7 Things to Know About COVID-19

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

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

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

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

7 Things to Know About COVID-19

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

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

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

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

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

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

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

More on COVID-19

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

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

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

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

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

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

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

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

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

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

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

When You Can be Around Others

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

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

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

Don’t want to deal with any of this?

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

More on COVID-19

Getting a Covid-19 Test Before Going to Summer Camp

Who told your child’s summer camp to test all of their kids for COVID-19?

Are your kids among the 11 million kids who usually go to a summer camp or day camp each year?

Do you have any memories about summer camp from when you were a kid?
Do you have any memories about summer camp from when you were a kid?

Are they going this summer?

Did you plan for a COVID-19 test?

Getting a Covid-19 Test Before Going to Summer Camp

While many parents are likely thrilled that their kids can still even go to camp, they might be confused on why they need to get a COVID-19 test if their child hasn’t been sick.

Your pediatrician is likely shaking their head about it too.

Memories of summer camp this year might include a weekly nasal swab for COVID-19 testing.
In addition to pushing tests while staff and kids are at camp, some camps want to have kids tested before they arrive.

After all, there is no recommendation for general testing in the guidelines for opening up summer camps.

Instead, the CDC says to “screen children and employees upon arrival for symptoms and history of exposure.”

“He said that optimally camps would retest each camper upon arrival and several times more through the summer: six times for a seven-week session and four times for a five-week session.”

Summer Camp Kids Are America’s Coronavirus Test Subjects

The CDC guidelines on Youth and Summer Camps do mention testing.

“Some camps might have the capacity to conduct COVID-19 testing. CDC has guidance for who should be tested, but these decisions should be made in conjunction with state and local health departments and healthcare providers.”

CDC on Suggestions for Youth and Summer Camps

But still, that guidance isn’t to test everyone, but only those who are high risk, with symptoms, or with suspected COVID-19.

What’s the problem with testing everyone at camp?

It could lead these camps to rely too much on testing instead of cleaning and disinfecting and encouraging hand hygiene, respiratory etiquette, cloth face coverings, and social distancing, etc.

Remember, COVID-19 tests can give false-negative results, so some people might actually be infected with the SARS-CoV-2 virus and have a negative test. Without a healthy environment at camp, that person might get many other kids and staff members sick.

And a true negative test just means that you are negative when the test was done. It doesn’t mean that you will remain negative until you have your next test.

Also, just because you aren’t testing everyone doesn’t mean that you can’t test those kids and staff members once they begin to show symptoms.

Are your kids going to summer camp this year?

Do they need a COVID-19 test before they go and while they are at camp?

More on COVID-19 Tests for Summer Camps

Those COVID-19 Death Comparisons

Don’t be mislead by the folks making false comparisons about COVID-19 deaths.

Have you seen folks trying to compare COVID-19 deaths to other things?

What other things?

All Dr. Phil revealed was that he shouldn't have been talking about COVID-19...
All Dr. Phil revealed was that he shouldn’t have been talking about COVID-19…

Basically anything and everything, from smoking, drowning, and car accidents to the flu…

Those COVID-19 Death Comparisons

It’s not that surprising that those comparisons were made when the COVID-19 pandemic first got going.

It’s like Jenga?

But it is disappointing that some folks are still making these arguments.

“I’m not denying what a nasty disease COVID-19 can be, and how it’s obviously devastating to somewhere between 1 and 3.4 percent of the population. But that means 97 to 99 percent will get through this and develop immunities and will be able to move beyond this. But we don’t shut down our economy because tens of thousands of people die on the highways. It’s a risk we accept so we can move about. We don’t shut down our economies because tens of thousands of people die from the common flu.”

Senator Ron Johnson of Wisconsin, chairman of the Senate’s Committee on Homeland Security and Governmental Affairs

What’s even worse, they seem to be using the arguments to discourage others from social distancing and wearing masks!

Fortunately, most people understand that you can’t really compare COVID-19 deaths to those other things.

