It’s November 2020 and we’ve been living with the novel coronavirus, SARS-CoV2, for 9 months. The disease it causes, COVID-19, has wreaked havoc across the world. In the United States, we have had over 10 million cases already and over 240,000 Americans have died. Unfortunately, we are far from over this pandemic and in fact cases are surging more than they have at any other time. What have we learned thus far and what can we do to make it better?
First, a disclaimer: as an outpatient pediatrician, I have not taken care of patients with COVID-19 myself. Everything I know I’ve learned along the way with most everyone else. Using information from the CDC, AAP and hundreds of doctors around the country I’ve been able to make recommendations for my patients and readers to help them stay safe. I’ve written about masks, the effects of school closure and staying safe over holidays. While this post isn’t a scientific review of the disease and treatment options, it is a recap of the types of questions I receive every day.
COVID-19 Spread
Over the past 9 months we’ve learned a lot about how SARS-CoV2 spreads. The virus spreads via direct contact. That means the virus lives in respiratory droplets that we release when we breathe, talk, sing, cough or sneeze. Both symptomatic and asymptomatic people can spread these droplets. They can travel several feet and smaller droplets may stay in the air for an extended period of time. This is why people can get sick even without a direct exposure to a positive person. A less likely source of spread is from what we call fomites. This is when the virus-containing particles land on a surface. When someone touches these surfaces and then touches their face, they can potentially become infected. Knowledge of how the virus spreads helps us know how to prevent it and stay safe.
COVID-19 Prevention
Based on how SARS-CoV2 spreads, we know that preventing spread can be done with some basic methods.
- To stay away from potentially contaminated air space, don’t spend time in large gatherings, especially indoors where ventilation is poor. While spending time outside is safer due to evaporation of viral particles, it’s not zero risk. Gathering outside can still cause spread when there is a crowd and people are not masked.
- When in public spaces, stay 6 feet away from others.
- Wear a mask anytime you are out of the home or with those who do not live in your household. This keeps your respiratory droplets from spreading to others and may even keep virus containing droplets from infecting you.
- To prevent spreading virus directly to your face, wash your hands often, don’t touch your face and regularly sanitize frequently touched surfaces.
- For anyone experiencing symptoms, stay home. Always cough or sneeze into your elbow.
Exposure and Symptoms
One of the most common concerns I’m seeing in the office these days is the possibility of exposure to someone with COVID-19. Many children require testing because someone in their school or class, or a family member of another student has tested positive. Most of these exposures are not considered “significant exposures”. The Centers for Disease Control and Prevention defines significant exposure as direct contact (less than 6 feet) with someone who has a known infection or who develops symptoms within 48 hours of the exposure. The amount of exposure is to be a total of 15 minutes or more in a 24 hour period. This also includes physical contact like hugging or kissing. While mask wearing and being outside does reduce the risk of spread, the CDC does not differentiate these factors with regards to exposure risk.
Of note, schools are also requiring tests for children with a variety of symptoms, not just exposures. COVID-19 causes any of the following symptoms:
- Fever
- Chills
- Body aches
- Runny nose
- Sore throat
- Cough
- Shortness of Breath
- Loss of taste or smell
- Nausea, vomiting, and/or diarrhea
- Headache
What next?
What happens after a diagnosis or an exposure? This is the most common question I get from families. First, anyone who has a significant exposure should quarantine at home away from the public for 14 days per expert recommendation. However, the CDC has changed this recommendation to add that quarantine can end at 10 days if no symptoms have developed or 7 days if no symptoms have developed and there is a negative test. Second, if someone tests positive and they are well enough to be at home, they should isolate away from other family members if possible. That means staying in a separate room, using a separate bathroom, eating separately and wearing a mask when separation isn’t possible. The positive person is considered contagious for 10 days and can come out of isolation after that time as long as they are fever free for 24 hours and symptoms are resolving. Finally, anyone living with someone in isolation does not begin their 14 day quarantine until the 10 days of isolation are over or from the last time there was exposure. That means children of COVID-19 positive parents who cannot be cared for by someone else, will be home for the 10 day isolation period, followed by the 14 day quarantine period.
For children who test positive, the vast majority will have very mild symptoms. My advice is to treat cold-like symptoms like you would a common cold and gastrointestinal symptoms like you would a stomach virus.
Thanksgiving during COVID-19
What does this mean for Thanksgiving? SARS-CoV2 spreads from asymptomatic and pre-symptomatic people, as well as those with symptoms. It spreads easily in an indoor setting where people talk, eat and laugh without masks on. That means large holiday gatherings are extremely risky. If you will be seeing family for any holiday, your best bet is to quarantine the full 2 weeks prior to getting together. That means staying at home and wearing a mask if going in public is necessary.
Anyone who is experiencing shortness of breath, high fever, persistent vomiting, or severe headache should seek medical attention right away. Parents, talk to your pediatrician if you think your child is sick or has been exposed.