Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Isolating children in a COVID-19 pandemic: A primer
Warning: Becoming lax with isolating your children and teenagers to prevent spreading OVID-19 coronavirus disease can have serious consequences for your family and your community.
True, these age groups are far less likely to become severely ill or die from the disease than adults, says the American Academy of Pediatrics (AAP). “It’s not that they don’t get infected, and it’s not that they don’t get hospitalized. They are. It’s just that the disease is less severe than it is in adults.” Please see an important addendum at the end of the article.
Parents lax in enforcing isolation generally cite the following: children are only mildly sick, if at all; they know no one who has been infected; live in a part of the country with little OVID-19 activity, or, being cooped up at home for extended periods rattles the nerves of all family members. Or parents cite necessity; having to go to work without daycare or school to mind the kids. In these scenarios, young children end up with relatives or neighbors. Teenagers hangout with friends at each other’s houses or play basketball at an outdoor playground. Likely, maintaining a six-foot (one meter) physical distance from each other is not of prime importance. Nor is asking whether other players on the court have family members at special risk for this disease.
“There is increasing evidence emerging about the role of asymptomatic people in the transmission of COVID-19,” says the AAP. How important the role of young children in the spread has yet to be determined. This virus appears to spread more readily than many other viruses but not as readily as measles, for example. Known is that young children are effective transmitters. They may show no or minor symptoms when infected and because of the acute shortage of testing kits virtually none has been tested.
Also, COVID-19 is transmitted via two routes, mostly via tiny water droplets through the air when an infected individual coughs or sneezes and, less often, by touching objects or surfaces where such droplets have landed. Children’ poor hygienic habits promote both such transmissions. They do not cover their noses or mouths when they sneeze or cough, rarely wash their hands unless reminded and supervised, and enjoy touching objects and surfaces and then placing their fingers in their mouths and noses. Some young children drool a lot. Moreover, many adults cannot resist the urge to hug and kiss young children.
* Lower bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group; upper bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group with known hospitalization status, ICU admission status, or death.
Next week: The psychological effects, if any, on children and teenagers from social isolation. (Why is it called ”social isolation’’? Let’s change the name to physical isolation.)
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Corona virus #4
Your child has symptoms compatible with early coronavirus disease: mild cough, a runny nose, and a borderline fever. What do you do?
1. Stay calm. As more and more cases of Coronavirus (COVID-9) disease occur around the world, children continue to be infected far less frequently than adults, and when infected, the vast majority show either no symptoms, or mild, common cold-like symptoms. Rough estimates (no statistics available) are that less than two percent of cases occur in young children. Very few pediatric patients have required hospital admission. There have been no known deaths in children under the age of ten years. By comparison, at least 144 children in the U.S. have died after contracting the flu so far this flu season, says the CDC.
2. Familiarize yourself with facts. Yes, your child may have coronavirus (COVID-19) disease. However, the early signs are indistinguishable from those of the common cold and the flu. In fact, chances are that your child’s symptoms are not COVID-19-related. Children in daycare and in the first few years of school have on the average of three or four colds per year, with most of them occurring around this time of the year. Flu is also common at this time of the year, possibly more so this year than in other years. This is unrelated to COVID-19. Having had flu shots reduces considerably the chances of having the flu, but the possibility does exist.
3. Isolate your child promptly. COVID-19, flu and colds are all contagious. You, the parent, can’t differentiate one from the other during the early stages. Why risk spreading any of these viruses to others? Therefore, no daycare or school, no playdates, and no visits from the elderly or the immunosuppressed until you have more information. The main purpose for isolating possible cases of COVID-19 is to protect others.
4. Let experts decide whether your child needs prompt medical attention. Call your child’s pediatric office. Let them make the decision. They are aware of the COVID-19 situation in your community. Give them your observations: Is your child’s nose running continuously, coughing and sneezing a lot, and febrile? Is he or she happy, active, and playful? Make sure the medical personnel are aware of your child’s medical history, if significant, and whether household members have important medical issues.
5. Visiting a medical facility during a contagious disease outbreak can be counterproductive. Will the visit help your child or are you risking having your child pick up an additional respiratory infection? Pediatric medical facilities are ideal places for that. Moreover, unnecessary visits overburden facilities that may already be working at capacity. Generally, children with minimal respiratory symptoms need not be examined. The Rx for such children: No medications. Isolate. Do nothing. Observe carefully. Stay in touch. Call back, even within the hour, if there are changes.
