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?