It is like comparing apples to oranges. Sure, they are both fruits, but they aren’t the same kinds of fruits.

So why do some people make these false comparisons?

They do it to make you think that both sides of the argument are the same or are equal. After all, it makes easier to downplay COVID-19 deaths if ‘they’ can make you think they are the same as deaths from car accidents, drownings, and the flu, etc.

Instead of the death rate, it is more appropriate to use the case-fatality rate, which factors in the folks who actually had COVID-19.
Instead of the death rate, it is more appropriate to use the case-fatality rate, which factors in the folks who actually had COVID-19.

So why shouldn’t you make these comparisons?

For one thing, deaths from COVID-19 spiked suddenly. They haven’t been spread out over a year or many years, like deaths from car accidents, drownings, and cigarette smoking, etc..

“The demand on hospital resources during the COVID-19 crisis has not occurred before in the US, even during the worst of influenza seasons. Yet public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic.”

Faust et al on Assessment of Deaths From COVID-19 and From Seasonal Influenza

Also, unlike car accidents and drownings, COVID-19 is contagious.

And don’t forget, we go to great lengths to reduce deaths from car accidents and drownings, with everything from seat belts, air bags, and life jackets to fencing around swimming pools and laws against distracted driving.

Does anyone say “life is about risk,” while throwing their toddler in the pool and walking inside?

We make efforts to reduce that risk!

What is your risk of being in a car accident?
What is your risk of being in a car accident?

We also go to some effort to understand those risks…

“If we overestimate our risk in one area, it can lead to anxiety and interfere with carrying out our normal daily routine. Ironically, it also leads us to underestimate real risks that can injure or kill us.”

National Safety Council on Odds of Dying

So what is your risk of being in a car accident?

Believe it or not, it is fairly low, with the average person filing a claim for a car accident once every 17.9 years.

And since only about 3 in 1,000 car accidents are fatal, the chance of you being in a fatal motor vehicle accident is also fairly low.

“The total number of confirmed COVID-19 deaths in the U.S. exceeds 115,000, outnumbering each of the leading causes of preventable injury death (58,908 preventable drug overdose deaths, 39,404 motor-vehicle deaths, and 37,455 fall deaths in 2018). However, the full impact of COVID-19 is even greater than the number of deaths and confirmed cases. The rapid increase in COVID-19 cases, the uncertainty regarding how long the pandemic will last and the disruption to normal everyday activities is impacting society like no other safety issue in modern history.”

COVID-19 Cases in the United States

How does that compare to getting and dying from COVID-19?

Where do you live? Are folks around you wearing a mask?

If you are working from home in a small town with few COVID-19 cases, then your risk is obviously much, much lower than someone who works around the public in a bigger city with rising case counts.

Do you have any risk factors for a more severe case of COVID-19?

While the overall case fatality rate is about 1%, that starts to go up as you approach age 50 and is higher for those with many chronic health conditions.

Most importantly, what are you doing to lower that risk?

Just like your risk of dying in a car accident is going to be much higher than average if you drink and drive, don’t wear a seat belt, talk on your phone, and speed, your risk of getting and dying from a SARS-CoV-2 infection is going to be higher if you live in or travel to an area with a lot of cases, are around a lot of people who aren’t social distancing or wearing masks, and you are in a high risk group.

The bottom line though, whatever your risk, are you going to take steps to increase that risk for your self and those around you or are you going to lower that risk?

More on COVID-19 Deaths

5 Things You Need to Know About COVID-19

5 things you need to know to protect yourself, your family, and your community until we finally get COVID-19 beat.

As cases start to rise again after our initial efforts to flatten the curve, you are either ready to throw up your hands, wondering what’s next, or are resigned to staying home for awhile.

“Plan A, don’t go in a crowd. Plan B, if you do, make sure you wear a mask.”

Dr. Anthony Fauci

But what if you do have to go out?

5 Things You Need to Know About COVID-19

While a lot of folks are making mistakes, it’s certainly not time to throw in the towel.