6. However, visits are imperative when children appear ill. Ill means “not being themselves,” being listless, coughing, having fever and drinking less liquids than usual, for example. They could have the flu, for example, a disease that mimics OVID-19. Flu can be diagnosed with a simple test and can be treated.
7. The number of children diagnosed with COVID-19 disease will likely rise rather sharply in the near future. This is not an alarming turn of events but merely the result of more children being tested. Testing kits have been in short supply in many parts of the country and early tests were not totally reliable. Also, testing has been reserved for adults, especially older adults and particularly adults with underlying ongoing conditions. Children have had low priority for being tested because they have mild or no symptoms.
8. However, testing young children for COVID-19 is important. The two main reasons: One: Positive tests will detect asymptomatic children who require strict isolation for two weeks. Two: To help public health researchers better understand the role that children (and adults) play in the spread of COVID-19. Do children who are asymptomatic or have minimal symptoms shed virus? And if so, when and for how long ? Does shedding begin before symptoms appear and/or continue after symptoms disappear. All are possibilities. Such data are essential to formulate sensible recommendations regarding daycare and school attendance. Also unknown is whether becoming infected requires mere casual contact with an infected individual (passing in the school hallway, for example) or more prolonged contact (sitting opposite at a table at lunch, for example). Presently, the only solution is to close schools and daycare facilities indefinitely.
9. Formulate plans on how to handle COVID-19-related disruptions. Schools may close suddenly and unexpectedly which may affect your work schedule. Will babysitters want to watch an infected child? Are there immunosuppressed individuals in your home?. And should an outbreak occur in your community, are you prepared to discuss it with older children. Such events can be stressful for both adults and children. Try to stay calm, and reassure children that they are safe and will continue to be safe in spite of what is happening in the adult world.
10. Miscellaneous. Many health care facilities have established formal telemedicine centers staffed by specially trained personnel to answer questions via telephone or email and, in many cases treat children via COVID-19-related issues… Estimates are that the virus can be detected in the air for up to three hours after it was aerosolized with a nebulizer, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel… Launder washable toys as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely… Dirty laundry from an ill person can be washed with other people’s items.
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Update #3: Are your children at risk for coronavirus disease?
Note: Check the dates and sources of all information you read about the COVID-19 coronavirus, especially what you may read online. Many entries are not dated and anyone can post. For current and accurate information, consult the official sources listed at the end of this article. (You can find a link to my Bio/CV there as well.) Moreover, do not ignore phrases such as “appears to be,” “limited information,” and “in a small study.” These indicate what is not yet fully understood.
As the COVID-19 virus spreads within communities all over the world, it still appears that children are at far less risk of becoming infected than adults. Moreover, when children are infected, most show no symptoms or mild common cold-like symptoms: minimal coughing and runny noses, and little or no fever. Symptoms in this age group tend to be much milder than the symptoms associated with influenza. As far as is known there have been no deaths in children from COVID-19. The vast majority of serious cases occur in the aged, especially those with chronic underlying diseases. The fact that COVID-19 is a mild disease in young children is in line with other coronavirus diseases that have occurred in recent years such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
However, at present, testing kits for COVID-19 are in short supply and the tests available may not be totally reliable. As a result, few children are being tested. When testing becomes more accessible and results more reliable, more children will be tested. And, likely, more children will be found to be infected. This will help reveal whether or not children play an important role in the transmission of this disease. Likely, this may be the case.
To limit the spread of COVID-19 some communities have closed schools and taken other measures to quarantine children. Presently, the US Centers for Disease Control (CDC) does not recommend such measures unless extraordinary COVID-19 virus-related situations exist within a community. There is insufficient evidence regarding if, when and how children shed the virus. Possibilities include spreading the virus only while children show symptoms, before symptoms appear and/or after symptoms disappear. Such data are essential to formulate sensible recommendations regarding daycare and school attendance. Also unknown is whether becoming infected requires mere casual contact with an infected individual (passing in a hallway at school, for example) or more prolonged contact (sitting opposite an infected individual for half an hour at lunch, for example).
