Transcription:
COVID-19 and Kids in School - Tips for Parents and Caregivers

Tiffany Kaczorowski: Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Tiffany Kaczorowski. Today, we're checking in with Dr. Gigi Youngblood. She's a Pediatrician at Pediatrics East in the Birmingham Metro area. And she's talking with us today about school aged kids, and COVID-19. So welcome Dr. Youngblood.

Dr. Youngblood: Thanks for having me.

Host: This time of year. Kids are back in school. They have been for several weeks now, and we're looking at the Fall, flu season. So let's jump in and start talking about the screening process. And as you say, screening really starts in the home before the kids go off to school, right?

Dr. Youngblood: Absolutely. There's just not a practical way for schools to screen every single child every single day. So we are really depending on our parents to think about those symptoms at home and give it a second thought before sending your child to school. And just knowing that COVID symptoms are not like classic flu symptoms, they're different. So we're seeing up to 50% of kids will not necessarily have a fever. A lot of kids will have a sore throat, mild cough, runny nose. So things that we think of more with allergies in Alabama this time of year, so they can be subtle. So we need parents to be really diligent in checking those symptoms each day and not necessarily sending their child to school thinking, Oh, I think it's fine. I think it's just a little allergy. Just being really diligent with it.

Host: Okay. And asking those questions in the morning or even the night before.

Dr. Youngblood: Absolutely. And knowing that three major signs of potential COVID that the child should not be sent to school would be a new onset, bad cough, loss of sense of taste or smell. So breakfast is a great time at the table to say, Hey, everything tasted okay over there. And then shortness of breath. And if your child has any of those symptoms, they don't need to even be sent to school. You need to stop and call the doctor.

Host: And then what do we do if our child is sick? So if they are having those symptoms, how long should they stay out of school? Obviously we should notify the school.

Dr. Youngblood: Absolutely. So notify the school and really, and truly call your doctor because they probably do need an evaluation. And again, this season is very different than previous fall seasons for us. Historically, I have lots of patients that would not call me when their child has a scratchy throat and a runny nose and a slight cough. They would give them some Zyrtec and go to school. But this year is just very different and we need to embrace the fact that it's different. And that's how we're going to keep our schools open and safe is by realizing this is not a typical year and we have to be super diligent with these things. So if your child has those symptoms, we're going to need to evaluate the child, probably test the child for COVID, maybe strap, maybe flu also, depending on the season and what they've been exposed to. But most of these kids are going to need that test.

Host: So, there are tests two different tests, testing for COVID you've got the rapid test. And then a PCR, right?

Dr. Youngblood: That's correct. So I find as a clinician that the rapid test is helpful when I am not very suspicious that this is possible COVID. So it's a child that really, the symptoms are not worrisome for COVID. They've had no known exposure. They've been engaged in low risk activities. Maybe they're going to school and not doing a laundry list of extracurriculars and their families being very careful, really limiting their social interactions. So those are the kids that the rapid tests might be helpful for.

Host: They are having some type of symptoms, right? Maybe they have typical allergies around this time of year.

Dr. Youngblood: Exactly. Maybe a history of allergies. They haven't been on their meds because they were doing well in the summer. I would definitely not consider a rapid test helpful in the setting of loss of sense of taste or smell bad cough or shortness of breath. And really even with high fever, I probably wouldn't choose to use a rapid test with that. And the reason for that is there's a lot of false negatives and by false negative, the test is negative, but the child actually has COVID. So that's false negative. So there's a fairly high rate of false negative with the rapid test. There's also, and this is what's most frustrating for families because there's also a statistically significant rate of false positives with the rapid test. Meaning the test says you have COVID when you actually do not. So what I prefer to use typically now there's a few exceptions to that situation, but what my go to test is the send-out PCR. It's more frustrating for the families because they don't get that immediate answer. But it's much more accurate. For me as a clinician, I think it's really important that we have accuracy right now, both for the families so that they don't end up in unnecessary quarantine and all of the stress that goes with that. But also so that we are not potentially sending kids out to expose their teachers, their classmates, grandparents, all of these folks.

