Posts for: June, 2020
We've updated our COVID-19 general information page to be more up to date reflecting the current situation in Arizona and recommendations for reducing the spread. See it here:
We understand that there is some confusion about COVID-19 testing. Data suggests that people may spread the infection beginning a few days before symptoms begin (pre-symptomatic spread) and they also may be contagious even if they never develop symptoms at all (asymptomatic spread). We are following the current CDC recommendations on testing as listed here:
Symptomatic children: Call office to schedule testing (may be limited based on availability of test kits)
Fever (100.4 or higher) or chills
Shortness of breath
Fatigue (being tired)
Muscle or body aches
Loss of taste or smell
Congestion or runny nose
Nausea or vomiting
Asymptomatic children: Do not need to be tested
Individuals who have close contact (described as within 6 feet for 15 minutes or more) with a person who has COVID-19 symptoms or who has tested positive for COVID-19
Stay home for 14 days after last exposure. Maintain social distance for all others
Self monitor for symptoms: check temperature twice a day
Avoid contact with people at higher risk
However, it is important to know that a negative test does not necessarily rule out COVID-19 infection. The timing and type of testing are important. Rapid tests are much more likely to miss an infection than the PCR tests that take more time (false negatives). Even with PCR, a study in the Annals of Internal Medicine showed that the probability of a false negative test is 100% on the first day of infection (typically before symptoms start). By day 5, the typical day that symptoms start, the false negative rate is still 38%. On day 8, the false negative rate is at its lowest but is still 20%. So anyone who suspects they may be infected, especially if they have been in contact with someone who is infected, should assume that they are infected even if their test is negative and follow the self-quarantine recommendations above.
I’ve been getting a lot of questions from parents about whether it’s going to be safe to send their kids to school in a few weeks. Understandably, people are concerned about the safety of their kids with the outbreak continuing but also many are eager to get their kids out of the house and back to more of a “normal” life. Unfortunately there’s no right answer for everyone. These decisions need to be made by each family individually as there are many varying factors that contribute to the decision.
On one hand, it’s clear that a lot of kids would benefit greatly from heading out of the house and going to school. Being stuck at home for most of the last 3-4 months has been hard on all of us. It’s taking a physical and emotional toll on a lot of our patients and families – from lack of exercise, unhealthy snacking, and extra screen time to social isolation, boredom, and increased conflict within the home. Some parents can’t work from home and don’t really have a choice of allowing their kids to stay home; parents that do work from home may have a hard time getting things done when they are trying to manage/teach their kids all day. Getting kids back to school could do a lot to alleviate these problems.
On the other hand, of course, is the pandemic. COVID-19 is not going away any time soon. The United States has not seen a decrease in cases, and Arizona has had an alarming increase. While young kids rarely get very sick from COVID-19 and probably are not as contagious as adults, transmission of viruses in school is really impossible to prevent. So no matter how careful schools are, there’s a good chance that some kids are going to get the virus and some of those kids are going to get their family members sick. At this point, it’s impossible to predict how big a problem that is going to be.
So the decision really comes down to a balance between risk and reward: the risk of your child getting the virus and possibly getting family members and friends sick vs. the reward of getting your kids out of the house for the various reasons above. Families that have a household member who is high risk because they are immunocompromised have a different calculation of risk vs. reward than those that are young and generally healthy without any high risk family members. So our advice is: assess your own family’s risks and how much you are willing to tolerate, compare that to the benefits to your family of sending your kids to school, and go with whichever wins in the balance.
Good luck and we hope that you all stay safe and healthy this fall! And don’t forget to get flu vaccines for everyone this fall when they become available!
Jeff Couchman, MD
We had hoped that with summer we would see the end of this COVID-19 wave of infections, but unfortunately it appears that will not be the case. Neverthless, very few pediatric patients have been swabbed/tested so far. Now that there is an antibody test, people want to know if they or their child might have had the infection when they had some illness earlier this year but were never diagnosed.
The antibody test involves drawing blood from the patient’s vein. The test that is available is only 60% sensitive, meaning that only slightly more than half of the people who truly had the disease will be positive. So a negative test cannot really be trusted. A positive test might indicate that the person had the infection at some time in the past but again the test cannot be trusted completely. There can be false positive results too. Where the rates of COVID-19 are relatively low, as in Pima County, the likelihood of a false positive antibody test is higher, so there's actually about a 50% chance that a positive test result is incorrect. Additionally, a truly positive test does not indicate when the person was infected and there is not enough evidence to show that having the antibodies provides any sort of immunity.
So, should your child get antibody testing for COVID-19? Our opinion at Mesquite Pediatrics is: probably not.
For more information about the COVID-19 tests:
Susan McMahon, MD
For children with COVID-19, most children have mild illness or are asymptomatic. The most common symptoms for COVID-19 are respiratory symptoms, ie fever, chills, cough, fatigue, headache, muscle pain, and sore throat. However, in the news there are now reports of possible skin findings associated with COVID-19. Rashes are a common occurrence with other viral infections in general. Reports out of China showed rashes were only noted in 0.2% of patients whereas in Italy it was reported in up to 20%. There is no specific pattern that has been associated with COVID-19 but there are some recent reports of possible associations.
One you may have heard of is “COVID toes”. This is just another manifestation of a rash that just happens to involve the toes. This presentation looks similar to Chilblains (also known as pernio), something usually seen after exposure to the cold. It can cause red, pink or purple spots on toes or the soles of the feet. For most with “COVID toes”, this presentation was associated with low severity of illness.
The other rash patterns being investigated include a flat and raised red rash (maculopapular), hives (urticaria), a lace-like or fishnet pattern (livedo), and blistering rash (vesicular). The flat and raised red rash is a common type of rash seen with viruses. Sometimes these rashes have been described as showing up before other symptoms, a few days into the illness, or later in the course of the infection. There is still limited data on these types of rashes and if they are a manifestation of the illness versus the body’s reaction.
In the news there has been a lot of mention about Kawasaki syndrome and multi-system inflammatory syndrome associated with COVID-19 (MIS-C). These are very rare presentations for COVID-19. It is occurring in older children than what is typical for Kawasaki and may present in a different way than typical Kawasaki syndrome. Kawasaki’s typically presents with persistent fevers (5 or more days), red eyes without discharge, red, cracked lips and/or tongue (strawberry tongue), rash with red swelling of hands or feet (sometimes peeling), swollen neck lymph nodes. If your child has fever (100.4) and at least 2 of the above symptoms and fever please contact us immediately.
If your child has fever, abdominal pain/diarrhea/vomiting, rashes, trouble breathing, has confusion or seems overly sleepy, or your child appears very ill please contact us immediately.
For more information about MIS-C check out: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/covid_inflammatory_condition.aspx
We are here for you if you have concerns about your child’s health.