Perhaps the only good part of experiencing any deadly pandemic is that, at least during warm weather, the physical distancing has cut way down on not only COVID-19 illness, but all viral illnesses.

That happens every summer of course, but this year the drop in typical viral illnesses such as colds and stomach flus, and the common bacterial problems such as strep and ear infections, has been profound.

But two events, we anticipate, will end this very welcome break from the usual viruses and infections they bring:  cold weather, schools and day care re-opening.

Every year, in everyone’s life, when cold weather makes us huddle indoors, and, when our children huddle together all day in day care and school, all the usual viruses that we all had before COVID-19 appeared, come roaring across all our communities.

Everyone Gets Sick

I recently asked a child in the office, have you ever had a cold?  The school aged child stopped to think and was not sure, but their mother remembered well that they have had lots of colds.  It turns out to be an easy question to answer.  There is no person alive who has not had a cold, or some sort of viral infection.

Everyone gets sick.  The amount of illness we experience can be surprising.  Across all ages, the average number of colds and flus each of us gets in one year is eight!

This is hard to believe, but study after study comes up  with that number, and the fact that nearly everyone mercifully forgets ever having them. 

Most Viral Illnesses are Harmless

The good news is that the vast majority of viral illnesses, particularly in childhood, and even for us adults, are completely harmless.  Miserable, but harmless.  By harmless we mean once you recover there is no lasting harm.

They are also impossible to cure, so the treatments are limited to keeping comfy as you heal.

Since they are harmless, and there is no actual cure, we usually do not have people come to the office, but recommend you stay comfy at home.

Some Viral Infections are Harmful

Before COVID-19, we would say some viral infections are harmful, if the person gets complications or seriously ill, which as just noted, was unusual in the pre-COVID-19 era.

How do you know if any infection is serious or minor?  The key is how bad the symptoms are, in particular four to mention:

1. Trouble breathing
2. Severe pain
3. Stiff neck
4. Unable to stand or urinate

If someone feels well, even if they are infected with COVID-19, and are breathing comfortably, has no significant pain, can move their neck easily without stiffness, can stand up easily, and are urinating well, then the viral infection is likely minor.

Clearly, with COVID-19 present or not, if you have serious symptoms, you need to call us to be evaluated and cared for.

What to Do If Your Child Gets Ill

So of course we all know we all get colds and other viruses and infections, but managing your child who is ill is now very different now that COVID-19 is here and spreading.

As noted above, it used to be if you, or we, could tell the viral infection was mild, nothing needed to be done beyond comfort and healing.

But in the age of COVID, any symptom of a virus must consider this illness as a possibility.  After all, at least half of all children with COVID-19 have no symptoms, so any symptoms could be a clue that COVID-19 is present.

In contrast to the usual approach to a mild viral illness, the issue now goes beyond your ill child, who will be fine as long as symptoms remain mild.  Now with the risk of COVID-19 present, you need to know if your child has a virus that could spread to others and cause real harm to those older than your child.

Finding out if the Virus Your Child has is SARS-CoV-2

Advanced Pediatrics is prepared to find out, if your child develops a fever, runny nose, cough, the usual symptoms of having a virus, whether he or she has COVID-19.

Starting Tuesday, September 8, we will be separating well and sick visits, with regularly scheduled check-ups and conferences in the morning and sick visits in the afternoon.

We will have the capacity to test those with viral illnesses, even if only mildly ill.

Should demand grow as the cold and flu season comes upon us, we are even prepared to expand our office and staff to meet that demand.

And so, what to do this fall, winter, and spring, as long as the pandemic runs, when your child comes down with a viral infection?

Simple:  Call us to arrange for us to see your child and test her or him for COVID-19.

The appointment will be in the afternoon, and depending on whether we need to really examine as well as test, we will let you know if the testing will be in your car or in the office when you set up the appointment.

What to do if your child tests positive for COVID-19

First things first.  Managing your child’s illness will always be the same challenge, whether we are in the pandemic or not, first we always determine if the illness mild or not.

Again, mild means no harm is looming.   Mild viral illnesses are not only common, they are the rule.  Almost all viral illnesses in the typical year are mild.  We get a fever, we feel sick, we sneeze, we cough, then we get better.  Sometimes it takes a maddeningly long time, but that’s how it almost always goes.

We anticipate that is how it will almost always go for your children too.  That is because COVID-19 in young children is a mild illness in the overwhelming majority of children.

So this year too, nothing will change in terms of starting with the question, is this viral illness mild or not?  If mild, we treat as noted just below.  If not severe, as defined as above, call us!

Second, if it is mild, there is really nothing to do beyond keeping your child comfy, even if the virus is SARS-CoV-2, mild viral infections are mild viral infections.  We use ibuprofen for for fever and aches and lost of comforting.   Like all mild viral illnesses, COVID-19 will go away with time and comfort.  

The only issue with COVID-19 for mild infections is the great unknown of long-term effects for anyone at any age of this infection, no matter how mild, or even asymptomatic the experience of the immediate infection.  But that is for a later day.  For the infection at hand, if the illness is mild, we treat it exactly the same as any mild cold or flu.