“It is important to remember that anyone who has close contact with someone with COVID-19 should stay home for 14 days after exposure based on the time it takes to develop illness.”

When You Can be Around Others After You Had or Likely Had COVID-19

Here are 5 things you need to know to protect yourself, your family, and your community until we finally get COVID-19 beat.

  1. While people probably aren’t contagious if they don’t have symptoms, they can be contagious in the days just before they develop symptoms. Unfortunately, you don’t know when that might be, which is why it is important to self-quarantine after you have been exposed (or think that you might have been exposed) for a full incubation period.
  2. Understand that SARS-CoV-2 is typically spread through close contact with someone who is infected (again, this is also in the days before they show symptoms). That means you can likely avoid getting sick if you practice social distancing (stay 6 feet away from other people), wash your hands often, and avoid touching your face, etc. To protect others, you should also cover your coughs and sneezes and wear a mask.
  3. Protect yourself if you are caring for someone at home with COVID-19, limiting contact, shared spaces, and shared personal items, etc.
  4. Avoid other people if you have COVID-19 until you are fever free for 3 days AND your respiratory symptoms are improving AND it has been at least 10 days since your symptoms first started.
  5. Get a viral test for current infection (not the antibody test) if you think you are sick and want to get tested for COVID-19.

Why is all of this important?

You can reduce your risk of COVID-19 by wearing a mask, washing your hands, and watching your distance.

Because there are still no real treatments for COVID-19, so while we wait for a vaccine, our best hope is simply to keep from getting sick.

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 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 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

Why There is Still So Much COVID-19 Confusion

Cognitive biases, heuristics, and logical fallacies are likely affecting how you are viewing information and advice about COVID-19.

Early on, it was easy to understand why there was so much confusion about COVID-19, after all, it took some time before we even got a real name for the new or novel virus that is causing this pandemic.

And now?

While there is still a lot more research to do, we have already learned a lot about the best ways to help prevent and treat COVID-19 infections.

Do you know who to turn to for trusted information and advice about COVID-19?

Too many people don’t seem to understand that though…

Why There is Still So Much COVID-19 Confusion

Many people also don’t understand that advice and recommendations often shift and change as we get new information.

“It is irrational to hold any view so tightly that you aren’t willing to admit the possibility that you might be wrong.”

What would it take to convince you that you were wrong?

And of course, you have to expect that to happen when you are dealing with a brand new disease!

So what are people confused about?

Everything from the effectiveness of face masks to prevent the spread of the SARS-CoV-2 virus (they do) to whether our COVID-19 death counts have been inflated (we are probably seeing under-counts).

Surprisingly, some people are still confused about just how deadly COVID-19 infections really are.

If you think made-up news and information is true, you might want to rethink where you regularly get your news and information from...
If you think made-up news and information is true, you might want to rethink where you regularly get your news and information from

Why are so many people still confused?

“Compared with other Americans, adults who “often” use social media to get news about COVID-19 report higher levels of exposure to the conspiracy theory that the pandemic was intentionally planned.”

Three Months In, Many Americans See Exaggeration, Conspiracy Theories and Partisanship in COVID-19 News

Where are they getting their information???

Who do you trust for information and advice about COVID-19?

I’m guessing it isn’t from experts…

Who to Trust About COVID-19

Adding to a lot of the confusion we are dealing with are folks pushing misinformation.

As you learn who to trust for information about COVID-19, you will hopefully develop the skills you need to be more skeptical about all of the things you see and read.

“Although my main message is that awareness of cognitive biases can lead to more effective messages and measures to mitigate the effects of the pandemic, where cognitive bias is regarded as harmful, it may be helpful to take steps to reduce such bias. Education and awareness of cognitive biases are key, so that individuals and organisations question flawed or traditional thinking habits and try to promote evidence based thinking. At an individual level, the additional advice is to slow down in your thinking, pause and reflect, and seek external views.”

Covid-19 and cognitive bias

And you will hopefully turn to sources that many of us use, including:

Still confused?

Check your biases.

