You may be asking questions like:

“Does my child still need to wear a mask?”

“What does this mean for my child’s school?”

“Can we have a normal spring break?”

Mandate or no mandate, unfortunately COVID-19 is still spreading in our community. This means unvaccinated people, including children, are still at risk for developing the disease and severe symptoms.

According to Marc Mazade, M.D., medical director of Infection Prevention and Control at Cook Children's Medical Center, Tarrant County (and many other Texas counties) remain in a state of substantial transmission according to public health advisories. This means large-scale community transmission is still occurring, including within communal settings such as schools and workplaces.

At Cook Children’s, the number of COVID-19 patients has dropped dramatically since peaking in January. Our rate of patients testing positive within a seven day period is now below 4%. At the beginning of 2021, that rate was over 20%, meaning we are making progress. (See chart below.)

To continue this trend, Dr. Mazade says we must remain vigilant, especially in schools.

“Shortly after Memorial Day 2020, we released our ‘Recommendations for the Safe Reopening of Schools K-12 in Texas,’ which urged the wearing of masks in schools and elsewhere in the community,” said Dr. Mazade. “Our recommendations have not changed as they were developed with a scientific understanding of how infections spread and of basic human nature.”

Dr. Mazade urges everyone to revisit these recommendations and says they are as important today as ever.

“As most people are now aware, more highly transmissible and even some vaccine-resistant COVID-19 strains are gaining a foothold. Now is not the time to relax. Rather it is the time for even more vigilance,” said Dr. Mazade.

With spring break coming up (or even in full swing for some), it’s vital to remember the basics of COVID-19 prevention:

• Wear a mask around people outside of your household
• Stay six feet away from others
• Wash your hands diligently

“We all want to get back to normal, but this spring break is not the time to let your guard down,” said Dr. Mazade.

This message could seem confusing with changes like the Texas mask mandate expiring and a new direction from the Centers for Disease Control and Prevention (CDC) that says fully-vaccinated people can gather without masks. Despite these changes, parents need to stay the course until children are able to be vaccinated against COVID-19, which could happen later this year.

“We must trust the people who best understand what we are up against and how best to combat it and follow their lead,” he said. “When the CDC eradicated smallpox, it did so because it never stopped pressing, diligently researching disease clusters, vaccinating everyone wherever disease emerged, never abandoning the objective. We all would do well to remember that we live and interact closely with many beloved yet vulnerable teachers, students, and family members who benefit from our diligent adherence to public health guidance.”

Now that schools have opened, who needs COVID-19 testing?

Rapid testing for COVID-19 can be helpful to promote isolation for positive cases, and to prevent prolonged unnecessary isolation for those children exposed to COVID-19 or with questionable symptoms. The symptoms that most likely warrant testing are combinations of the following: fever and headache, vomiting, diarrhea, congestion, loss of taste or smell, cough, muscle soreness, extreme fatigue and shortness of breath. Children with diabetes may see unexplained difficulties with sugar control. Any combination of these symptoms should be taken more seriously if there has been a known contact with a COVID-19 case.

Does a child who has had COVID-19 need a negative test to return to school?

While we have seen some schools and athletic programs requiring a negative test in order to return, this is based on outdated guidance. Testing may remain positive for weeks after symptoms have passed but does not mean that the child remains contagious. The current guidance is that students may return when their symptoms have resolved for 24 hours AND they are 10 days since the start of symptoms. In practicalities, most of these students will be waiting until the 10 days pass. If a child was hospitalized, it is recommend that they wait 20 days from the start of symptoms.

If a child is exposed to COVID-19, can we end their quarantine early with a negative test?

Testing is reasonable if symptoms develop to make a diagnosis, but quarantine should continue for 14 days from the end of the last contact. A negative test should not provide false reassurance as symptoms could continue to develop throughout the 14 day period despite a negative test.

Many parents are concerned about whether their child is at more risk for COVID-19. Which patients are at risk for more severe disease?

Risk factors for severe disease at any age include: cancer; COPD; immunosuppressed state due to organ transplant; obesity (BMI >30); serious heart disease such as heart failure, coronary artery disease, and cardiomyopathies; sickle cell disease; and type II diabetes.

Individuals with the following conditions MAY be at increased risk for severe diseases: asthma; stroke; cystic fibrosis; hypertension; immunocompromised state due blood or bone marrow transplant, steroids, or immunosuppressing medications; neurologic conditions; HIV; liver disease; pregnancy; pulmonary fibrosis; smoking; thalassemia; and type I diabetes.

Children who are medically complex, who have serious genetic, neurologic, metabolic disorders, or congenital heart disease might be at increased risk for severe illness from COVID-19, as well as children with obesity, diabetes, asthma and chronic lung disease, or immunosuppression.

What do you do when a child has a family member who is at risk for severe disease? Does the child’s age matter?

In this situation, distance learning might remain the best option for this family. Because the disease can be contracted at any age, this should not factor into the decision. While child to adult spread may not happen as easily as adult to child, there are studies that show it does occur.

Do children who are planning to do virtual learning need to have their vaccines updated?

According to the Texas Department of State Health Services (TDSHS), vaccine rules are still in effect regardless of whether a student is participating in on-campus or virtual learning.

Read more about Cook Children's recommendations for safely returning to school on our website.

*This post includes information provided by Marc Mazade, M.D., medical director of Infection Control and Prevention at Cook Children’s and Justin Smith, M.D., pediatrician at Cook Children’s Pediatric Trophy Club.