases of COVID-19. If a school has cases of COVID-19, local health officials will help identify those individuals and will follow up on next steps.”

Considerations for School Nurses Regarding Care of Students and Staff that Become Ill at School or Arrive Sick

Fortunately, there are plans in place to deal with all of these scenarios.

Still, everyone should understand that most “sick kids,” whatever they have, will likely be sent home from school, just in case they have COVID-19. While that might sound drastic, the risk of getting others sick if they did have COVID-19 is too great.

“Actively encourage employees and students who are sick or who have recently had close contact with a person with COVID-19 to stay home.”

Operating Schools During COVID-19

So how do these plans work?

Back to School COVID-19 Sick Policies

While each state and school district seems to have their own back to school sick policy, in general, what to do should likely depend on the child’s symptoms, the possibility of an alternative diagnosis for the symptoms, potential for exposure to someone with COVID-19, the amount of community spread in the area, and COVID-19 test results, etc.

The Minnesota COVID-19 decision tree is for people in schools, youth, and child care programs who are experiencing symptoms consistent with COVID-19.
The Minnesota COVID-19 decision tree is for people in schools, youth, and child care programs who are experiencing symptoms consistent with COVID-19.

If one thing isn’t clear in all of these guidelines, it is to your pediatrician – we typically won’t be able to simply say that your sick child doesn’t have COVID-19 and can go back to school.

“A doctor’s note or negative test should not be required to return to school. Some tests can yield false negatives if taken too soon, and individuals with confirmed COVID-19 can continue to test positive after the infectious period has passed. Antigen tests currently are not as reliable in determining a true negative.”

Decision Tree Tool for School Nurses

Fortunately, many of the guidelines seem to understand this and don’t require a doctor’s note when kids have very mild symptoms.

“If the person is sent home, they can return to the school or program 24 hours after the symptom has improved.”

COVID-19 Decision Tree for People in Schools, Youth, and Child Care Programs

They aren’t perfect, but hopefully we can use these guidelines to help balance keeping those kids who might have COVID-19 out of school, perhaps learning virtually, while those kids who don’t remain at their desks.

More on Back to School

Fact Check – Did a Doctor Prove That Face Masks Don’t Work?

A recently uploaded video on YouTube by an anesthesiologist doesn’t prove that face masks don’t work to protect people against COVID-19.

Why do some people still think that face masks don’t work to protect them and others against COVID-19 infections?

Ted Noel did not prove that face masks don't work in his YouTube video.
Ted Noel did not prove that face masks don’t work in his YouTube video.

The usual suspects…

Did a Doctor Prove That Face Masks Don’t Work?

Of course, most people understand that face masks work well to protect us from the SARS-CoV-2 virus and COVID-19 infections.

“Face masks are a simple way to help decrease coronavirus transmission and save lives.”

Which type of face mask is most effective against COVID-19?

Sure, not all types of face coverings are created equal, but if you are wearing a face mask when you can’t social distance, then you will help to reduce the spread of SARS-CoV-2.

And no, despite his claims and video on YouTube, Dr. Ted Noel, a retired anesthesiologist, did not prove that face masks don’t work!

As an anesthesiologist with 36 years of experience, you would think he would understand how a surgical mask is supposed to fit...
As an anesthesiologist with 36 years of experience, you would think he would understand how a surgical mask is supposed to fit…

What did he prove?

If you are vaping and exhale through a poorly fit face mask, then, not surprisingly, the “vape smoke” is going to find a way around your mask!

Will it go through your face mask ?

Again, not surprisingly, it depends on the type of face mask.

This is probably a single layer cloth mask and not one made with a recommended two or three layers.
This is probably a single layer cloth mask and not one made with a recommended two or three layers.

In Ted Noel’s little experiment, you can see that his cloth mask didn’t perform very well.

Interestingly, someone else had already done this face mask experiment and got widely different results!