Don’t let them get in your way of following the advice from the experts that could protect you and your family from getting and spreading the SARS-CoV-2 virus.

What does that mean?

Well, if you don’t think anyone should tell you to wear a mask, then you will likely look for information and advice that says masks don’t work and aren’t necessary (confirmation bias).

You will also likely not believe any information and advice that says COVID-19 is deadly.

Why?

Well, if you believed it was deadly, then you would work to avoid it and try to keep those around you safe, including doing things like wearing a mask. Instead, cognitive dissonance, the anxiety you get from believing in two things that contradict each other, will push you towards believing things that reinforce your idea that you don’t have to wear a mask.

What to Know About COVID-19 Confusion

Tired of being confused about COVID-19 and other things?

“It’s sobering to note all the ways in which human brains distort decision processes; perhaps it’s a wonder that any good decision is ever made.”

How to Make Better Decisions About Coronavirus

Be more skeptical and look for new sources of information and advice and understand how cognitive biases, heuristics, and logical fallacies affect our decision making.

More on COVID-19 Confusion

What to Know About Face Masks and COVID-19

Wearing a face mask is safe and may help slow the spread of COVID-19.

Why do some people still think they shouldn’t wear a mask to help control the COVID-19 pandemic?

A chain link fence won't keep out a mosquito, but it will keep out a dog covered in ticks...
A chain link fence won’t keep out a mosquito, but it will keep out a dog covered in ticks…

The usual suspects…

Confusion About Face Masks and COVID-19

Much of the confusion about face masks stems from the fact the initial guidance from the WHO and CDC said that wearing a mask wasn’t necessary for everyone.

“Wearing medical masks when not indicated may cause unnecessary cost, procurement burden and create a false sense of security that can lead to neglecting other essential measures such as hand hygiene practices. Furthermore, using a mask incorrectly may hamper its effectiveness to reduce the risk of transmission.”

Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak – WHO Interim guidance January 2020

Using a mask incorrectly?

If you are going to wear your mask under your chin or with your nose or mouth exposed and think you are protected and not social distance, then wearing a mask might actually get more people sick. With little information that masks were helpful, this fear that they would create a false sense of security likely influenced initial guidance.

Experts were likely also concerned about a limited supply of medical masks at the time.

Of course, as we have gotten more information about the SARS-CoV-2 virus and how it spreads, that guidance about face masks changed.

“CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.”

Use of Cloth Face Coverings to Help Slow the Spread of COVID-19 (April 2020)

We know that the best way to avoid getting COVID-19, at least until we get a vaccine, is going to be trying make sure you are never exposed to the SARS-CoV-2 virus. In addition to social distancing and washing your hands, wearing a face mask correctly will help to decrease your risk of exposing others. And if those around you are wearing a face mask, then they won’t expose you!

What to Know About Face Masks and COVID-19

But what about the idea that the pore size of the masks are too big to stop the small size of the SARS-CoV-2 virus?

This 2009 photograph captured a sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth, thereby, dramatically illustrating the reason one needs to cover his/her mouth when coughing, or sneezing, in order to protect others from germ exposure. Photo courtesy CDC/James Gathany
A sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth. Photo by James Gathany.

The thing is, the SARS-CoV-2 virus, while it is very small, isn’t just floating around in the air by itself! It gets carried in and on larger respiratory droplets.

And if the mask blocks those respiratory droplets, then it should keep you from exposing others to the SARS-CoV-2 virus.

What about the claim that face masks cause folks to breath their own carbon dioxide, even leading to breathing problems?

OSHA has issued guidance to protect workers from getting COVID-19, which includes that they wear face coverings.
OSHA has issued guidance to protect workers from getting COVID-19, which includes that they wear face coverings.

Most folks realize this isn’t a real problem, after all, health professionals wear face masks all of the time without any problems, right?

But just think about these arguments…

On the one hand, they are worried that the pore size of face masks won’t block out the SARS-CoV-2 virus, which is about 0.1 μm in diameter.

But then they think these very same face masks will block carbon dioxide? How big are carbon dioxide molecules???

