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COVID-19 FAQ and Resources for Physicians & Providers

Updated August 28, 2020

FAQ and resources

Children's Mercy is committed to providing physicians and providers with the answers and information you need during COVID-19. Answers to provider questions are categorized by topic and updated on an ongoing basis below. All questions received during COVID-19 LIVE events and otherwise are published here.

Resources including webinars, podcasts, toolkits, and more are also archived for your reference. Specifically, locate materials related to the following: 

  • General COVID-19 resources 
  • Telemedicine 
  • CARES Act
  • Well-being 

FAQ for physicians and providers

Reference answers to frequently asked questions from physicians and providers. 

Who decides if schools will require testing? What is the guidance if this is required?

 

The school itself may require testing. If this is the case, do not test an asymptomatic child before day 5, because the mean incubation period for the virus is 5 days. It will be up to the individual school and district, in conjunction with the health department, to decide if tests will be required to return to the classroom.

 

As children return to school, what is the testing and return guidance?

 

Refer to the “What to do if a student has symptoms of COVID-19” resource in Appendix A of the Guidance for School Re-opening During the COVID-19 Pandemic. This will help determine what steps should be taken and when the child can return to school.  

If students are positive, CDC guidance states they need to be at home in isolation for 10 days from positive test AND fever free for 24 hours with improving symptoms. If you have tested positive and are asymptomatic, you should remain under home isolation precautions for a minimum of 10 days from the date of the test. If symptoms develop, home isolation must continue until there is no fever for 24 hours without the use of medications to lower fever AND symptoms are better AND at least 10 days have passed since the symptoms started.

For children who are considered exposed, the Children’s Mercy guidelines advise they should be at home and quarantined for 14 days. While the CDC does recommend testing asymptomatic exposed people, they do not give timing on when that should be done. It is important to note that if someone is tested and found negative during their 14-day quarantine, they can’t come out of quarantine because of a negative test. They still have to quarantine for those 14 days. 

The CDC has defined exposure as being closer than 6 feet for a total of 15 minutes or more over 24 hours to someone with symptoms known to be COVID, or diagnosed with COVID. However, some health departments are defining exposure as people who were not wearing masks (those wearing masks are not considered exposed). It’s important to know what your health department’s position is, because that will be important from a school-based scenario.

Children’s Mercy is encouraging schools and daycares to not require a negative test to return. 

 

If a child is asymptomatic, how do we determine if testing is needed? 

 

Refer to the “What to do if a student has symptoms of COVID-19” resource in Appendix A of the Guidance for School Re-opening During the COVID-19 Pandemic.

Children with high-risk symptoms (new cough, difficulty breathing or loss of taste or smell) should be tested for COVID. Children with mild symptoms - a runny nose and congestion - don’t need to be tested, as they are less likely to have COVID. With the additional symptoms, testing should be considered for children with two or more of these symptoms. 

This is not going to be a perfect science, but in general, kids with COVID-19 infection have fever and respiratory symptoms. A little over half of kids manifest fever. Most have respiratory symptoms when they have symptoms with COVID. A smaller proportion of kids have diarrhea, a smaller proportion of kids have congestion or runny nose. That does help us to tease it out a little bit, but you’re going to have to use some clinical judgement on whether you think a child needs to be tested or not, given an alternative diagnosis. 

If you have an alternative diagnosis and the child is improving and afebrile for 24 hours, they should be allowed to go back to school and not have to miss the 10 days they would need to be home if they did have COVID infection.

 

Will Children’s Mercy offer “Return to School Testing”?

 

Right now, Children’s Mercy is not offering asymptomatic testing. We are trying to secure the appropriate supplies and want to ensure we have testing for all of those who are symptomatic.

 

What do you know about high school athletics? Is it appropriate? And what about having lunch in classrooms? Is there any increased risk related to that?