Doctors Who Proved That Face Masks Do Work

And these results that face masks work have been shown in much more sophisticated experiments using high tech equipment, including high speed cameras and laser light scattering.

How much protection your face mask offers depends on the type of mask, but you can clearly see that face masks work!
How much protection your face mask offers depends on the type of mask, but you can clearly see that face masks work!

These experiments confirm that face coverings can block aerosols and droplets when we cough, sneeze, and breath. And since viruses like COVID-19 are carried on these droplets, they prove that masks work.

Well most face masks…

To make sure your face mask works effectively, you should:

  • use a face covering made of at least two layers of a washable, breathable fabric
  • avoid face masks with valves
  • use a properly fitting face mask instead of a neck gaiter or bandanna
  • avoid face coverings made with fleece
  • wash your cloth face mask

And don’t listen to or share misinformation from folks pushing propaganda about COVID-19.

“Among 139 clients exposed to two symptomatic hair stylists with confirmed COVID-19 while both the stylists and the clients wore face masks, no symptomatic secondary cases were reported; among 67 clients tested for SARS-CoV-2, all test results were negative. Adherence to the community’s and company’s face-covering policy likely mitigated spread of SARS-CoV-2.”

Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020

Face masks work!

More on Fact Checking Face Masks Work

Misinformation about COVID-19 Deaths

All of the misinformation about COVID-19 deaths from folks pushing propaganda is easily debunked if you do even a little bit of research.

We are over six months into the pandemic and if there is one thing folks should understand, it is that there have been a lot of deaths from COVID-19.

The number of COVID-19 deaths in the US literally doubled in just a few months this summer, but that's hard to see on this chart because of the scale she used. #propaganda
The number of COVID-19 deaths in the US literally doubled in just a few months this summer, but that’s hard to see on this chart because of the scale she used. #propaganda

Unfortunately, propaganda and misinformation about COVID-19 deaths makes that hard to see for some folks.

Misinformation about COVID-19 Deaths

Fortunately, you can keep from being fooled if you check the data on COVID-19 yourself.

Remember, data doesn’t usually lie.

Melissa Floyd's graph on daily new COVID-19 deaths actually doesn't paint the rosy picture she wants. While daily deaths have been down from the start of the pandemic, they then rose again and are just recently declined from those peaks in the past few weeks.
Melissa Floyd’s graph on daily new COVID-19 deaths actually doesn’t paint the rosy picture she wants. While daily deaths have been down from the start of the pandemic, they then rose again and have just recently declined from those peaks in the past few weeks.

But it can certainly be manipulated or misrepresented though.

See how the type of graph representation makes all the difference?
See how the type of graph representation makes all the difference?

That’s why some folks don’t realize that even if COVID-19 deaths have decreased a bit in the last few weeks, there are still over 1,200 deaths a day in the United States!

What other misinformation might you hear about COVID-19 deaths?

This should be big news, as these folks are fact checking their own propaganda! They even highlight the explanation from the CDC that "For 6% of the deaths, COVID-19 was the only cause mentioned."
This should be big news, as these folks are fact checking their own propaganda! They even highlight the explanation from the CDC that “For 6% of the deaths, COVID-19 was the only cause mentioned.”

Have you heard that only 6% of COVID-19 deaths are actually caused by COVID-19???

“For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.6 additional conditions or causes per death.”

Weekly Updates by Select Demographic and Geographic Characteristics

It’s not true.

The CDC was just saying that people who die with COVID-19 often have other comorbid conditions, such as cancer, obesity, and diabetes, etc. But these aren’t just high risk conditions that they had before they got COVID-19.