They are about 1000 times smaller than the SARS-CoV-2 virus…

So a face mask is not going to affect your ability to breath well.

Who Should Not Wear a Face Mask

Not surprisingly, a face mask is even recommended for folks with asthma, as long as their asthma is well controlled.

“There is no evidence that wearing a face mask makes asthma worse.”

AAAI Recommendations on the use of face masks to reduce COVID-19 transmission

Infants and toddlers under age two years can skip wearing a face mask because of the risk of suffocation, as can “anyone who has trouble breathing, is unconscious, incapacitated or otherwise unable to remove the mask without assistance.”

If you have “trouble breathing” though, you likely have a severe respiratory condition and you aren’t simply someone who doesn’t want to wear a mask.

Flyers about the Americans with Disabilities Act (ADA) and the use of face masks due to the COVID-19 are fake.

And there are no face mask exemptions under the Americans with Disabilities Act (ADA).

People are selling fake face mask exemption cards.
People are selling fake face mask exemption cards.

Are you ready to put on a mask now?

Since we are seeing higher rates of COVID-19 in states that don’t have mask mandates, the only confusion should be over why anyone still won’t wear a mask when they are around other people.

More on Controlling COVID-19

What Did the AAP Say About Sending Kids Back to School?

The AAP has offered guidance for a safe way to get our kids back in school during the COVID-19 pandemic. Will schools follow any of it when they open up?

The American Academy of Pediatrics recently issued some guidance about what to do about kids going to school this fall.

The AAP said a lot more than that parents should send their kids back to school. They offered guidance on how to safely send kids back to school...
The AAP said a lot more than that parents should send their kids back to school. They offered guidance on how to safely send kids back to school…

Not surprisingly, folks are a little confused about what they actually said…

What Did the AAP Say About Sending Kids Back to School?

It is true, the AAP guidance does favor opening up schools this fall.

“With the above principles in mind, the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020. Lengthy time away from school and associated interruption of supportive services often results in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. This, in turn, places children and adolescents at considerable risk of morbidity and, in some cases, mortality. Beyond the educational impact and social impact of school closures, there has been substantial impact on food security and physical activity for children and families.”

COVID-19 Planning Considerations: Guidance for School Re-entry

But, that isn’t all they said…

The goal is for kids to be in school this fall...

To get to that goal of opening schools, the AAP offered a list of key principles that schools should follow, including that:

  • school policies are going to have to be “flexible and nimble” so that they can quickly change as we get new information, especially “when specific policies are not working”
  • schools develop strategies that depend on the levels of COVID-19 cases in the school and community
  • schools make special considerations and accommodations for those who need them, “including those who are medically fragile, live in poverty, have developmental challenges, or have special health care needs or disabilities, with the goal of safe return to school”

So clearly, this is not a one-size-fits-all, lets open up schools no matter what kind of thing.

“Highest Risk: Full sized, in-person classes, activities, and events. Students are not spaced apart, share classroom materials or supplies, and mix between classes and activities.”

CDC on Considerations for Schools

The AAP didn’t say to simply open up schools without doing anything else…

“No single action or set of actions will completely eliminate the risk of SARS-CoV-2 transmission, but implementation of several coordinated interventions can greatly reduce that risk. For example, where physical distance cannot be maintained, students (over the age of 2 years) and staff can wear face coverings (when feasible). In the following sections, we review some general principles that policy makers should consider as they plan for the coming school year. For all of these, education for the entire school community regarding these measures should begin early, ideally at least several weeks before the start of the school year.”

COVID-19 Planning Considerations: Guidance for School Re-entry

They offered guidance on how to safely open schools.

Or at least how to open schools as safely as possible, as the alternative of keeping kids at home has risks too. And many people are skeptical that a strategy of closing schools is all that helpful in controlling the spread of SARS-CoV-2.