 

High schools are evaluating options related to athletics and approaches will vary. In some states, they have flip-flopped seasons, so instead of having football in the fall, they’re having it in the spring, and they’re having track and field in the fall - because you can physically distance for that sport much easier. 

The AAP has provided guidance about returning to sports. One important thing we need to have happen in order for people to feel comfortable with sports is to have a decrease in cases. To achieve this, people in the community need to be wearing masks, physically distancing and not be in crowded areas. 

With regard to lunch in classrooms, if kids are distanced, their risk should be low and it is likely a better way to do it than having a large group of kids in a lunchroom. There’s not going to be zero risk, but it’s low.

 

How do you minimize risk of school bus riding?

 

Strategies such as having assigned seats on the bus, having windows open if possible, filling the bus from the back to the front, and wearing masks will help mitigate risk.

 

Any advice that community pediatricians can give families with newborns at home and who have kids going to school? 

 

Each family will need to decide what feels right for them. Zero risk is not possible.

There are a lot of factors that go into choosing to send your child to school, not the least of which is what is the school doing to ensure safety for your children. Is there physical distancing with desks? What are they doing about masks, handwashing and cleaning protocols? What are they doing about specials classes?

Even though we’ve had a decent number of cases in children under 1 year of age, they’re either asymptomatic or they are experiencing very mild symptoms, and we need to continue to keep that in mind. We have had very few hospitalizations at Children’s Mercy and no deaths.

 

What would you recommend for school-age children and grandparents in the same home?

 

This depends on the co-morbidities of the grandparents and what other activities the family is doing. Are you all out and about? Mostly at home, other than going to work and school? And what measures do you have in place in the home to keep people safe such as handwashing and social distancing?

Coronavirus Disease 2019 (COVID-19) is caused by the novel virus SARS-CoV-2. First identified in Wuhan, China in late 2019, the virus is now circulating world-wide, including in Kansas City. People with COVID-19 may have no, mild, or severe symptoms. Common symptoms include fever or chills, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste or smell, sore throat, nasal congestion, runny nose, nausea, vomiting, or diarrhea. Older adults, and those with underlying medical conditions, including heart disease, lung disease, or diabetes, seem to be at high risk for severe COVID-19. Children seem to present with milder disease, and severe illness is less common. Specific treatment for COVID-19 is generally only prescribed for children hospitalized with severe disease. Children with mild disease can be managed with fever reducers (e.g. acetaminophen or ibuprofen) and supportive care. On average, people develop symptoms 5 days after exposure.

Multisystem inflammatory syndrome in children (MIS-C) is a condition where different organ systems become inflamed. Most children with MIS-C have evidence of recent infection with SARS-CoV-2. Treatment for MIS-C is based on symptoms, and most children recover with medical care.

SARS-CoV-2 is mainly spread from person-to-person by being in close contact with an infected person. An infected person may or may not feel sick. Household secondary attack rates are between 10-20%. Community secondary attack rates vary. In many studies, the secondary attack rate is <5%; however, rates can exceed 50% in areas where social distancing is not maintained. The best way to prevent getting infected is to practice social distancing, washing hands, routinely cleaning high touch surfaces, and covering your mouth and nose when you cannot socially distance. By keeping ourselves healthy, we keep others healthy.

Although COVID-19 is circulating in our community, Children’s Mercy continues to see more children for other common pediatric conditions than for COVID-19. In some cases, children can have COVID-19 and another infection. Information is rapidly changing, and we would encourage providers to reach out to physicianservices@cmh.edu if you have additional questions.

Reminder: Universal Masking Policy at Children's Mercy

 

Reminder: Universal Masking Policy at Children's MercyReminder: Universal Masking Policy at Children’s Mercy

As a reminder, a universal masking policy is in effect at Children's Mercy. All employees, families and patients age 2 years and older will be asked to wear a mask within Children's Mercy facilities.* Exceptions will be allowed for certain underlying medical conditions. Families can elect to bring their own mask; if they do not have a mask, one will be provided at the visitor screening stations. This policy aligns with current recommendations from the CDC and is intended to promote the health and safety of our staff, patients and families.**

**CDC guidance for appropriate PPE when caring for confirmed/suspected patients with COVID-19 and additional Infection Control information can be found here.

