Read on for an opinion piece and a middle-ground approach to remove ill children, but keep facilities open for working parents.
Does anyone else feel like the first two weeks of January have felt like two months? I know it’s been a long two weeks for many of us. This surge of covid will likely improve by early to mid-February (following trends from other countries).
What if your child gets COVID?
I want to remind you that we are overall seeing good acute outcomes with children in that it acts like many other viruses (causing typical URI symptoms and for some: croup and wheezing that is treatable like in other viruses). This variant seems unique in that it’s not attacking receptors in the lung as much as prior variants hence the more “mild” URI symptoms.
Do remember to do your own assessment of what level of risk you’re comfortable with as I do agree we don’t know 100% how this virus will impact each new host it infects. The reality is some people have mild symptoms, some flu-like symptoms, and some may need admission to a hospital (very similar to what we see with other common viruses like RSV).
My specific situation
My husband and I realized with the nature of this variant and how it’s spreading that evading this strain would be difficult with our line of work and our son being in childcare. We couldn’t keep him home because we have no alternate care and we weighed the benefit (going to childcare/him loving childcare/us needing childcare to work) versus the risk (getting COVID AND getting very sick).
Contracting COVID may be a reality, but we also knew that many people were having good outcomes with this variant. While we don’t know everything about COVID, we also understand our own personal limitations and resources and the information we do have. As a family we decided the benefit of childcare outweighed the risk, so we sent him back to school.
Ryaan tested positive
Ryaan tested positive for COVID January 7. He started with a runny nose on a Monday (January 3) which continued into Wednesday. When he had the runny nose, I did temperature checks when he woke up and before bed to make sure he wasn’t spiking. He was acting wonderful (eating, drinking, etc.).
By Thursday, he had a wet cough which prompted me to keep him home from school. Our at home rapid tests came that evening so we tested him the next morning and he was positive. His course with COVID was a wet cough. His highest temperature was 100.1 and he continued to eat, sleep, and act normally. It was only the cough that prompted me to test.
We kept him home for 5 days from the onset of the cough and the positive test (total of 9 days from the onset of the runny nose). We sent him back to school after that (he was also fever free and fever-reducing medicine free for more than 72 hours).
My thoughts on childcare facilities
I have helped guide our son’s school (along with other medical professionals) on COVID policies for the last two years. Policies that allow the facility to stay open for working parents, balance toddler development, but try to reduce risk for those attending.
The policy does mean there is risk of exposure, however parents are allowed to decide if they agree with the policy or stay home. Our son’s school doesn’t have a policy that requires testing to return nor do they do isolations/closures.
During this surge, we decided on a symptomatic testing protocol which basically means if your child is sick (sick is described as a new onset cough, vomiting/diarrhea, and/or fever), keep them home for at least 72 hours and ideally get a COVID test.
If positive, stay home for 5 days from onset of symptoms and only return after that period if fever free and med-free for 72 hours.
If negative, only return if fever free and med-free with improving symptoms for 72 hours.
Consider personal benefit vs. risk assessment
I want to explain why I support this and think more families should have this choice at this point with this variant:
- We are seeing large amounts of vaccinated adults and young unvaccinated children under 5 get this virus and have good outcomes.
- Many parents need to work and many childcare employees need to work. So, shutdowns are causing more disruptions when we compare it to the risk of this variant for clinical outcomes in children at this point. I would not be saying this if delta was the one surging like this. This variant is different so measures should understand benefit/risk.
- There are exposures happening OUTSIDE of the daycare/childcare facilities so quarantining and isolating asymptomatic children makes little sense when we all have likely been exposed.
- In clinical practice with this variant, I am largely seeing the children with symptoms test positive (And FYI: COVID is not the only virus out there right now). We have swabbed exposures in asymptomatic children and they often come back negative. If someone is positive, this does mean they are likely infectious so using rapid positive tests can help in removing cases.
- Based on the clinical picture, we see rapid tests be very sensitive when there are symptoms. Rapid tests are also VERY SPECIFIC for the infectious period (ie only positive when someone is infectious.) unlike PCR which can remain positive long after someone is no longer contagious.
- PCRs are WAY better for asymptomatic cases than rapid tests.
- There is still so much to learn about Omicron, but it is my opinion a symptom-based isolation plan makes sense.
What about pre-symptomatic kids?
Could kids be brewing the virus but are not yet showing symptoms? Yes, there is a chance they can spread this, but if they are not coughing, not having a fever, and are in good spirits; their viral load may not be high enough/forceful enough (cough propels more particles) to shed and spread. In an ideal world, rapid testing our kids every 48 hours would be great if showing any signs of illness, but testing supplies are still hard to come by in this country.
Childcare policies should center around keeping open and instituting their own feasible mitigation strategies and letting parents decide if that risk is too high for them during the surge.
If a family is able to have alternate childcare that is great.
But the goal should be to keep the facility open and remove positive cases (similar to what we would do if someone would have the flu, RSV, or HFM).
Schools don’t shut down for HFM, RSV, and Flu (the latter two being more concerning to me for kids than Omicron).
Our son’s school created the policy and notified parents before January and only two families pulled out until the surge was over. All the families who remain are doing their due-diligence to monitor symptoms and keep their kids home. It is not perfect because we are relying on everyone to be honest, but can you imagine if we all just did our part right now to keep our kids home if they were not feeling well?