Host: So, you're reserving that rapid test, more for the kids who you're not exactly that worried about. And then you recommend the PCR, which takes a little bit longer. Right now you're getting results back in as fast as 24 hours, 48 hours. So it's not taking as long as it was several months back.

Dr. Youngblood: Exactly. Now what I'm warning my parents is that can change at any point in time because we are in a pandemic situation. Even though we feel like things have gotten a little bit back to normal, we are still definitely in a pandemic. And so things can change rapidly. So, I don't want people to go into it saying I heard on this podcast, it was only going to take two days to come back because that can change. And it can change depending on which lab your particular doctor uses, but it's gotten a lot better. And so I don't want families to be so afraid of it and they can also talk to their individual doctor and say, how long is that more accurate test taking right now? And that's an option to you and talk through it with your doctor.

Host: And to not be afraid of that PCR test. There's nothing wrong with getting accurate results and finding out if you do need to quarantine, if you do need to protect yourself, protect your loved ones.

Dr. Youngblood: Exactly. And there's almost no false positives with a PCR test, which is really, for me as a mother, that's what I would, I want that accurate test. I'll wait a few days for that because I don't want to put my family through the stress of an unnecessary quarantine.

Host: While you are waiting for the results to come back, what should you be doing? Should you be quarantining?

Dr. Youngblood: Absolutely. And I have a handout that I give each of my parents, so they know, and I'll tell them if I think they're high risk or low risk for coming back positive. And honestly, most of my patients are low risk for a positive test. We really only see about five to 15% of our tests come back positive. That varies based on community disease activity. So how prevalent is it in the community at any particular time. If they're low risk, what I usually tell families absolutely keep them at home. No play dates, no playing in the driveway with a neighbor. They really need to be kept at home. Obviously no school while we're waiting on those test results. Parents need to talk with their individual employers. Cause that's a question I get a lot to do. I have to quarantine. And it depends on your employer's rules, but I always encourage full disclosure. So parents need to call their employer and say, Hey, my child has been tested for COVID. What is our protocol? And any adult that has to leave the house during that period of time, while we're waiting on test results needs to mask up at all times, you really shouldn't do social interactions at that time, optional things. But definitely if you are like mask up. And keep your distance. Absolutely. But for things like go into the grocery store and if you do have to go to work mask at all times.

Host: If we do know that your child has been exposed, maybe they've been to a birthday party or a family gathering or something like that. And somebody calls and says, Hey, so, and so was tested positive. So what do we do then?

Dr. Youngblood: First of all, an exposure is defined as less than six feet for more than 15 minutes. And because there's inconsistencies with how people are masking, unfortunately we can't really say, well, if you were masked, you're fine. And that's the reason that distinction is made. Even though I would definitely encourage you to mask because it will significantly lower your risk of contracting COVID. But we can't use that as a, Oh, they had their mask on. Everything's fine.

Host: Right? They hugged grandma, but they had their mask on.

Dr. Youngblood: Exactly. Cause I can't tell you how many noses I see hanging out of masks. So if they've had a direct exposure, they have to quarantine for 14 days, you cannot test out of quarantine. So that is just, that is a common misconception. You cannot go get a test negative and out of quarantine, that is 14 days. Now, if you develop symptoms, absolutely call your doctor. If you want to be tested, just to see absolutely call your doctor and see if that's appropriate. And we are encouraging more people to get tested after even if they stay asymptomatic, but the timing is important. So typically we want people to wait at least four or five days after that exposure to test because their body has to have a little bit of time for the virus to replicate, to manifest. But you can't test out of there. You've got to stay in quarantine, and if it's a close in home contact that you're going to have ongoing exposure, that gets even more complicated because basically the sick person can continue to shed virus and expose you to it. And so that's not just a strict 14 day that quarantine can actually go beyond. And because that's a fairly complex question, I would encourage patients and parents to call their pediatricians to say, okay, I'm positive as mom. How long does my kid stay in quarantine? And they can spell that out for them. But just the main take home point is you just know, you cannot go get a negative test and come out of quarantine. That is not a thing.