**CDC guidance on N95 extended use/reuse and N95 decontamination can be found via the links below:

*N95 respirators and cloth masks with exhalation valves allow for unfiltered air to escape into the environment. If the wearer coughs or sneezes, infectious droplets could travel thru the one-way valve. Based upon the above information, N95 respirators and cloth masks with exhalation valves should not be worn in Children’s Mercy facilities. Individuals who enter a CMH facility wearing a N95 respirator or cloth mask with an exhalation valve should change to an appropriate mask (e.g. cloth mask, paper mask, or isolation mask) or place an appropriate mask on top of the N95 respirator or cloth masks to cover the exhalation valve.

 

Polymerase chain reaction (PCR) testing can be performed by using a mid-turbinate, nasopharyngeal, or nasal swab for SARS-CoV-2. Some places are also accepting saliva samples in patients that can provide enough saliva volume for testing. Most testing machines require that the swab be placed in viral transport media before being sent to a laboratory for testing. There are pediatric swabs for children < 2 years and regular swabs for children and adults aged 2 years and older.

Antigen testing is also available in commercial labs. In general, this is not as sensitive as PCR testing and thus has a relatively high false-negative rate. We are not using antigen testing at CM for this reason.

Antibody testing provides IgM, IgG, and/or combined IgM/IgG results from blood. There are tests currently on the market that appear to be specific for SARS-CoV-2. Obtaining an antibody test may allow for a retrospective diagnosis of COVID-19 and may be useful when there is high suspicion for multi-system inflammatory syndrome in children (MIS-C). However, right now we do not know if having antibodies confers protection from future infection, and if it does, for how long does this protection last. There are still many unknowns with antibody testing and with limited insurance coverage right now, it is only recommended in specific circumstances.

CM is currently testing children who have symptoms of COVID-19 whether they are being admitted to the hospital or not, as well as those who are asymptomatic but starting immune suppressive therapy or are being admitted for ongoing immune suppressive therapy, or are undergoing sedation procedure or imaging.

 

What is the risk of a false negative on a COVID test?

PCR-based platforms to test for COVID-19 are highly sensitive and specific, and results should be trusted in the setting of symptoms consistent with COVID-19 infection. In exposed, but asymptomatic patients, a negative result could mean that viral replication is insufficient at that time to result in a positive test. This is the basis for maintaining quarantine for 14 days after exposure despite a negative test. Retesting is not recommended for symptomatic patients who have a negative PCR test, unless a new illness is suspected. Repeat testing is also not recommended for patients who previously tested positive unless a new illness develops. This is because patients with COVID-19 infection may continue to shed viral particles for weeks to months and do not indicate infectiousness beyond 10 days from the positive test or symptom onset, whichever is longer.

Ensure that your workforce is coming to work healthy each day by implementing symptom and temperature screening. Screen parents and patients prior to the visit and ensure that your patient-facing staff are wearing medical-grade masks and for non-facing patient staff who are not in an individual office cloth masks are enough. Parents and older children that can wear a mask should be wearing one during their visit. Frequent cleaning of high touch surfaces and hand hygiene with either soap and water or 60% alcohol hand sanitizer are also important. Staff should try to maintain social distance of 6 feet and should not gather in break rooms or lunchrooms if social distance cannot be maintained. Washing hands before and after eating are also important.

If you are seeing a patient confirmed or suspected to have COVID-19, bring them immediately back to an exam room and shut the door. Utilize the PPE available in the office for providers to care for the patient and clean the room per routine at the end of the visit. If you performed an aerosol-generating procedure during the visit, then shut the room for one hour prior to performing cleaning.

