For the second year in a row, Cook Children’s Emergency Department and Urgent Care Centers are seeing a big influx of parents bringing in children who have been exposed to COVID-19 but show no symptoms. This is causing long wait times at all locations and putting unnecessary strain on the health care system.

On Monday, Aug. 29, our Emergency Department (ED) staff saw 614 patients, which is equivalent to a patient checking in every 2 minutes for 24 hours straight. That’s nearly double the number of patients we typically see in the ED. Our seven Urgent Care Centers (UCC) saw 873 patients, which is also much more than usual.

“We are seeing patient volumes equivalent to our worst winters, and it’s taking a toll on our staff,” said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care. “We need everyone’s help by staying home if you only need a COVID test or if your child has mild symptoms.”

Currently, 23% of COVID tests at Cook Children’s UCCs are coming back positive. In addition to COVID, Dr. Starnes says they are seeing a lot of colds.

“If your child tests positive for COVID at home, you can trust the test. You don’t need to have a health care provider confirm the results,” Dr. Starnes said. “If a COVID test comes back negative, it’s safe to monitor minor symptoms at home and re-test in 48 hours.”

Parents and caregivers are encouraged to reach out to their primary care physicians if their child is not feeling well.

Cook Children’s experienced a very similar situation in August 2021, likely triggered by kids going back to school.

Please avoid the emergency room and UCCS for COVID-19 testing. If your child has been exposed to COVID-19, please use an at-home test or schedule an appointment with a testing location such as a pharmacy.

“If your child needs emergency care treatment, our Emergency Department is here for you. That’s why we’re here,” said Natalie Carpenter, director of Emergency Services at Cook Children's. “But please don’t come to the emergency department for a simple COVID test.”

The ED should only be used for COVID-19 symptoms such as:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

If you are going to the ED, please limit the number of people you bring with you (if possible).

Where do you go when your child needs to be seen by a doctor?

Here’s a guide:

• Go to the emergency room if your child has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. 
   
• Call your health care provider if your child has ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns. The pediatrician’s office can help you decide what steps to take. 
   
• If you can’t get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Free COVID Tests Still Available to be Delivered to Your Home

Every home in the U.S. is eligible to order three rounds of at-home COVID-19 test kits from the government. You can easily sign up at covid.gov/tests and have the tests delivered to your home. The last day to order tests is Friday, Sept. 2.

For detailed information about what to do if your child tests positive or negative, download the PDFs attached to this article. 

Hey friends. Our phone lines are blowing up with exposure and quarantine questions. I love that you guys are calling – it’s the right thing to do! And we are here for ya.

But just wanted to spell out some common scenarios so that you have quick answers:

What does the CDC consider a “close exposure”?

• Being within six feet of someone indoors for more than 15 minutes in a day.
• This is common in classroom settings where kids aren’t masking.
• The CDC does not consider it a “close exposure” if both kids are masked (what a GREAT REASON to mask all kids in school!).

What should I do if my child had a close (classroom or otherwise) exposure to COVID-19?

• Keep your kiddo home for 10-14 days after exposure to the positive person.
• Make sure your child wears a mask in any indoor setting for 14 days, if over age 2.
• An infection could show itself anytime in those 14 days – but if you get to day 10 and the child has zero symptoms, most of the time it’s fine to end quarantine.
• Sometimes a negative test on Days 5-7 will allow return to school on Day 7 of quarantine if no symptoms appear.

What if my child has been vaccinated and then exposed? Does she have to quarantine?

• Nope. If she is symptom-free, she does not have to quarantine.
• The CDC does recommend a COVID-19 test on day 3-5 after exposure though, to be on the safe side.
• Your child should wear a mask indoors for a minimum of 14 days after the exposure, even if vaccinated.

What should I do if someone in my house tests positive for COVID-19?

• Try to keep them in their room as much as possible, and using their own bathroom.
• If they’re older than 2, have them wear a mask in shared spaces.
• Don’t share towels, cups, utensils or bathroom supplies.
• Wash your hands a lot.

What if someone in my home tests positive for COVID? Can my child go to school?

• If your child is VACCINATED and has no symptoms, yes. Get a COVID test 3-5 days after the last close exposure to that person.
• Regardless of vaccine status, have the child wear a mask in indoor spaces (if over age 2) for at least 14 days
• If unvaccinated, they need to quarantine for 10 days after their last exposure to that person. If the COVID+ person cannot isolate (say a parent who must help with childcare), the child must quarantine for 24 days (14 days they could potentially catch it, and 10 days to become non-infectious if they do have it). Again, these times could be shortened with negative testing and no symptoms, as discussed above.

My child has been in close contact with someone who was positive for COVID, and is starting to show symptoms. What do I do?

