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Challenges for the School Year

The primary care providers of Lancaster understand that this school year is bringing challenges to families unlike any in the past.  We know that many of you have felt disappointed by the medical system and its ability to give the concrete, research-based answers to your questions that you rely on us for.  The lack of data and research about pediatric COVID 19 and contagiousness has been frustrating.  The HEROS research project (Human Epidemiology and Response to SARS-CoV-2) through the National Institute of Health is studying 6000 people in 2000 families, and 11 cities.  We are hopeful that in November there will be preliminary data from this study that will be especially useful for guiding parents and schools.  In the meantime, a task force of Lancaster pediatric and family medicine providers has been meeting to try to address concerns related to the 2020-2021 school year so that parents can hear an informed, consistent, and compassionate message.   Based on current available information here is what we think may be helpful for everyone to know:

COVID 19 remains a serious threat in Lancaster County and precautions must be taken to ensure that the health of both the individual and the community are preserved.  For the most part children who become infected with COVID19 do very well and recover quickly and entirely.  However, we do know that children can transmit the virus to family and community members who come into close contact with them.

As we head into the triple whammy of allergy, cold, and flu season we are certain that children will come down with these typical illnesses.  Children with any symptoms including fever, runny nose, cough, shortness of breath, sore throat, loss of sense of taste or smell, diarrhea, or vomiting should be kept home, and you should contact your healthcare provider for advice

Based on recommendations from the Department of Health (DOH) and the Center for Disease Control that advice should correspond closely to the following parameters:

Symptoms of COVID 19 can be divided into two groups:

·         Major symptoms: cough, shortness of breath, or loss of sense of taste or smell

·         Minor Symptoms: fever, chills, body aches, headache, sore throat, vomiting, diarrhea, fatigue, and congestion/runny nose.

o   Children who may have other illnesses such as a urinary tract infection, skin infection, hand foot and mouth disease, or strep throat can be seen, diagnosed, treated and returned to school once they are feeling better and are no longer contagious.  Determining this will likely require an office or telehealth visit.

o   Children who have mild to moderate illness and have a known COVID contact should be monitored closely and will need to be tested.  They should isolate themselves until test results are available.

o   Children who are asymptomatic but have a known close contact with a COVID patient should NOT be tested but must quarantine for 14 days.  These people will receive information from contact tracing.  We do not test asymptomatic contacts because a negative test does not ensure that they will not develop COVID 19

o   Children who have illness, with 2 or more symptoms in the Minor list or 1 symptom in the Major list,  with no known exposure to COVID, should be quarantined for 10 days and/or tested.  They may return to school after 10 days from symptom onset and upon symptom improvement and when they are without fever for 24 hours.  If they are tested, they may return to school if the test is negative, and symptoms have improved, and they have been without fever for 24 hours.

o   Any child with a positive COVID 19 test must isolate for 10 days from the onset of symptoms and may return to school after the 10 days and upon symptom improvement and fever resolution.  Positive COVID tests will trigger contact tracing and DOH involvement.

o   Children who have one, and only one, of the symptoms in the Minor list can be monitored closely by parents at home for 48 hours.  If the symptom resolves and no other symptoms appear; they may return with caution to school or daycare.

Quarantine means no contact with the public.  This means no non-urgent medical appointments, no school, no SAT class, no 16th birthday parties….  there is an entire column to be written on how hard this can be for teens and their parents.  It is important for everyone to follow quarantine recommendations when necessary, despite the challenges.

As you read the above list the words isolation and quarantine are a common theme.  I recognize that this is a culture shift for our students, especially high school students who are used to “powering through” illness to keep up with the academic and social demands of school.  This is a change we must embrace this year.  Keeping our children home from school when they are sick will prevent a spike in COVID 19 cases, transmission to vulnerable populations, and will be important for allowing our schools to stay open.  Flexible attendance policies have been shown to reduce transmission of influenza, and we are counting on that effect for COVID19.