The risk of becoming infected from exposure to an infected patient with COVID-19 is minimal if you are wearing a face mask, eye covering, and using good hand hygiene before and after each patient encounter.

There are several COVID-19 vaccine candidates that are advancing into phase III clinical trials. CM is participating in one clinical vaccine trial for a candidate vaccine made by the University of Oxford and manufactured by AstraZeneca. This trial is enrolling adults >18 years of age and has a focus on older adults and those with chronic conditions.  

 

What is the difference between the mRNA vaccines versus other types of vaccine technologies?

 

The mRNA vaccine is another technology used to create the vaccine. The idea is that it can be made and mass produced quickly. The other technology focuses on the spike protein and can be made and mass produced quickly. That one was originally created for the MERS virus, and they knew that it worked, so they thought that it had a good chance of working for SARS-CoV2 as well. 

If a patient has a cough and a fever, plus known COVID-19 exposure, what do we tell them to do?  


Patients with known exposure and compatible symptoms should be assumed to have COVID-19. Children with mild disease symptoms do not require testing and can be managed at home with supportive care and home quarantine. PPE should still be worn in caring for those children, as well as proper room cleaning and thorough hand hygiene.

 

When do I refer a patient with suspected COVID-19 to Children’s Mercy?


Children who are dehydrated or are having difficulty breathing can be referred to Children’s Mercy. If you need to speak with a physician because your patient has severe enough symptoms that warrant them to be seen in the ED or Urgent Care, call the hotline at (816) 302-8800 for admission or consultation prior to their arrival.

 

What should we do when sending a patient to Children’s Mercy Radiology?


Do not send patients with suspected COVID-19 to radiology for a diagnostic CT or CXR. Viral testing remains the only specific method of diagnosis for COVID-19. Call Children’s Mercy Radiology at (816) 234-3270 in advance of sending a sick patient for radiology testing and provide the office’s/provider’s contact information.

Children’s Mercy is following the CDC guidelines for home isolation and return to work criteria which are available here. 

 

Can you address if the hospital or the Emergency Department is a safe place for patients and families considering COVID? 


We are doing all we can to ensure that the Children’s Mercy Emergency Department is a safe place for patients and families. All of our patients with respiratory symptoms are cared for in a designated area. This is true at both the Kansas and the Adele Hall locations. Our non-respiratory patients are cared for in a separate area. Providers who work in these areas do not move back and forth between the two. This reduces the risk of illness transmission within the Emergency Department. We also work very hard to maintain distance between symptomatic and asymptomatic patients. In addition, we carefully abide by all rules regarding PPE. Because we are doing all we can to reduce the transmission of illness, we encourage your patients to come in sooner rather than later. We have seen quite a few sick kids who have waited at home too long before seeking care.

 

Should community providers be referring patients to surgery at this time?

 

Absolutely. In this video, Shawn St. Peter, MD, Surgeon-in-Chief at Children’s Mercy, discusses how the hospital is still seeing new patients via telehealth and encourages providers to send any referral they would under normal circumstances. Additionally, watch to learn more about guidelines in place to ensure the health and safety of our patients and providers. Watch now. 

 

 

 

 

Resources

The following resources have been identified for use in practices and with families. 

Halloween is a great time of year for many children. Like many other activities, Halloween will look different this year during the COVID-19 pandemic as we all work to keep our families and community safe.

General Safety Tips:
• Young children should always walk with a trusted adult, especially after dark.
• Cross at crosswalks, use sidewalks and use extra care when crossing streets.
• Never enter a home or car for a treat.
• Wear something bright to be sure you can be seen at night (reflective tape, flashlight, glowsticks, etc).
• Avoid costumes with tripping hazards and sharp objects such as sticks, canes or swords.
• Check treats for sealed packaging and remove any treats that may be choking hazards.

