Are Kids Dying With COVID-19?

How many children have died with COVID-19?

Breaking News – A one year old in Maryland has 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

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.

Breaking News – new CDC guidelines do offer options for ending quarantine early. (see below)

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.

New Options to Test Out of Quarantine Early

And although it is not without risk, the CDC has suggested some alternatives to the traditional 14 quarantine after being exposed to someone with COVID-19.

This includes ending quarantine after day 7 if you have tested negative within 48 hours and you have no symptoms, understanding that you will have to continue to monitor yourself for symptoms each day and that this strategy has a 5-12% risk of failure (you might still develop COVID-19).

Or even ending quarantine after day 10 without testing if you have no symptoms, understanding that you will have to continue to monitor yourself for symptoms each day and that this strategy has a 1-10% risk of failure (you might still develop COVID-19).

“Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.”

Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing

For most people, 14 days of quarantine will likely still be the safest option.

More on Testing out of Quarantine

The Latest COVID-19 Treatment Regimens

The latest COVID-19 treatment regimens do not include zinc, vitamin C, vitamin D, CBD oil, azithromycin, or hydroxychloroquine.

As cases surge once again, let’s do an update on COVID-19 treatment regimens, after all, you have likely been hearing about cures and treatments for months now, right?

This doc also has a daily "immune booster" regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.
This doc also has a daily “immune booster” regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.

Unfortunately, despite the “treatments” that some folks are pushing, there still isn’t a cure and there aren’t any treatments that are very effective for COVID-19.

Sure, the FDA has granted emergency use authorization (EUA) for some treatments, including monoclonal antibodies, convalescent plasma, remdesivir, bamlanivimab, baricitinib, and casirivimab and imdevimab, but most are either for patients with severe COVID-19 or who are progressing to severe COVID-19.

The Latest COVID-19 Treatment Regimens

But why wouldn’t you take over a dozen medicines if someone on the Internet tells you they read a bunch of well designed studies, he has the support of “America’s Frontline Doctors,” and he has his own statistics proving they work?

Take home point - don't trust a health care provider who says that masks and lockdowns do nothing.
Take home point – don’t trust a health care provider who says that masks and lockdowns do nothing.

Because it all quickly falls apart if you really take a close look at what he is doing.

Consider Dr. Procter’s comparison of “death rates”…

He is trying to talk about the case fatality rate, but fails to mention any of the things that would cause his practice to have lower rates than the rest of the world, especially younger patients without many co-morbid conditions who aren’t yet hospitalized.

How many of Dr. Procter's patients are over age 65?
How many of Dr. Procter’s patients are over age 65?

And the bias in his data aside, there is evidence that shows his recommended treatments don’t work.

Some are even dangerous.

“The results of an observational study suggest that delayed viral clearance may be a concern in patients with non-severe COVID-19 who are receiving corticosteroids without antiviral drugs. Corticosteroids have also been associated with delayed viral clearance and/or worse clinical outcomes in patients with other viral respiratory infections.”

Therapeutic Management of Patients with COVID-19

So you should likely avoid these medications and unless you have a vitamin deficiency (zinc and vitamin C deficiency are very uncommon in developed countries), there is likely no good reason to take extra or high doses of vitamins to try and prevent or treat COVID-19.

The latest NIH recommendations for treating COVID-19 in hospitalized patients.
The latest NIH recommendations for treating COVID-19 in hospitalized patients.

You should certainly make sure you are getting plenty of all of these important nutrients, especially vitamin D, but there are no treatments for COVID-19 if you aren’t hospitalized. And understand that no treatments that will keep you from requiring hospitalization.

Mostly understand that the kind of multi-drug COVID-19 treatment regimens you might see some doctors pushing are not proven, are not recommended, and likely won’t help you get better any faster.

And again, some are harmful!

So why do some people think they work?

“Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.”

Coronavirus disease (COVID-19) advice for the public: Mythbusters

Probably the same reason that some folks think that eating garlic works against COVID-19 – it is a highly variable disease and some people have very mild symptoms and get better quickly. If you are lucky enough to be one of these people and you tried some alternative treatment, you will likely associate your quick recovery with that treatment, even if it was just a coincidence.

“New symptoms are usually due to the virus rather than side effects of medications.”

Brian Procter, MD

And if you are really lucky when following one of these treatment regimens, you won’t suffer any side effects as you try to recover from your COVID-19 symptoms. Especially if you are being treated by a doctor who might ignore those side effects…

More on COVID-19 Treatment Regimens

What to Do if You Have Been Diagnosed with COVID-19

Do you know what to do if you get diagnosed with COVID-19?

Do you know what to do if you think you might be sick or have already been diagnosed with COVID-19?

What's worse than having a party when you have symptoms of COVID-19? How about refusing to cooperate with contact tracers who are trying to control an outbreak?
What’s worse than having a party when you have symptoms of COVID-19? How about refusing to cooperate with contact tracers who are trying to control an outbreak?

Hopefully you know that you shouldn’t host a party and expose lots of other folks…

What to Do if You Have Been Diagnosed with COVID-19

Unfortunately, lots of mistakes are being made that are causing COVID-19 cases to again rise.