It is my recommendation that the CDC quarantine recommended for childcare is too strict.
If a child is asymptomatic, they should be allowed back in.
What about just letting it rip??
By this I mean like we do during flu and RSV season (no testing needed, fever free/med free for 24 hours), etc.
I think because there is still a question mark on long-term effects of COVID and to protect the healthcare system for being overloaded, we need to find a balance between strict guidelines and a “let it rip” mentality so we can reduce the risk of spreading COVID but also understand that it’s not fear and dread if your child gets it.
It’s this mentality that has worked for our childcare facility. When Ryaan tested positive, only two other children did of the 40 children in the school (not even in his class).
Ryaan was exposed by a known contact outside of the school. (We were notified a day before he developed the cough).
So, this policy can work.
But, it requires parents to do their part and monitor symptoms and they need to understand that there is still risk and make the best choices for their families.
We CAN’T shut down schools and childcare two years out!
For the sake of our children’s development and our mental health.
Here are my thoughts on how childcares should operate during this surge. My recommendations also include comments about “if” testing is not available.
I think testing is important, but I also know many families who don’t have access to it STILL due to parental time off or cost of home-kits. You can get free home-kits from the U.S. government here.
- Mask optional for the kids under 4 (I go by WHO guidance on masks in childcare facilities for developmental reasons). Wearing a mask is great, but for this variant it only works if every child is wearing a higher quality mask such as a KN95 or KF94). And I know so many kids who are not, so this variant can spread through cloth masks in childcare settings. Also kids under 4 developmentally are not always able to keep it on the entire time.
- No need for testing asymptomatic individuals who have been exposed. But, parents should absolutely monitor the following during this surge regardless of known exposure or not:
- Keep your child home if they have a fever, vomiting/diarrhea, new onset cough, or just feel crummy. The latter being to monitor symptoms of any kind.
- Get a COVID test is ideal if you have access to one as any viral symptoms can be this COVID variant.
- If the initial rapid test is negative and child is still exhibiting symptoms, I would retest in 48 hours to confirm still negative. If still negative on rapid and PCR on this second round of testing, can assume not COVID, but still keep home for the 72-hour rule I mention below:
- Whether you test or not, your child should only return to school if:
- Fever free AND medicine free for 72 hours with improving symptoms to allow whatever virus this is to reduce in viral load (there are other viruses besides COVID circulating). The medicine free (ibuprofen or acetaminophen) is vital to me because sometimes you can be masking a fever or discomfort. Pre-pandemic, I usually say 24 hours fever free/med free, but during this surge a 72-hour rule is a reasonable balance.
- Feeling good to go back. This means eating and drinking and acting at baseline and whatever symptoms they had are improving.
- I don’t think kids need to stay home for runny nose if they are afebrile and in good spirits. Doing temperature checks (like we did) can help make sure virus isn’t brewing to higher viral loads. We kept Ryaan home the day we noticed the cough because from an infectious standpoint, I am more concerned of coughs spreading viral particles (force of propelling mucous out as aerosols into the air) than a runny nose.
- Try to implement ventilation strategies like air purifiers (outdoor if weather allows).
- School notifying of a positive case so parents are aware of monitoring symptoms and they can also decide if they want to pull their kid out based on their resources and individual risk assessment.
Think about this: If we all just monitored symptoms, tested, and kept our kid home if they were sick, on meds, or feeling crummy; we could avoid spreading this.
I’d rather keep my son home for 5-7 days to monitor all this than close down an entire school for weeks and have it happen over and over. The opening and closing of childcares is adding more stress. During a surge of this nature with this variant: Either close down for three weeks completely or stay open with removing symptomatic cases. The back-and-forth is causing more disruption.
Yes, there is a risk of doing this. Yes, this is not 100% full-proof. And that is why working parents with other options can pull their kid out if the risk seems too high. But, this opening and closing is not working for so many families.
We need some balance!
In my opinion at this stage of the pandemic, we need to be able to balance resources available with a risk assessment given the reduced severity of Omicron versus Delta.
To me, Every 48 hour PCR testing would be the most ideal situation right now (testing everyone with a test-to-stay) mentality but we just don’t have these resources here in America. Which is why I think the above mentioned protocol balances our resources with risk reduction.
The virus is evolving and we need to evolve with it with our measures.
This is a tough time to be a parent because the amount of decision-making is at an all-time high. We have been so exhausted by making risk-benefit decisions this entire pandemic. And right now, parents are having to decide what is best by facing the reality of COVID spreading in their homes.
I don’t believe there is a right answer here because whatever we do—not everyone is going to be happy.
But I feel if we can monitor our child’s symptoms (whether we have access to testing or not), we can reduce the spread of this and keep our facilities open.
Our system is broken.
Truly, our system is broken in that we don’t have the resources to do what is “right or “best” public health practice due to lack of access to affordable testing and lack of childcare support.
In case you missed it, Episode 100 of my podcast (Finding Joy as a Parent in a Pandemic) is a short, but impactful listen to get you through the ups and downs and process the last two years.
Ask me a question!
Have a parenting question you want answered on the podcast? Call in a question to The PedsDocTalk Podcast (954-526-2641) and I may answer it on my Monday Mornings with Dr. Mona series.