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.

A recent Seton Hall Sports Poll shows 25% of Americans say they will hold or attend a party for the big game. According to Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children's, it is important to avoid large gatherings, even if you’re vaccinated.

“The COVID-19 vaccine is not a green light to get together with people,” Dr. Whitworth said. “If you’ve had the immunization, you can still get an asymptomatic infection and transmit it to others.”

Cook Children’s Medical Center is finally seeing lower numbers of COVID-19 patients after record hospitalizations and positive test numbers in December and January. The percentage of COVID-19 tests administered by Cook Children’s that are coming back positive is under 10%, which is a great improvement.

Dr. Whitworth says more good news is on the horizon. Vaccine rates are going up, and community spread of the disease is declining.

“The more people do their part, the sooner everyone can have large gatherings and celebrate with loved ones,” she said.

COVID-19 can spread from people who are symptomatic or asymptomatic by secretions coming from the nose and mouth. As you exhale, talk, yell, etc., those secretions fall within six feet of you. This is why it’s so important to stay six feet apart from others, wash your hands and wear a mask. When people are yelling at the TV or taking a break to eat or drink, there is always a possibility of spreading COVID-19. Dr. Whitworth reminds everyone, “Cloth, paper or N95 masks keep secretions in so you don't share germs with others around you.”

Although we can’t celebrate like years past, there are alternatives for large indoor gatherings, such as hosting a virtual party or starting a group text thread. These options allow us to enjoy the action with other fans while keeping distance and remaining safe.

As more COVID-19 vaccinations become available, health officials urge everyone to take the same precautions whether fully vaccinated or not. Dr. Whitworth says if everyone gathering is vaccinated, it’s safer, however, the vaccine is only about 95% effective. There’s still a chance someone could get sick.

While some may argue having a gathering in their home is safer than going out in public, Dr. Whitworth says any gathering comes with risks.

“A public place could have an influx of people with no masks and closed doors, and that is a high-risk environment,” she said.

The best way to protect yourself is to celebrate with those you live with.

It is also important to understand COVID-19 testing does not predict the future. If everyone gets tested before a gathering, the risk is lower because you can exclude those who test positive. However, you can test negative one day and transmit the virus the next day. While taking a COVID-19 test could lower the risk, it’s not the best indicator for a gathering.

Dr. Whitworth urges everyone to remain hopeful and to remember that we are getting closer to celebrations like Super Bowl parties, holidays, and birthday celebrations.

“As I've heard one of our scientists say, ‘The months ahead look a lot better than the weeks ahead and vaccine rates are going up everywhere,’” Dr. Whitworth said.

For more information on safer ways to enjoy the Super Bowl, visit the CDC’s website.

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.

The answer is we simply don’t have the ability to test every patient suspected of having the virus. And that’s OK, because our recommendations for taking care of those patients wouldn’t change based on the test results.

Currently, Cook Children’s will only perform COVID-19 testing on patients who are admitted for inpatient care.

“At this time, there is a shortage of testing supplies in both public health laboratories and clinical laboratories. Labs cannot keep up with the demand of testing every patient who has symptoms of COVID-19,” said Morgan Pence, Ph.D., a microbiologist at Cook Children’s. “At this time, Cook Children’s is unable to test every patient suspected of having the virus.”

The number of tests currently available in the U.S. is not enough to test every patient who is suspected of contracting COVID-19, so the medical field has focused on patients most at-risk who need to be tested immediately. In addition to not enough tests, there is a shortage of components of the test kit and a shortage of the sample tubes used to collect patient specimens. Labs cannot keep up with the testing demand of every patient who has symptoms of COVID-19.

In situations where there’s a known exposure and symptoms are consistent with COVID-19, the patient and family should call their primary care doctor and isolate themselves from others until they are no longer showing symptoms and they are well.

“The good news is that children have been the least affected by this virus,” said Alice Phillips, M.D., a Cook Children’s pediatrician at Cook Children’s Cityview. “If you suspect your child has COVID-19, call your doctor. It’s important to limit exposure to others and prevent the spread of the disease.”

As with everything involving COVID-19, this situation is fluid and changing frequently. Please continue to follow Cook Children’s for the latest information.

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