“For COVID-19, a close contact is defined as anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient was isolated.”

COVID-19 Frequently Asked Questions

One of them is that many people simply don’t understand the importance of staying away from others if they have been diagnosed (isolation) or exposed (self-quarantine) to SARS-CoV-2.

“If possible, have the person who is sick use a separate bedroom and bathroom. If possible, have the person who is sick stay in their own ‘sick room’ or area and away from others. Try to stay at least 6 feet away from the sick person.”

Caring for Someone Sick at Home

What happens if you don’t stay away from other people?

You may expose others, beginning in the days before you start to show symptoms (presymptomatic transmission).

Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.
Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.

Once you are diagnosed with COVID-19, be sure to tell all of your close contacts that they have been exposed, which includes everyone who was within 6 feet of you for at least 15 minutes starting from 48 hours before you began feeling sick. That way, they can begin to self-quarantine and avoid exposing others if they get sick too.

How Long Will Your Quarantine Last?

How long will you have to stay home, away from other people?

It depends…

The CDC provides a variety of scenarios to help explain how long folks should stay in quarantine.
The CDC provides a variety of scenarios to help explain how long folks should stay in quarantine.

If you are in self-quarantine because you were exposed to someone with COVID-19, then you should stay home for 14 days after your last contact with that person. That’s the incubation period for the SARS-CoV-2 virus. Keep in mind that your quarantine restarts every time you have a new exposure, although there are now options to shorten your quarantine.

On the other hand, if you are in isolation because you have been diagnosed with COVID-19, then you should stay home until:

  • at least 10 days have passed since your positive test (if you have been asymptomatic)
  • you are fever free for at least three days, have improving respiratory symptoms, and it has been at least 10 days since your symptoms began

You might also be able to end your quarantine early if you have two negative tests in a row at least 24 hours apart, of course, while fever free and with improving respiratory symptoms.

If You Have COVID-19

What if you need to go to the doctor or ER after you have been diagnosed with COVID-19?

Call ahead so that they can be prepared and don’t end up exposing any staff or patients.

Hopefully you will have mild symptoms that will go away as you rest and stay hydrated, but if you develop emergency warning signs or symptoms (trouble breathing, chest pain, confusion, and trouble staying awake, etc.), then seek emergency care, being sure to mention that you have been diagnosed with COVID-19.

What if you need to go somewhere else?

You shouldn’t go anywhere or be around other people if you are in isolation after being diagnosed with COVID-19.

“People who are in isolation should stay home until it’s safe for them to be around others. In the home, anyone sick or infected should separate themselves from others by staying in a specific “sick room” or area and using a separate bathroom (if available).”

Isolate If You Are Sick

When in isolation, you should stay home except to get medical care.

What if you need food, medicine, or something else that you don’t have in your home? Ideally, you would order it and have it delivered, being sure to not expose the delivery person. If that isn’t an option, call your local support services for help.

More on COVID-19

What to Do if You Have Been Exposed to COVID-19

Folks need to understand that they should begin self-quarantine as soon as they learn that they have been exposed to someone with COVID-19.

Do you know what to do if you have been exposed to someone with COVID-19?

Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.
Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.

Hopefully you already know that you shouldn’t go to a party and expose lots of other folks…

What to Do if You Have Been Exposed to COVID-19

Unfortunately, lots of mistakes are being made that are causing COVID-19 cases to again rise.

“For COVID-19, a close contact is defined as anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient was isolated.”

COVID-19 Frequently Asked Questions

One of them is that many people simply don’t understand the importance of self-quarantining themselves for 14 days (or consider one of the options to shorten your quarantine) after they have been exposed to SARS-CoV-2.

In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention...
In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention…

What happens if you don’t self-quarantine?

You may expose others in the days before you start to show symptoms (presymptomatic transmission).

But can’t you just get tested after your exposure to see if you have it?

Sure, you can get tested, but if it is negative and you are early in your incubation period, it doesn’t mean that you still won’t become sick later on. For example, you could have a negative COVID-19 test four days after being exposed to the virus, but then develop symptoms of COVID-19 two days later.

“Yes, you are still considered a close contact even if you were wearing a cloth face covering while you were around someone with COVID-19. Cloth face coverings are meant to prevent someone from transmitting the disease to others, and not to protect someone from becoming infected.”

COVID-19 Frequently Asked Questions

What if you’re not sure if you have COVID-19 and you are waiting on your test results?

That should be a no-brainer.

Self-isolate yourself why you are waiting for your COVID-19 test results!

Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.
Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.

And if you think you have COVID-19, be sure to tell all of your close contacts, which includes everyone who was within 6 feet of you for at least 15 minutes starting from 48 hours before you began feeling sick.

Of course, social distancing and wearing a mask are important too.

But folks need to understand that they should begin to self-quarantine as soon as they learn that they have been exposed to someone with COVID-19. That’s the easiest way to limit the spread of SARS-CoV-2 and the size of outbreaks.

More on COVID-19

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 (although there are some new options to end quarantine early).
  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

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

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

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

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