CDC does recommend that families engage in the usual preventive actions to avoid infection. Teach or supervise children to clean hands frequently using soap and water or alcohol-based hand sanitizer and to avoid people who are sick. Keep children up to date on their vaccinations, especially influenza vaccine. Influenza can easily be confused with COVID-19. Wearing of facemasks is not necessary unless specifically ordered to do so by medical personnel. Discourage hand shaking, hugging and kissing. Stay at least six feet (two meters) away from individuals who show signs of upper respiratory infections. The virus can travel about that distance through the air via minute droplets that infected people cough up, sneeze out, or expel while talking. Regularly clean frequently touched surfaces and objects (e.g., tables, countertops, light switches, doorknobs, and cabinet handles) using household detergents and water.
There is no way that you can differentiate a cold from the flu or from COVID-19. Immediately isolate your children if they show symptoms of an upper respiratory infection (cold). Then call your children’s pediatric office. Let them decide whether your children need to be seen. Unnecessary visits to medical facilities will overburden them at the very time that the maintenance of strict protocols is especially important. Moreover, medical facilities are prime locations in which to contract respiratory infections. Also, your medical facility may want to prepare for your arrival in case isolation is deemed necessary.
Finally, formulate plans regarding how you will manage your children should their school suddenly and unexpectedly close, including giving thought to how that may affect your work schedule. And should an outbreak occur in your community, talk with your children about it. Outbreaks can be stressful for both adults and children. Try to stay calm, and reassure children that they are safe and will continue to be safe in spite what is happening in the adult world.
For current information about COVID-19 virus and children, see https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/children-faq.html
For current information about COVID-19, pregnancy and newborns, see https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html
To read my article, Will your children be wearing facemasks anytime soon?, see http://kidstraveldoc.com/will-your-children-be-wearing-face-masks-any-time-soon/
To read my bio/CV, see http://kidstraveldoc.com/CV/
Karl Neumann MD, FAAP, CTH
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Are your children at risk for coronavirus disease?
For today’s official news bulletins about corona virus COVID 19 and children, please see the following sources, at the end of this article:
Children appear to be at less risk of being infected by the coronavirus (now officially known as COVID-19) than are adults, says the US Centers for Disease Control. The frequency and severity of infection appears to increase in humans from infancy to old age. Moreover, when children do become infected, many show no symptoms at all or mild common cold-like symptoms with minimal coughing and runny noses, and little or no fever. The symptoms in this age group tend to be far milder than the symptoms associated with influenza. The vast majority of serious cases of COVID-19 occur in the aged, especially those with chronic underlying diseases.
Note: Here is a primer for reading public health updates in the age of C0VID-19 diseases. Check the dates and sources of reports, especially reports you read online. Many reports online are not dated and anyone can post items. (To find a link to my bio/CV, go to the end of the article.) Moreover, do not skim over phrases such as “appears to be,” ‘limited information,” “and in a small study.” These phrases are as important as the facts stated. Information reported tomorrow might be quite different.
The fact that COVID-19 is a mild disease in young children is in line with other coronavirus diseases that have occurred in recent years such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). What is not presently known about COVID-19 is whether children who are infected but showing no symptoms can spread the disease and, if they can, if they spread the virus only while the cold-like symptoms are present or also before symptoms appear and after they dissipate. All are possibilities. Such data is essential to formulate sensible recommendations regarding daycare and school attendance should the disease become epidemic in this country.
Currently, there is no COVID-19 vaccine available nor are there specific treatments. Optimistically, a vaccine may be available by the end of the year.
At the present time, in the US and Canada, person-to-person spread of COVID-19 has been seen only among close contacts of returned travelers from Hubei province in China. The virus is not currently spreading within communities in these countries. Children and their families should engage in the usual preventive actions to avoid infection, including cleaning hands often using soap and water or alcohol-based hand sanitizer, avoiding people who are sick, and staying up to date on other vaccinations, including influenza vaccine. The wearing of facemasks is not recommended. The only travel restrictions at the present time are regarding non-essential trips to China.
Also, not definitely known is whether pregnant women are especially susceptible to infection, are at increased risk of severe illness compared with the general public, or if infants of infected pregnant women are at risk. Currently, pregnant women should engage in usual preventive actions to avoid infection such as washing hands often and avoiding people who are sick. Recently, in a small number of cases involving infants born to mothers with COVID-19, none of the infants have tested positive for the virus. However, in previous coronavirus-type infections, rarely, there were cases of premature births, low weight infants and other adverse pregnancy outcomes.