They include all of the “conditions contributing to deaths where COVID-19 was listed on the death certificate,” including things like respiratory arrest, cardiac arrest, and sepsis, etc. It’s the why you died with COVID-19…

Other propaganda and misinformation about COVID-19 deaths include that:

  • COVID-19 death rates have been inflated and hospitals are reporting all deaths as COVID-19 related to make more money
  • routine use of hydroxychloroquine would reduce COVID-19 deaths
  • the United States has one of the lowest rates of COVID-19 deaths in the world
  • the CDC used flu and pneumonia deaths to inflate the COVID-19 death count
  • in the middle of the pandemic, the CDC reduced the COVID-19 death toll
  • the flu is killing more people than COVID-19
  • all non-COVID-19 deaths have increased during the pandemic because of lockdowns
  • kids aren’t dying from COVID-19
  • the strategy in Sweden proves that we could have done much less and had the same number of deaths

Don’t believe any of it (see below – all of the claims have been debunked over and over again) or the folks that are steering you away from the truth – that COVID-19 is a serious, life-threatening disease, especially for those who are high risk.

Just look at Sweden…

“More than 5,500 people have died with Covid-19 in this country of just 10 million. It is one of the highest death rates relative to population size in Europe, and by far the worst among the Nordic nations. Unlike Sweden, the rest all chose to lock down early in the pandemic.”

Did Sweden’s coronavirus strategy succeed or fail?

They did much less and have far more deaths than their neighboring countries.

And remember that the high number of COVID-19 deaths in the United States could have been even higher, in the millions, if we had done less.

Do more. Don’t listen to or share misinformation from folks pushing propaganda about COVID-19.

More on COVID-19 Deaths

Getting Diagnosed With Autism As an Older Teen Or Young Adult

What happens when a diagnosis of autism is delayed or overlooked for autistic teenagers or adults?

Ideally, all autistic kids would get diagnosed as young as possible, hopefully by age three years or younger.

“The American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools at 9, 18, or 30 months and for autism at 18 and 24 months or whenever a parent or provider has a concern.”

Concerned About Your Child’s Development?

That way they can start therapy or get accomodations, if necessary, as soon as possible.

Getting Diagnosed With Autism As an Older Teen Or Young Adult

Unfortunately, even with increased awareness and screening, some children aren’t diagnosed until they are much, much older.

“ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until much older. Some people are not diagnosed until they are adolescents or adults. This delay means that children with ASD might not get the early help they need.”

Screening and Diagnosis of Autism Spectrum Disorder

In fact, even though children can often be reliably diagnosed with autism at 18 months, when they are typically first routinely screened with the M-CHAT, many still aren’t diagnosed until they are about 4 years old.

The Autism Spectrum Quotient (AQ) Adolescent has screening questions for teens between the ages of 12 to 15 years.
The Autism Spectrum Quotient (AQ) Adolescent has screening questions for teens between the ages of 12 to 15 years.

And surprisingly, some aren’t diagnosed until they are much older, sometimes when they are adults.

“Yes, adults can be diagnosed with an ASD. Diagnosis includes looking at the person’s medical history, watching the person’s behavior, and giving the person some psychological tests. But, it can be more challenging to diagnose an adult because it is not always possible to know about the person’s development during the first few years of life, and a long history of other diagnoses may complicate an ASD diagnosis. Because the focus of ASD has been on children, we still have much to learn about the prevalence and causes of ASD across the lifespan. Behavioral interventions can be effective for adults coping with a new diagnosis of autism.”

Autism Spectrum Disorder Frequently Asked Questions

How do you screen or diagnose an older child, teen, or adult with autism?

“Parents may talk with these specialists about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.”

Autism Spectrum Disorder

Although the same developmental monitoring and screening tools that are available for toddlers (M-CHAT and ASQ-10) aren’t used for older children, teens, or young adults, others are available, including:

If you have any concerns, your pediatrician, a child psychologist, or a psychiatrist might use one of these questionnaires to screen your child.

Autistic Teenagers & Adults

So what happens when an autism diagnosis is delayed?

“Among the responses were many from people who didn’t get diagnosed until they were adults. Some had suspicions about their condition growing up. For others, the diagnosis was a revelation as much as it was a relief.”