So the AAP guidance says that we open schools and also plan for:

  • Physical distancing – cohort classes, block schedules, rotating teachers instead of students, etc.
  • Cleaning and disinfecting
  • Testing and screening – schools will need a rapid response plan for when a child or staff member develops a fever at school.
  • Face Coverings and PPE – although it won’t be possible in all situations and for all children, “school staff and older students (middle or high school) may be able to wear cloth face coverings safely and consistently and should be encouraged to do so.”
  • Organized Activities – although this isn’t something most folks want to hear, they should understand that opening schools doesn’t mean that everything will be back to normal… “It is likely that sporting events, practices, and conditioning sessions will be limited in many locations.”

If we do all of that, will it really be safe to go to school with these guidelines?

Unfortunately, the most important part of the guidelines, the section on Testing and Screening, was a bit light on details…

“Parents should be instructed to keep their child at home if they are ill.”

COVID-19 Planning Considerations: Guidance for School Re-entry

The guidelines acknowledge that it will be too hard to do temperature checks and symptom screening each day and that schools should have a rapid response plan if anyone has a fever had school, but then what?

“Here in Colorado, I’ve been following our state health department website very closely. They update data every day and include the outbreaks in the state they are investigating. As you can imagine, there are lots and lots in long-term care facilities and skilled nursing homes, some in restaurants and grocery stores. There have been a total of four in child care centers, and we do have a lot of child care centers open. In almost every one of those cases, transmission was between two adults. The kids in the centers are not spreading Covid-19. I’m hearing the same thing from other states, as well.”

Why a Pediatric Group Is Pushing to Reopen Schools This Fall

So what’s going to happen if kids in school start to get sick and test positive for COVID-19?

Among the 950 COVID-19 in Texas daycare centers are 307 children.
Among the 950 COVID-19 in Texas daycare centers are 307 children. (Dallas Morning News)

The 60,000 members of the AAP who didn’t participate in writing the guideline know what’s going to happen…

A ton of parents from the school are going to call their pediatricians looking to get their kids tested!

What likely should happen?

That classroom or cohort and their close contacts should move to self-quarantine and home/online education until they pass the incubation period from their last contact.

“Put in place the infrastructure and resources to test, trace and isolate new cases.”

Safely Reopening America’s Schools and Communities

(I’m guessing we will get more details about this from the AAP soon and well before school starts. )

Most importantly though, our communities should do everything they can to keep their case counts down – wash hands, practice social distancing, wear a face cover.

And if we are going to send our kids back to school, we should make sure that we are protecting all of the folks making that possible.

Can we do all of that?

Sure!

Will we???

Sending Your Kids Back to School

Are you still unsure about whether or not you should send your own kids back to school?

I don’t blame you…

Some things to consider when making the decision:

  • is your child or any of their contacts at risk for a more severe case of COVID-19, including having an underlying, chronic medical condition, keeping in mind that the risk increases with age, especially once you reach age 65 years? If possible, online schooling might be a better option for students in high risk categories.
  • was staying home from school hard for your child? If your child had problems learning at home or the social isolation was an issue, than that would make going back to school even more important.
  • will your school or school district be “flexible and nimble” and respond to new information, rising case counts, and evolve their policies if necessary?

Most importantly, if you send your kids back to school, are you going to be constantly worried that they are going to get COVID-19 or bring home the SARS-CoV-2 virus? If so, then keep them home this fall.

On the other hand, if they are healthy, have no high risk contacts at home, and are eager to go back to school, then you should probably feel comfortable sending them if the school follows the guidance offered by the AAP.

More on COVID-19

Why Are Social Distancing Kids Still Getting Sick?

Why are some kids still getting sick if they are have been our of school and stuck in the house for weeks because of COVID-19?

COVID-19 has kept most kids out of school for some time now. Many are also out of daycare. And few are out playing with friends.

So why are some still getting sick? What else is going on with kids stuck at home while we are all social distancing to flatten the curve.

Why Are Social Distancing Kids Still Getting Sick?

The first thought of some parents and pediatric providers upon reading this might be, wait, what, kids are still getting sick?

Flu activity is low in most of the United States.
Flu activity is low in most of the United States.