The third step is unique to the COVID-19 infection, and has nothing to do with your child who has COVID-19.  The third step has to do with the rest of the world, namely, how to keep this COVID-19 infection from spreading, to you, the siblings, the grandparents, the friends, the teachers, the community.  This step deserves its own discussion.

How to stop your child’s COVID-19 from spreading to others

The key to this urgent need is the fact that this virus spreads when an infected COVID-19 person comes within 6 feet of someone else while they are contagious.

When is a child with mild COVID-19 contagious?   From about 2 days prior to the first symptom through 10 days of symptoms.  Most of the contagion happens the day or two prior to symptoms through 5 days of symptoms.

I find it most helpful to use an easy calendar example.   Say your child is diagnosed on January 4th.  And say your child’s first symptom was on January 1.

This means this child started being contagious as early as December 30 and will be maximally contagious from December 30-January 4.  But might be contagious through January 10.   On January 11, we can all be confident your child is no longer contagious.

These numbers go out the window if the infection is severe enough to require hospitalization, in which case contagion goes on for 28 days, or up to and including January 28 in this example.  But children only rarely end up having COVID-19 severe enough to need a hospital admission.

Now let’s think for a moment about the contagion that happened before your child’s was diagnosed.  In our example, the diagnosis was January 4, so this child was contagious before the test, all the way back to December 30.  We would recommend you think about everyone your child was within 6 feet of and let them know they are now a direct contact (See below).

And going forward, this child is contagious from January 4  through January 10, and so should be kept fully away from everyone, as best as possible, through January 10.  And then free to join the world again starting January 11.

Now for children, what does isolation mean in the home?  For older children, that means really separating from everyone in the home.   Staying in a basement or other rooms, eating separately, really separating.  At some age, and it will vary by child and family, a child cannot be isolated from the whole household, at least one parent or guardian needs remain in close contact, to not only care for, but be with the child.   That parent and caregiver will of course be a direct contact, and directions for direct contact are below.

Managing being a direct contact and an indirect contact

The definitions matter here, a lot, so here we go:

1. A positive case.   A person is a positive case ONLY if they are tested for COVID-19 and the test is positive.
2. A direct contact.  Any person who spends some minutes within 6 feet of a positive case during the time they are contagious is a direct contact.
3. An indirect contact. All of us who have been near a direct contact, BUT NOT a positive case during the time they are contagious is a direct contact.

We discussed what to do about isolating a positive case right above.

Now about the direct contacts:

• All direct contacts can very easily turn out to be positive cases that just haven’t been tested yet.
• So all direct contacts need to be tested
• From the time of finding out your are a direct contact (even before getting tested) until your COVID-19 test is negative, all direct contacts should be isolated as if they are positive cases.
• If a direct contact’s test comes back negative, then you are now free to go back to your socially distanced, masked activities as before.
• If a direct contact’s test is positive, then they become a positive case and follow the guidance for positive cases above.

Indirect contacts require no special isolation or testing, as long as their contacts remain negative.

Now, in a household, if a child is found to have COVID-19, that means the child is a positive case.  That also means everyone in the house becomes a direct contact, and so all need to be isolated from all outside the home pending their testing.  A sib or parent in the house of a positive case remains a direct contact until the last moment of contact during contagion.  In our example, household members might all get tested January 5, the day after the first child was found to be a positive case.  But that child is contagious through January 10, so if the household tests negative on January 5, they become direct contacts all over again if any come within 6 feet of the infected child on January 6, 7, 8, 9, AND/OR 10.

BOTTOM LINES

1. Every fall, winter, and spring all of humanity gets viral illnesses.  That has always happened, and it will happen again starting this fall.
2. Like every other year, the vast majority of viral illnesses in our children will be harmless and will require no more medical care than any other mild cold or flu.
3. Like every other year, those with viral infections need to be watched to make sure their symptoms remain mild, and to call us should more serious symptoms appear.  Fever, sneezing, coughs are mild symptoms.  Severe symptoms are struggling to breath, severe pain, trouble standing or awakening, and stiff neck.
4. The big difference this year is that one of the fall and winter viruses that will be circulating will be SARS-CoV-2.
5. Given the risk that COVID-19 can present to adults, all children with colds and flus, with any symptoms of viral infection, need to call us to be tested for COVID-19.  We use a throat, not nasal, swab.
6. People with illnesses are going to be seen only in the afternoon from now through the spring.
7. When you make your appointment we will determine if you need to come inside for an evaluation, or if your child is so mildly ill, all that is needed is a test swabbed in your car.
8. For children who test positive we will need to figure out when their contagion began and when it will end, isolate the child as fully as possible until the period of contagion ends, and inform all who were in contact from the beginning of contagion.
9. For anyone within 6 feet of your child who tests positive, during ANY DAY during their period of contagion, that person is a direct contact and must isolate as if infected until their test is known to be negative.
10. For anyone within 6 feet of a direct contact, BUT NOT a positive case, no restrictions are necessary.

We hope these clarifications help!

To your health,
Dr. Arthur Lavin