When An Autism Diagnosis Comes In Adulthood

For one thing, you hopefully quickly understand that you are not alone, which becomes easier as you read the stories of other adult diagnosed autistic people.

“If you know you’re autistic, are beginning to wonder, share similarities with autistic people, or want to support an adult autistic friend or family member—or if you simply want to know why it’s so important that autistic adults know we’re autistic—this book is for you.”

Knowing Why: Adult-Diagnosed Autistic People on Life and Autism

And you learn that support is available if you need it, no matter what stage of life you are in, whether you are in high school, starting college, looking for a job, or getting married, etc.

More on Autistic Teenagers & Adults

Treating Hard to Control Keratosis Pilaris

Learn about what you can do if your kids have keratosis pilaris.

Keratosis pilaris is one of the more common rashes kids get that you have probably never actually heard of.

“Keratosis pilaris (KP) is a common inherited disorder of follicular hyperkeratosis. It is characterized by small, folliculocentric keratotic papules that may have surrounding erythema.”

Keratosis Pilaris: A Common Follicular Hyperkeratosis

Keratosis pilaris develops when hair follicles fill up with dead skin cells and scales instead of exfoliating normally. That doesn’t mean that kids with KP are doing something wrong though.

What Keratosis Pilaris Looks Like

Children with keratosis pilaris will have small, scaly, red or flesh colored bumps on both cheeks, upper arms, and/or thighs. It can even occur on a child’s back and buttocks.

Children with keratosis pilaris will have small, scaly, red or flesh colored bumps on both cheeks, upper arms, and/or thighs.

Although it can occur year round, it is often worse in the winter, when a child’s skin will feel rough and dry with small red bumps.

Keratosis pilaris feels rough, like sandpaper, but it typically isn’t itchy, making this mostly a cosmetic issue.

Keratotis Pilaris Treatments for Kids

Treatment isn’t always necessary, but if you want to try and get rid of your child’s keratosis rash, it may help to very regularly (every day) use an exfoliating moisturizer, like Eucerin Roughness Relief Lotion for Extremely Dry, Rough Skin (contains urea and lactic acid) or over-the-counter strength Lac-Hydrin lotion (contains 5% lactic acid).

It can also help to:

  • use a soap substitute, like Dove or Cetaphil, instead of a harsh soap
  • wash with an exfoliating sponge, exfoliator brush, or exfoliating gloves
  • use a humidifier, especially if it very dry in your home
  • avoid long hot baths or showers, which seem to make it worse
  • get a higher strength Lac-Hydrin 12% lotion
  • get a prescription for a topical retinoid cream, such as Retin-A or Tazorac
  • get a prescription for a topical steroid cream if the rash is very red, rough, and bumpy

Even with proper treatment, which might include some combination of the above prescription creams, you can expect your child’s rash to come back at times.

Fortunately, keratosis pilaris does seem to eventually go away when kids get older, especially in their late teens.

What To Know About Keratosis Pilaris

Keratosis pilaris is a common rash that is hard to treat and lasts a long time.

Since it is mostly cosmetic and may eventually go away on its own, you probably don’t have to go overboard trying to treat it.

More on Keratosis Pilaris

COVID-19 Registry List

To get answers as quickly as possible, researchers and health care providers have created COVID-19 registries that cover everything from asthma and diabetes to pregnancy and pulmonary embolism.

Since COVID-19 is truly a novel disease, we continue to look for answers about how to best treat our patients who are getting sick.

Fever and cough are the most common symptoms in this COVID-19 pediatric registry.
Fever and cough are the most common symptoms in this COVID-19 pediatric registry.

And to get those answers as quickly as possible, researchers and health care providers have created COVID-19 registries that cover everything from asthma and diabetes to pregnancy and pulmonary embolism.

COVID-19 Registry List

Not surprisingly, there is a COVID-19 registry to cover just about every aspect of this new disease.

The results from these registries will hopefully help us come up with better COVID-19 treatment protocols and answer some very important questions, such as whether or not SARS-CoV-2 truly is triggering new cases of type 1 diabetes and why some people have lingering symptoms.