And that’s because it does seem that in addition to flattening the COVID-19 curve, staying home from school and daycare, washing hands, and general social distancing techniques has worked to keeps from getting sick with the flu and most other contagious diseases!

So while pediatric providers are available to do telemedicine appointments, it certainly isn’t business as usual, even as their days have gotten quite unusual.

Some kids are still getting sick though, and while we know what you are thinking, most probably don’t have COVID-19.

Why?

It might be because:

  1. they aren’t social distancing as well as they think they are, keeping in mind that with many diseases, people can be contagious for a few days before they show symptoms and you can sometimes catch germs from touching fomites, or objects that a sick person has recently touched. That still doesn’t mean that they have COVID-19 though. If they have contact with others, they could catch almost anything.
  2. they caught something from someone who had a disease a few weeks or months ago and is still shedding. For example, some infants can shed RSV for as long as 4 weeks after they get better. And they can shed the virus that causes hand, foot and mouth disease (HFMD) for almost two months! Human parainfluenza viruses (HPIV), a common cause of colds and croup (seal bark cough), can also shed for many months.
  3. they caught something from someone who had a viral disease that causes a lifelong latent infection with periodic reactivation and shedding. Wait, what? While herpes (cold sores) is the main disease you might think of as causing a lifelong latent infection, there are others. You may not realize this, but after getting roseola (causes a high fever for a few days, followed by a rash after the fever breaks), HHV-6 (human herpes virus-6) kind of does the same thing. The big difference is that while you shed HHV-6 in your saliva from time to time, you don’t have any symptoms. You can get other folks sick though, especially older infants, once they lose the passive immunity they got from maternal antibodies.
  4. they have a sore throat caused by a virus, allergies, or reflux, but have tonsil stones and a positive strep test because they are a strep carrier. Nearly 20% of kids are thought to be carriers of strep, which means that every time they get tested, they will be positive, whether or not they actually have strep throat. That means that you don’t have to worry about testing the dog to see if they are carrying strep…
  5. they were exposed to a disease with a long incubation period. While the incubation period (the time between getting exposed to something to when you get sick) is just a few days for many diseases, it can be several weeks or months for others. In fact, your child might not get sick until 30 to 50 days after being exposed to someone with mono!
  6. they had a virus a few weeks ago and now have Gianotti Crosti syndrome (GCS), a post-viral rash on a child’s legs, arms, and buttocks. Although GCS might linger for weeks or months, it eventually goes away on its own. Another rash, this one likely caused by reactivation of the virus that causes roseola, might have you thinking your child is covered in ringworm (how would they get that if they haven’t left the house??). Instead, they likely have pityriasis rosea.
  7. their symptoms are caused by a non-contagious infectious disease that is spread from an animal or insect and not from another person – think Lyme disease (ticks), Cat scratch disease (cats), and West Nile virus (mosquitoes), etc.
  8. they got sick (bacteria, virus, or parasite) from contaminated lake or well water, which can cause diarrhea – giardiasis, Crypto, shigellosis, norovirus,
  9. they got sick (bacteria, virus, or parasite) from eating raw or contaminated food – giardiasis, shigellosis, norovirus, E. coli, salmonellosis
  10. their symptoms are caused by a non-infectious disease, which could be anything from allergies and asthma to poison ivy or herpes zoster (shingles).

It is also possible that their symptoms are being caused by anxiety, fear, and stress, which is not unexpected as they see schools closed, people getting sick and wearing masks, and are likely unsure about what’s coming next.

Has your child been sick recently?

Do you have a pet turtle or chickens in your backyard? They could be a source for Salmonella…

Do you understand why now?

Now call your pediatric provider if you have questions and need help getting them well, especially if they seem anxious or have extra stress from being home all of the time and away from school and their friends.

You especially want to call if you think that they might actually have COVID-19. While most kids have mild symptoms or are asymptomatic, if your child has a fever, cough, and difficulty breathing, you should call your pediatric provider or seek medical attention.

More on Covid-19 Kids Getting Sick