Regarding breast feeding, in the small number of cases where the milk of infected women was tested, there was no evidence of the presence of the COVID virus.
For current information about COVID-19 virus and children, see https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/children-faq.html
For current information about COVID-19, pregnancy and newborns see https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html
To read my article, Will your children be wearing facemasks anytime soon? see http://kidstraveldoc.com/will-your-children-be-wearing-face-masks-any-time-soon/
To read my bio/CV, see http://kidstraveldoc.com/CV/
Karl Neumann MD, FAAP, CTH
Will your children be wearing face masks any time soon?
1. The US Centers for Disease Control CDC) recommends that children (and adults) NOT wear face masks at this time. Facemasks are the hallmark of coronavirus disease. Pictures from China show that even the very young are bedecked with them. However, wearing facemasks makes sense only where and when person to person spread is prevalent and ongoing, as in China, not where spread is minimal, as is presently the case in the US and most other countries.. The reasons for not wearing facemasks are discussed below. Also discussed are the rare exceptions to this rule.
2. The CDC is also advising parents against stocking up on face masks for “just in case.” Parents are buying masks helter-skelter with little understanding regarding which kind to buy and how and when to use them. Retailers are running out of masks, even ones that offer no protection. Some American children are already wearing masks.
3. The US government says it has huge stockpiles of face masks for children and adults. The government has storage facilities holding drugs and supplies in the case of bioterrorism, nuclear attack or outbreaks of serious infectious diseases.
4. The optimal masks for preventing coronavirus-type diseases are not suitable for young children. These are N95 respirator masks and are intended for healthcare professionals only. However, they can be bought by the public. Health care workers who wear them must undergo periodic “fit’ tests to assure the masks fit tightly around the mouth and nose to prevent air from the outside entering. They block out more than 95% of the small airborne particles that spread viruses from person to person. These masks are somewhat uncomfortable to wear and may make breathing slightly labored.
5. Most masks commonly worn by children (and adults) are surgical masks. These were specifically designed to protect surgeons from being contaminated by splatter from the surgical field, not to provide protection from infectious diseases. The masks fit loosely around the edges, allowing some unfiltered air – and any viruses that may be present in that air – to enter the mouth and nose of the wearer. However, the masks are fairly comfortable to wear, even for prolonged periods of time. Surgical masks are available online for young children.
6. Surgical-type face masks provide very limited protection against coronavirus-type illnesses, says WHO (World Health Organization). Protectiveness depends on how masks fit, how much of the time they are worn, whether children are cooperative with wearing them, the concentration of viruses in the air and numerous other factors.7. The time and effort parents spend in teaching and enforcing proper mask wearing could be better used in teaching children simpler and more effective protective measures. (See #8 ) Few children are compliant with mask-wearing and become less so as the novelty of wearing them wears off. They remove them, pull them away from their faces or place their fingers under them. The younger the child the more difficult it is to have them wear masks.
8. Presently, the CDC recommends wearing face masks for only a small number of children. This includes (1) children sick with the virus, (2) children believed to have been exposed to someone sick with the virus (3) and children living in such households. For other children in countries where coronavirus disease activity is only minimal children should be taught the following: proper handwashing techniques, how to cough and sneeze into disposable tissues and how to dispose of those tissues, to stay away from sick individuals, and to stay home when sick. And, of course, parents must keep up with the news.
9. Check that the face masks you purchase are designed to protect against coronavirus-type illnesses. Many other types of masks are on the market. For information, contact your local health department or health care professionals. Also check with the manufacturers of masks on the internet. There are masks for protection against “pollution”, cold weather, and allergies, to mention just a few. There are masks which are just for fun and play and kits for children to make their own masks. Some masks should be used only once, others claim to be reusable. There are cotton masks said to be rewashable.
10. Assist children in removing their masks lest they contaminate themselves in the process. Remove masks as gently as possible so as not to disturb minute liquid and solid particles on the mask. Place masks in a plastic bag, preferably in a zip lock bag. Secure bag tightly, Place bag in a waste disposal unit. Wash hands thoroughly immediately.