More on COVID-19

What is Skeeter Syndrome?

Skeeter syndrome is a large local reaction after a mosquito bite that can mimic an infection.

What’s your first thought if your child has a large swollen area that is hot, red, and either painful or itchy?

A child with Skeeter syndrome - a bite that quickly got red, hot, and swollen.
A child with Skeeter syndrome – a bite that quickly got red, hot, and swollen. Photo by Vincent Iannelli, MD

You’re probably thinking that this bite is infected, right? It was gone without treatment over about 48 hours.

What is Skeeter Syndrome?

While that is certainly a possibility, if the reaction occurs right after a bite or sting, it is much more likely to be an inflammatory reaction – Skeeter syndrome.

The American Academy of Allergy Asthma and Immunology defines Skeeter syndrome as an inflammatory reaction to mosquito bites.
The term Skeeter syndrome was first used in a report by Simons and Peng in 1999.

Although the American Academy of Allergy Asthma and Immunology says that Skeeter syndrome is relatively rare, spend a few minutes with a pediatrician and they will likely tell you that we see it all of the time…

“The large local reactions to mosquito bites that we have designated as skeeter syndrome occur within hours of the bites and are characterized by the cardinal signs of inflammation: swelling (tumor), heat (calor), redness (rubor), and itching/pain (dolor). By inspection and palpation, it is impossible to differentiate between inflammation caused by infection and inflammation caused by an allergic response.”

Skeeter syndrome Case Studies

These reactions can be especially impressive, and scary, for parents if they occur on a child’s eyelid or penis – as loose tissue in these areas can lead to a lot of swelling.

So how can you tell if a child has Skeeter syndrome or cellulitis, an infection that requires antibiotics?

“The reactions were initially misdiagnosed as cellulitis and investigated and treated as such, although by history they developed within hours of a mosquito bite, a time frame in which it would have been highly unlikely for an infection to develop.”

Skeeter syndrome Case Studies

Although cellulitis can mimic or look just like Skeeter syndrome, it is the timing of the reaction, very soon after the bite, that will help you and your pediatrician make an accurate diagnosis. That’s important, because the treatments for Skeeter syndrome and cellulitis are very different.

In general, kids with Skeeter syndrome only require symptomatic care, perhaps an antihistamine and topical steroid cream, while cellulitis is treated with antibiotics.

Are there any other differences between Skeeter syndrome and cellulitis?

While cellulitis will likely continue to worsen, especially if it isn’t treated with antibiotics, you can expect the redness and swelling triggered by Skeeter syndrome to start to get better after two to three days. Keep in mind that many bites and stings do worsen over the first day or two though…

What Causes Skeeter Syndrome?

The large local reaction that occurs with Skeeter syndrome is triggered by antigens in the saliva of the mosquitoes.

While these typically just cause mild local reactions in most of us, others can have severe, delayed reactions, exaggerated local reactions, or very rarely, anaphylactic reactions.

“The children with skeeter syndrome remain healthy, except for recurrent large local inflammatory reactions to mosquito bites.”

Skeeter syndrome Case Studies

So what should you do for your child with Skeeter syndrome?

For one thing, use insect repellents so that they don’t get mosquito bites. And work to control the mosquitoes around your home.

You might also give them an age appropriate dose of a second-generation H1-antihistamine such as cetirizine to prevent or treat the reaction if they do get some bites.

Are mosquitoes the only insects that cause Skeeter syndrome?

By definition, yes.

But we often see these same type of large, local reactions (LLRs) after fire ant bites, bee stings, and other bites and stings.

“There is no clear definition of LLRs. They are generally described as any induration larger than 10cm in diameter around the insect sting. The swelling can occur immediately or 6 to 12 hours after the sting and can gradually increase over 24 to 48 hours. The swelling usually subsides after 3 to 10 days. LLRs represent a late-phase immunoglobulin E (IgE)–associated inflammation.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

Sweat bees, very small bees, for example, are notorious for “stinging” people around their eyes and causing what looks like periorbital cellulitis, as they like to drink the salt on our sweaty skin.