• Don’t panic. Remember that most of the time, COVID-19 is mild in kids.
• The child must isolate at home for at least 14 days from first symptoms, and must be 24 hours without fever and improving.
• Have the child mask indoors for at least 14 days, if over age 2
• Get your child a test for COVID
• If the test is negative, consider a repeat in 24 hours (or if it was a rapid, consider a PCR)
• COVID is a virus, and will need time to run its course. Typically, the only thing kids need is time.
• If your child is under 3 months old, call your pediatrician.
• Make sure he’s breathing comfortably.
• Make sure he’s drinking enough to urinate every 6-8 hours.
• Make sure he’s acting coherent and normal.
• He’ll probably be more tired, and may be dealing with coughing and congestion.
• Some kids have GI symptoms like vomiting or diarrhea.
• We are okay with fever for up to 5 days. We don’t want fevers trending higher over time.
• We don’t want breathing to become labored, wheezy, or faster.

My child tested positive for COVID-19, but has no symptoms. What do we do?

Your child is infected and needs to be in isolation from others even though they don't have any symptoms.

• You may end your child’s isolation if 10 days pass after the positive test with no symptoms.
• If over age 2, have them mask in indoor spaces for at least 14 days

What if my kid has symptoms of COVID-19, but I don’t know of any positive contacts. What do I do?

• Typically if a child is showing symptoms of COVID-19 (which, let’s face it, can look like a whole lot of other viruses), and they have no known exposures, I will perform a rapid or PCR test on them. If it is negative, they can go back to school as long as fever-free for 24 hours and symptoms are improving.
• If I am VERY suspicious for COVID (let’s say they’re having shortness of breath and have lost their sense of smell), I will ether get a PCR (more accurate than the rapid test), or I will repeat testing in 24 hours.

Quick reminder about RAPID versus PCR testing:

• Rapid testing (the kind we do in the office which is done in 15 minutes) is 80-85% sensitive. This means if it’s negative, and I really think a kid has COVID, I will re-test again in 1-2 days, or send them for a PCR
• PCR testing (often drive-thru or hospital testing that takes a day or two to come back): 99% sensitive! One test is sufficient to rule in/rule out COVID.

Beginning today, the following changes will take place:

• All Cook Children’s Urgent Care Center locations are available for walk-in only. At this time, the UCCs are not taking online check-ins.
• The outlying Cook Children’s Urgent Care locations will close at 9 p.m. and the Fort Worth location will close at midnight. 
• Urgent Care Center locations will offer two options for patients.
  • One option will strictly be a lab-only visit for those patients that simply need a COVID-19 test but don’t need to be seen for an urgent care visit.
  • The other option will be the usual urgent care visit for all other patient needs.

These changes are taking place to keep up with the high demand of recent patient volume. Yesterday, our seven UCC locations saw more than 1,000 patients in one day. Prior to the recent surge in patient volume, the average number of patients seen in one day was about 600.

The Urgent Care Clinics and Cook Children's Emergency Department are seeing a big influx of parents bringing in children who have been exposed to COVID-19 but show no symptoms. Please avoid using the Emergency Department for testing if your child is not showing symptoms. Click here to read more.

All patients with exposure to COVID-19, regardless of symptoms, will need to quarantine for 14 days. This is required, regardless of test results, because COVID-19 can develop between two and 14 days after an exposure.

At Cook Children’s Urgent Care, a patient may be required to have two negative COVID-19 tests before their doctor or nurse practitioner will sign a form allowing the child to return to school. This will likely be the case if the child's symptoms are high risk for the virus. 

If a child tests positive for COVID-19, they will need to stay home for 10 days after the onset of their own symptoms. This could mean a quarantine longer than 14 days. 

Cook Children's Health Care System follows guidelines from the Centers for Disease Control and Prevention (CDC).

We also follow the Infectious Disease Society of America which has issued the following COVID-19 guidelines: 

• Intermediate to high clinical suspicion of COVID-19: A COVID-19 test should be repeated in 24 to 48 hours (different samples if indicated)
• Low clinical suspicion: No re-testing

All patients with high-risk symptoms should be tested for COVID-19 before returning to school based on physician or nurse practitioner discretion.

These symptoms include:

• Fever
• Cough
• Shortness of breath
• Body aches
• Loss of taste/smell
• Headache
• Sore throat
• Sustained vomiting or diarrhea (and usually a combination of the these symptoms)

“Our goal is to make sure we limit the spread of COVID-19 as much as we possibly can to keep everyone healthy,” said Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “If the first test gives a false negative result, we could potentially be sending a contagious child back into the classroom. That is why a second test is needed in cases of high suspicion.” 

All patients with low-risk symptoms and NO known exposure to COVID-19 can be tested before returning to school based on physician discretion. Low-risk symptoms include congestion or runny nose, rash or a single episodes of vomiting or diarrhea.

Click here to read more about COVID-19 testing.

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.

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

1. Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
2. Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
3. Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
4. Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
5. Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
6. Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook^® or being on the computer. You can wait on that until after the test.
7. Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
8. Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid  high sugar foods that may keep your child up all night and  make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
9. Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
10. After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

1. Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
2. Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
3. Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
4. Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
5. Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
6. Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook® or being on the computer. You can wait on that until after the test.
7. Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
8. Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid high sugar foods that may keep your child up all night and make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
9. Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
10. After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

About the Author

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children’s Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appointment, call 940-484-4311. Cook Children’s Psychology provides care focused on children’s behavior, from ages 3 years through 17.