Consider fun, low risk activities like:
• Save the pumpkin carving for parents or teens and plan on the little ones decorating pumpkins with markers.
• Walking outside and viewing pumpkins and decorations at other houses from a safe distance.
• Decorating inside and outside your living space.
• Have a virtual Halloween costume contest.
• Participate in a scavenger hunt for Halloween decorations or a costume parade where children can remain outside and physically distanced.

Higher-risk activities include parties and trick-or-treating. Consider making these activities safer.

• Move your party outdoors.
• Limit the number of people.
• Wear a cloth face covering (make it a Halloween spirited one!).

Note: wearing a Halloween mask over a cloth face covering can block vision and can also cause difficulty breathing in some children and should not be done.

• Keep physical distance, 6 feet if possible.
• Avoid sharing beverages and food.
• Wash your hands frequently.
• Leave goodie bags for trick-or- treaters so they can pick them up.

For more information, visit: cdc.gov/coronavirus/2019ncov/daily-life-coping/holidays. html#halloween

General 

Masking

While policies will vary from district to district, masking is likely to be implemented to some degree at all institutions this fall. Wearing masks in public settings can be difficult for everyone, and children and adolescents may struggle with this critical safety skill. The good news is that kids learn to wear new clothes all the time (coats and gloves in the winter, shoes in public, etc.) and we can use the same teaching approaches as they learn how to wear masks and stay safe. 

Additionally, Children’s Mercy supports efforts to mask universally where possible as this practice is proven to disrupt spread of the virus; however, we understand the need to partner in cases where exemptions are needed due to health reasons. 

Resources related to masking in school settings are available below:

Video: Telemedicine Care & Reimbursement

Telemedicine protects patients and families from unnecessary exposure, while still enabling them to receive the care they need. In this video, representatives from Children’s Mercy discuss how community providers can best leverage telemedicine to provide care. Updates on reimbursement and newly relaxed guidelines are also provided. Watch now. 

Telemedicine Toolkit

We are aware that many providers and practices have been considering telemedicine as an option for patient care. Children’s Mercy has been at the forefront of telemedicine by providing services for regional areas throughout Kansas and Missouri for more than eight years, and we are expanding the telemedicine services we offer in light of this pandemic. Telemedicine is an effective way to provide patients with high-quality and accessible care, especially in an environment where it is important to limit community spread and exposure.

We believe this option will help you bridge the access between your patients and you. In the spirit of collaboration and to answer some of your questions, we have compiled information to help you navigate the uncharted territory of telemedicine.

See Full Telemedicine Resource

 

Claims for MO HealthNet Participants with Medicare or Commercial Insurance 

The MO HealthNet Division (MHD) has recently increased flexibilities related to telehealth due to the COVID-19 public health emergency. Providers should continue to submit claims to the participant’s primary payer before submitting any claims to MO HealthNet, in accordance with Section 208.215, RSMo. Read more MO HealthNet Provider Hot Tips 

The Coronavirus Aid, Relief, and Economic Security Act, also known as the CARES Act, is legislation aimed at providing relief for individuals and businesses that have been negatively impacted by the coronavirus outbreak. The CARES Act was passed on Friday, March 27, 2020. 

Access resources and see how this stimulus bill may apply to your practice here. 

Moving forward in the face of uncertainty

We experience uncertainty every day of our lives. But since COVID-19, it may feel like nothing is certain anymore -- our health and the health of loved ones, job security/finances, or even previously mundane and predictable things like where to buy toilet paper. It is normal to experience some level of stress or anxiety when life occasionally becomes unpredictable. But with an unprecedented situation like COVID-19, the feeling of uncertainty can increase to the point that our normal ways of coping no longer seem as effective.