Coronavirus disease and children: PART II
January 28, 2020. When reading this and similar articles, mentally jot down the date they were written. Very likely, some of today’s recommendations will be updated tomorrow.
(PART I, written on January 24 (four days ago) is available at: http://kidstraveldoc.com/are-your-children-at-risk-for-coronavirus-disease/)
1. The latest advice from the CDC. Unless you have been in China in the past few weeks or are presently in contact with someone who recently visited China, the risk of anyone in your family becoming infected with coronavirus illness is at the moment extremely remote, says the US Centers for Disease Control. Watchful waiting is the only reasonable action to take.
2. How do the coronavirus and other viruses spread from person to person? Infected individuals exhale, cough, and sneeze viruses into the air. Generally, viruses can “‘fly” about six feet (two meters), enabling individuals within that area to inhale them. Viruses also land on nearby surfaces. Touching those surfaces transfers viruses to one’s hands. Subsequent touching of one’s mouth and nose allow them to enter the body.
3. Are young children especially at risk? This is a new virus and definite answers are not yet available. However, during previous outbreaks of somewhat similar coronavirus diseases, fewer children than adults were infected and the disease was considerably milder in children. More information on this aspect of the disease will become available as more cases occur.
4. What other information is needed to formulate meaningful control measures? The incubation period is believed to be two to five days, but may be longer. Still unclear are the following: can individuals be infected, show no signs of illness yet spread the virus? Does the virus start spreading in the days before symptoms appear? Does it spread only while symptoms are present or is spread possible after symptoms disappear? Answers should become available within the next week or two.
5. How can I tell whether my child has a cold or the coronavirus disease? Unfortunately, you can’t with certainty. At the onset of these diseases, the symptoms (runny nose, cough, sore throat, muscle pain, fatigue, and fever) are identical. There is no specific treatment for either illness. Cough and cold remedies, mostly antihistamines and dextromethorphan (for coughs), are no longer recommended for children due to occasional side effects. Use appropriate doses of acetaminophen or ibuprofen to reduce fever and relieve aches. However, these medications do not shorten the duration of viral infections.
6. Should parents take children with cold-like illnesses to medical facilities to rule out coronavirus disease? No, says the CDC. As yet, in the US, there has been no reported person-to-person spread. Healthy young children who attend daycare or school average three to five cold-like illnesses per year, mostly in winter months. Moreover, unnecessary visits overburden medical facilities at the very time maintaining efficiency is especially important. Also, medical facilities at this time of year especially are common places to catch colds. If you strongly suspect that your child may have coronavirus disease, call your facility before arrival, allowing them to prepare to isolate you upon arrival.
7. Does wearing a facemask reduce the risk of becoming infected? While such masks have become the hallmark of the coronavirus outbreak, masks offer limited protection. Presently, the CDC does not recommend wearing masks. To be effective, the right type of mask must be worn; many types are available. And masks must fit tightly and be removed correctly, with a fresh mask applied each time. Children especially object to wearing masks. They frequently subvert the efficacy of the mask, by placing their fingers under the mask, for example. Wearing masks is important for individuals dealing with an infected person. The US government has stockpiled facemasks and other supplies necessary to contain epidemics. See below.
8. How can doctors diagnose coronavirus disease? There are no rapid diagnostic tests. Presently, diagnostic testing can be performed only at the CDC laboratory. Tests are not routinely performed. They are done only in cases where there is strong suspicion that the disease is present, generally due to a history of recent travel to China or close contact with someone who has been diagnosed with the disease.
9. When will a vaccine be available? Scientists at three different institutions are already working on coronavirus vaccines, says the National Institute of Health (NIH). Vaccine development technology has greatly improved in recent years with rapid response platforms ready and able to speed up the process. However, there are no guarantees of success; each virus is unique and unforeseen problems are common. The most optimistic estimates say a vaccine could become available before the end of the year.
10. Is the government prepared for major epidemics? According to the Washington Post, the U.S. government has several secret storage facilities holding drugs and supplies that are part of a $7 billion Strategic National Stockpile ready to be used in the case of bioterrorism, nuclear attack or an outbreak of an infectious disease. The medical contents of the repository held nationwide would cover more than 31 football fields if laid out.
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