Host: Let's talk a little bit about the schools and what if your child is having some coughing or something like that. They go to school, the school maybe sends them home and says, you need to have a test before you can come back to school.

Dr. Youngblood: We're seeing a lot of that and that's very appropriate. And again, I know this whole season is very frustrating for families and for schools, but that's very appropriate to be sent home with mild symptoms that you would not have been sent home for previously. In those situations, the best thing to do is call your primary pediatrician. Certainly you can go to urgent care and get a test, but your pediatrician is going to have a better sense of, okay, I know this child has chronic allergies. I know that this is probably not COVID versus, Oh no, you've never had allergies a day in your life. This could definitely be COVID. And then again, they'll decide the best mode of testing, but don't be afraid of that, send out PCR.

Host: Just in general, staying healthy as we head into the holidays, Halloween is coming up and then we've got Thanksgiving. A lot of people will gather at Thanksgiving. And on top of that, we've got flu season.

Dr. Youngblood: Absolutely.

Host: So, first line of defense, get that flu vaccine, right?

Dr. Youngblood: Please get a flu shot, please, please, please. Or Flu Mist, whatever.

Host: Whatever's the best option for your family, but please get protected against the flu because this is going to be even more complicated this year than it typically is. And the flu shot is the number one way to prevent flu related deaths. So I always tell my parents, you don't necessarily vaccinate your kid to keep them from getting the flu. They can still get the flu even with the vaccine, but you give them the vaccine to keep them from dying from the flu. And we lose children every year in the state of Alabama to flu. So it's really important. And especially this season, because we have no idea what COVID and flu together, coinfection at the same time is going to look like in kids. And that worries me as a pediatrician because flu is really hard on kids, even more so than healthy adults. So this could be a nasty flu season.

Host: And what are some other ways that we can stay healthy during the holiday season?

Dr. Youngblood: So, stay diligent. That's one of the most important things. I know everybody's tired of this. I'm tired of it too. I'm so ready for this to be, but just stay diligent. Continue your social distancing practices. Good hand washing, frequent hand washing, hand sanitizer, and then just approach your holiday gatherings with social distancing, with pandemic precautions in mind, we can't expect this to be a typical Halloween, a typical Thanksgiving, a typical holiday season. We really need to go into it knowing that things need to be a little bit different this year so that we can get out of this together. If you have even mild symptoms, do not go to those holiday gatherings, do not go. And if you think that you are a little bit sick and felt like you really need to go, go get a test before you interact with your family.

Host: For sure. What about traveling this holiday season? Are you getting questions about that already?

Dr. Youngblood: Not yet, but I'm sure that we will. I think right now our rates are so elevated, especially in the Southeast, we're all in the same boat. But the thing that worries me more about traveling is you're going to mix households for long periods of time. You're not going to socially distance. You're not going to keep a mask on. So that's going to increase the risk significantly. It's one thing to have a three or four hour gathering, maybe outside with local family, you might be able to maintain some social distance with that. But when we start getting into going to see distant relatives, that's going to get really complex. We've got to really weigh these things and not expect a typical holiday season.

Host: The children's website, childrensaol.org/coronavirus, on there we have some good tips for parents and some good handouts. Are there any other resources that you would recommend Dr. Youngblood?

Dr. Youngblood: The Alabama Department of Public Health website ADPH.org has excellent coronavirus resources there also, and also check your local County Health Department and look for resources there that would be curated for your particular area. So those are both great resources.

Host: Thank you so much for coming in today and joining us.

Dr. Youngblood: Thanks for having me. I really appreciate it.

Conclusion: Thanks for listening to Inside Pediatrics, more podcasts like this one can be found at childrensaol.org forward/insidepediatrics.