New Resources have been identified to aid you in navigating this uncertain time. Specifically, online resources are available for each of the following strategies: 

  • Focus on the things that are currently stable and certain in our lives, and things we can control
  • Plan for what we can
  • Manage our feelings in the moment

Access well-being resources here

Physician role in ensuring well-being of families 

With more kids out of school and staying at home, we may unfortunately see an increase in child abuse cases. We encourage community physicians and providers to watch for the signs and conduct thorough skin exams. We may be the only people in the community to see these children because teachers and school faculty are not able to look out for their well-being right now.

Our Emergency Department is also expecting an uptick in trauma. With warmer weather and kids going outside to play, we may see an increase in broken bones, lacerations, abrasions and head traumas. We may see more trauma cases than COVID-19 cases.

We also expect more questions around fear and anxiety. Children may be anxious about parents, grandparents and relatives getting sick. Children's Mercy has resources available on our website.

Children's Mercy resources

COVID Testing - Parent Notification Letter Templates

Children’s Mercy has developed a letter for parents requesting confirmation of their child’s COVID-19 test results. The letter provides options based on the patient’s testing results and symptomatology. Letters are available in English and Spanish. 

Please consider leveraging these letters in your practice and customizing for your needs: 

Resources in the community during COVID-19

Many families in our community need extra support right now. Children’s Mercy has gathered resources for Kansas and Missouri families who need assistance with food, transportation, and other basics during the COVID-19 pandemic. 

Click here to access resources related to the following: 

  • Family toolkit: Social Distancing with a Plan
  • Food resources 
    • Children's Mercy free lunch program
    • Harvesters
    • School district nutrition services 
  • Transportation and lodging 
    • Free rides for essential needs
    • Resources for families with Missouri medicaid coverage
    • Resources for families with Kansas medicaid coverage
  • Mental health support
  • Helpful websites and hotlines

Community and donor town hall 

A town hall event was held on May 13 to provide our donors and members of our community the opportunity to hear directly from experts about how to navigate the region's re-open plan for children and the importance of pediatric COVID-19 research.

Watch a recording of the event

Related resources: 

Podcasts

The Children’s Mercy Pediatric Ethics Podcast Series

This series features Children's Mercy specialists and other pediatric experts from across the globe covering topics that are changing pediatric ethics.

Recent podcasts include: 

  • Ethics and Communication During a Pandemic 
  • Pandemic Ethics
  • Planning for COVID in Washington State
  • COVID and Child Abuse

Access the series

Transformational pediatrics series

  • "Pediatric Provider Well-Being and the COVID-19 Pandemic" with Jennifer Bickel, MD, pediatric neurologist and Medical Director of the Children’s Mercy Center for Professional Well-Being. Listen now.

Special issues of The Link

Other

Battelle CCDS Critical Care Decontamination System™

With sites expected to launch in Missouri and Kansas soon, the Battelle CCDS Critical Care Decontamination System™ addresses the current shortage of critical Personal Protective Equipment (PPE) across the United States. Battelle CCDS™ is designed to work on N95 respirators for the decontamination of the novel coronavirus (SARS-CoV-2). These services are available to heath care personnel. 

Detailed information on the Battelle CCDS™ collection process and how to prep N95s can be found in the following documentation:

Additionally, reference the Kansas N95 Respirator Decontamination Program FAQ.

Learn more about the service and how to enroll here.

Once contact with Battelle has been initiated by the provider, more information will be made available to them. 

Websites

AAP & CDC guidelines/reports

Reopening schools & daycare centers

Vaccination Rates

About COVID-19

Symptom Chart 

A chart has been developed to assist in differentiating between flu, allergies, colds and COVID19.

 

Webinars

American Academy of Pediatrics

Policy/governance updates

Missouri Hospital Association (MHA) – State and federal waiver overview 

The Missouri Hospital Association advocated with various state and federal agencies to waive requirements that impede hospitals' ability to rapidly respond to the spread of COVID-19. View a comprehensive resource from MHA capturing Missouri state and federal waivers granted to date, via the link below. Please consult the relevant agency with questions about processes and specific applications. Access the resource.

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