Should You Be Tested for COVID-19?

A limited supply of test kits has meant that few people have been tested for the SARS-CoV-2 virus, but that will likely change as more test kits become available and more people get diagnosed with COVID-19.

Breaking News – criteria for COVID-19 has been expanded to include more symptomatic patients. (see below)

As SARS-CoV-2 infections continue to spread, many people are probably wondering if they should be tested if they think they have COVID-19.

“Call your healthcare professional if you feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19, or if you live in or have recently traveled from an area with ongoing spread of COVID-19. Your healthcare professional will work with your state’s public health department and CDC to determine if you need to be tested for COVID-19.”

CDC on Should I be tested for COVID-19?

While it might sound like a good idea, especially if there are any COVID-19 cases in your state, getting tested for SARS-CoV-2 isn’t as easy as you might think it should be…

Should You Be Tested for COVID-19?

What’s the biggest problem with getting tested for SARS-CoV-2?

Since this is a new infection, a new test had to be developed to detect it.

And that test is not widely available. In fact, most testing has been done at the CDC so far.

“The California Department of Public Health announced today that new CDC test kits used to detect Coronavirus Disease 2019 (COVID-19) now available in California can be used to do diagnostic testing in the community. California will immediately receive an additional shipment of kits to test up to 1,200 people.”

COVID-19 Testing Kits Arrive at State Public Health Laboratories

More and more local and state health departments are now getting a limited supply of test kits though.

The CDC is now shipping its laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to qualified state and local public health laboratories.
The CDC is now shipping its laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to qualified state and local public health laboratories.

Still, even if you should be tested, it won’t be a test that your pediatrician has on hand.

But what happens if you think that you have COVID-19? Can you get tested?

Unless you are hospitalized and have severe symptoms, the criteria for possible COVID-19 from the CDC, which might lead to testing, has included:

  • Fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath), AND
  • Any person, including healthcare workers, who has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset.

If a patient is hospitalized with COVID-19 symptoms, then a history of recent travel from affected geographic areas (China, Iran, Italy, Japan, and South Korea) is added to the criteria.

Only those with fever and severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza) would be investigated for SARS-CoV-2 even though no source of exposure has been identified.

Those who meet the criteria can get tested if necessary, as can many others under the latest expanded criteria.

“Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness.”

Evaluating and Reporting Persons Under Investigation (PUI)

In general, your provider will obtain the samples (nasopharyngeal swab AND oropharyngeal swabs) and send it to a local or state health department or the CDC for testing.

And if there is any doubt about whether or not someone needs testing, your provider will call their local or state health department for extra guidance.

But why would you want to get tested if there is no treatment for COVID-19?

“For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar coronaviruses.”

COVID-19 Frequently Asked Questions and Answers

Testing can help identify folks who really need to be quarantined, keeping them from getting others sick. That can be important, as many people might not be able to quarantine themselves for 14 days unless they are sure they are sick with SARS-CoV-2.

What to Know About COVID-19 Testing

A limited supply of test kits has meant that few people have been tested for the SARS-CoV-2 virus, but that will likely change as more test kits become available and more people get diagnosed with COVID-19.

More on COVID-19 Testing

Can Your Sick Child Still Go to Daycare or School?

Is your child to sick to go to school or daycare?

There are a lot of different rules that dictate when kids can go to daycare or school when they are sick.

Kids don't always have to stay at home from daycare or school when they are sick.
Kids don’t always have to stay home from daycare or school when they are sick.

The actual rules of your daycare or school are the ones that you are likely most familiar with, but there are also recommendations from the American Academy of Pediatrics and the CDC, in addition to  state-specific regulations.

Can Your Sick Child Still Go to Daycare or School?

Most people know to stay home when they are sick.

“Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness. Avoid close contact with people who are sick.”

CDC on Information for Schools & Childcare Providers

But what exactly does it mean to be “sick” and how long are you supposed to stay home and avoid other people?

“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”

Recommendations for Inclusion or Exclusion (Red Book)

In general, your child does not need to be kept home and out of daycare or school if they are able to participate in routine activities, do not need extra care, and have:

  • a cold (unless they have a fever) or other upper respiratory infection, even if they have a green or yellow runny nose
  • RSV (unless they have a fever)
  • croup (unless they have a fever)
  • diarrhea that can be contained in a diaper or the child can make it to the bathroom without having an accident, as long as they aren’t having more than 2 stools above their usual or stools that contain blood or mucus
  • a rash without fever – most skin rashes won’t keep your kids out of school, like if they have poison ivy, hives, or even molluscum contagiosum and warts
  • Fifth disease – interestingly, you aren’t contagious once you have the characteristic Fifth disease rash
  • head lice – why not keep kids out of school if they have lice? It doesn’t stop them from spreading. They can get them treated at the end of the day.
  • pinworms – like lice, keeping kids out of school with pinworms isn’t going to stop them from spreading, although kids should be treated
  • pink eye – if caused by an infection, in general, should be able to stay or return if is improving, but keep in mind that most experts now think that kids with pink eye do not need to be excluded from daycare or school at all
  • oral lesions and are able to contain their drool (unless they have a fever), which would include hand foot mouth disease
  • skin lesions that can be covered, and if they can’t, then they can return after they have been on antibiotics for 24 hours (impetigo) or have started treatment (ringworm)
  • strep throat and have been fever free and on antibiotics for 24 hours
  • scabies – if you have started treatment
  • a sore throat (unless they have a fever)

Why don’t you have to keep your kids home when they have RSV or many of these other common childhood diseases?

In addition to the fact that some kids would never get to go to daycare or school, since these diseases are so common, many kids continue to be contagious even after their symptoms have gone away. So excluding them doesn’t really keep the illnesses from spreading through the daycare or school.

So why not just send them when they have a fever or really don’t feel well?

In addition to the possibility that they might be a little more contagious at those times, it is because the typical daycare or school isn’t able to provide the one-on-one care that your child would likely need when feeling that sick, as your child probably isn’t going to want to participate in typical group activities.

Policies that are overly strict at excluding children from daycare and school may also lead to antibiotic overuse, as parents rush their kids to the doctor for and push for a quick cure because they need to go back to work.

Exclusion Criteria for Vaccine Preventable Diseases

While the exclusion criteria for many diseases simply extends to when your child is fever free, starts treatment, or feels well enough to return to daycare or school, for many now vaccine-preventable diseases, you will be excluded (quarantined) for much longer:

  • hepatitis A virus infection – exclusion for one week after illness starts
  • measles – exclusion until four days after start of rash
  • mumps – exclusion until five days after start of parotid gland swelling
  • pertussis – exclusion until completes five days of antibiotics or has had cough for at least 21 days
  • rubella – exclusion until seven days after start of rash
  • chicken pox – exclusion until all lesions have crusted
  • diphtheria – if survives having respiratory diphtheria, would likely be excluded until finishes treatment and has two negative cultures at least 24 hours apart
  • rotavirus – as with other diseases that causes diarrhea, children should be excluded until “stool frequency becomes no more than 2 stools above that child’s normal frequency” as diarrhea is contained in the child’s diaper or they aren’t having accidents
  • tetanus – if survives having tetanus, wouldn’t be excluded, as tetanus is not contagious

Unfortunately, kids are often contagious with many of these diseases, especially measles and chicken pox, even before they have obvious symptoms, which is why large outbreaks used to be so common.

Children will often be excluded from daycare or school if they are unvaccinated or not completely vaccinated and they are exposed to a vaccine-preventable disease.

More on Sending Your Sick Child to Daycare or School