Is your child’s bite or sting infected?

Just remember, even if the area is hot, red, and swollen, if it got like that within hours of a bite, then it probably isn’t infected.

“The type of clinical reaction determines the risk of allergic reactions to future stings.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

And also be reassured that children who only have large local reactions are very unlikely to go on to have more severe, anaphylatic type reactions in the future.

More on Insect Bites and Stings

Why Do Some People Still Think Hydroxychloroquine Works for COVID-19?

We are more than six months into the COVID-19 pandemic and we are still talking about hydroxychloroquine, a dangerous treatment that doesn’t work.

As the COVID-19 pandemic continues to rage throughout the world, we don’t have a vaccine, there are few treatments and no cure, and as some still refuse to wear masks in public or social distance, there are still those think that hydroxychloroquine works.

We are still talking about hydroxychloroquine.

Can you guess why?

Why Do Some People Still Think Hydroxychloroquine Works for COVID-19?

Sure, it’s not complicated…

The US has a stockpile of hydroxychloroquine.

There are plenty of people pushing for the continued use of hydroxycloroquine as a treatment for COVID-19, even though many experts were skeptical from the beginning and there are new warnings from the FDA.

“Based on its ongoing analysis of the EUA and emerging scientific data, the FDA determined that chloroquine and hydroxychloroquine are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA. Additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorized use.”

FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems

But how do these folks convince anyone to listen to them?

Zev Zelenko is one of the doctors pushing hydroxychloroquine as a treatment for COVID-19.

Mostly it is because people want to believe that there is a treatment, especially when the alternative is doing nothing.

Dr Urso is another doctor pushing hydroxychloroquine as a treatment for COVID-19.

They want to believe, even though that false hope for an effective treatment puts them at risk of dangerous side effects.

An extra risk without any benefits, as hydroxycholorquine doesn’t actually work as a COVID-19 treatment.

“We know that every single good study – and by good study I mean randomised control study in which the data are firm and believable – has shown that hydroxychloroquine is not effective in the treatment of Covid-19.”

Anthony Fauci on Coronavirus: Hydroxychloroquine ineffective says Fauci

Again, then, why do so many people think that hydroxychloroquine and these other protocols actually work?

In addition to some poorly done studies that say it works, it is mostly because of the anecdotal data and testimonials they are hearing from the doctors who have appointed themselves experts on treating COVID-19.

How are they determining that false negatives are really false negatives?
How are they determining that false negatives are really false negatives?

For example, is the fact that there are no deaths and only one hospitalization on this list of COVID STATS from the McKinney Family Medicine a good reason to take hydroxychloroquine?

“The overall cumulative hospitalization rate is 120.9 per 100,000 population.”

COVIDView Weekly Summary

Of course not, especially when you consider that you likely wouldn’t expect any hospitalizations or deaths when you only have 271 COVID-19 patients.

Wait, why is that?

With a hospitalization rate of 120 per 100,000 cases, you can expect one person to be hospitalized for every 1,000 cases!

Of course, that rate is higher in groups with higher risk factors, but even if all of the patients at McKinney Family Medicine were older and had some risk factors, it is doubtful that you would expect more than one hospitalization.

“Mild to moderate (mild symptoms up to mild pneumonia): 81%”

Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)

Remember, most people with COVID-19 have mild symptoms and recover without any specific treatments.

Unfortunately, some don’t, especially those in high risk groups.

Craig Spencer warns that anecdotes about hydroxychloroquine are harming people.

And that’s why we need to work to control COVID-19 with face masks, social distancing, handwashing, testing, contact tracing, and quarantining, and stop all of the pseudo-scientific nonsense about hydroxychloroquine and other COVID-19 misinformation.

More on Hydroxychloroquine