Pediatricians understand the challenges of balancing a sick child and the demands of life.  The idea of keeping a child home for 2 weeks is overwhelming, especially for parents with minimal support.  Planning and preparation are going to be important so that when it does happen you are not panicked.

o   Talk to your employer about options for working from home, sick leave, and flexible hours.

o   Reach out to family and friends without risk factors and form a small bubble of support for each other.

o   Keep nonessential outside commitments to a minimum this year so that you are not canceling lots of things if you must quarantine.

o   Get everyone in the house who is over the age of 6 months a flu vaccine.  Getting the vaccine diminishes your chances of having even more illness and further disruption of your routine from influenza.

Since it is highly likely that there will be positive cases associated with school children it is important that everyone understands how the process works.  Contact tracing in Lancaster County is occurring through a partnership with Penn Medicine/Lancaster General and the DOH.  As soon as a school is notified of a positive case, they will notify the DOH who will begin contact tracing.   This process should begin within 24-48 hours of notification.  Students and faculty who are determined to be close contacts will be asked to quarantine for 14 days.  Parents should follow the guidance given to them from contact tracing and the school, it is not recommended that you seek out alternative advice from other healthcare providers as consistency is critical to handling school exposures effectively.  If a parent has a concern about school cases/exposures, then they should contact the school or their school physician liaison which should be available on the school website.

A word or two about mask exemptions.  Please do not contact your school or healthcare provider for a mask exemption letter unless your child meets the following requirements:

o   Children younger than 2 years of age

o   Anyone who is actively having trouble breathing.

o   Anyone who is unconscious, incapacitated, or otherwise unable to remove the cloth face covering without assistance.

There are ways to make children feel more comfortable wearing a mask and they are a great way for everyone to do their part to prevent disease spread.  A few more notes about masks:

o   Patients with asthma, allergies, sensory problems, or autism are not exempt from wearing masks.

o   If you have concerns about your child wearing a mask for long periods of time, please reach out to their teacher to discuss safe ways to take mask breaks and other ideas to help make it easier.

o   Masks with expiration valves and neck gators have not been found to be acceptable for preventing the spread of COVID19.

o   Masks should always be worn to cover both the nose and the mouth.

If you are a community member who wants to help during this trying time, please consider doing the following:

·         Deliver a meal to a family of school aged children who may be struggling with balancing school (virtual or live) and work demands.

·         Donate hand sanitizer, wipes, masks, gloves etc. to your local school.

·         Organize an uplifting community event such as food trucks, socially distanced music, or a scavenger hunt.

·         If you are able, consider donating your time or money to an organization which has stepped up to provide free or low-cost childcare to families who need it.  In Lancaster some of these are The Benchmark Program, The Boys Club Girls Club, The Lancaster Family YMCA, Brightside Opportunity Center, Teen Haven, Millersville Mennonite Church, The Mix at Arbor Place, The Lancaster Recreation Center, and many others.

All the above advice is motivated solely by the goal of getting kids back to school and keeping them there safely and happily.  We know that kids need school.  We can see that their emotional health has suffered, and we know how much good the teachers and staff do for the minds and bodies of children and teens.  Primary care providers also understand that the above information is overwhelming and falls mostly on the shoulders of parents to navigate. Parents should not hesitate to reach out to their child’s health care providers for information, advice, tips, and reassurance.  I have stubborn optimism that we will emerge from this soon, and stronger than before, in the meantime as Mr. Rogers says: “look for the helpers”.

For more information:

https://www.nih.gov/news-events/news-releases/study-determineincidence-novel-coronavirus-infection-us-children-begins

https://www.education.pa.gov/Schools/safeschools/emergencyplanning/COVID-19/SchoolReopeningGuidance/ReopeningPreKto12/PublicHealthGuidance/Pages/default.aspx

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/cloth-face-cover.html

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Return-to-School-During-COVID-19.aspx

https://www.education.pa.gov/Schools/safeschools/emergencyplanning/COVID-19/SchoolReopeningGuidance/ReopeningPreKto12/PublicHealthGuidance/Pages/default.aspx#screening

https://policylab.chop.edu/sites/default/files/pdf/publications/PolicyLab-Policy-Review-Evidence-Considerations-School-Reopenings-2020.pdf

https://www.lancastergeneralhealth.org/covid-19-information/lancaster-county-contact-tracing-program

 

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