A message from Shelly Voet, MD: Back to school guidance

Greetings! I hope you and your families and staff are well.  While we focus on our summer well visits, many of us have been thinking about the implications of kids going back to school.  The work of our Medical Staff Communications Committee this month has been focused on this very issue.  We have developed the documents (Primary Care Covid-19 Algorithms and Covid-19 School Guidance) to provide definitions and guidelines for testing, isolation, and quarantine for children with symptoms of possible COVID-19.  The guidelines are informed by CDC guidelines, local public health partners, state school guidance, as well as Cincinnati Children’s Gen Peds, Infectious Diseases faculty, and lab.  They are regional recommendations based on the assumption that the test performed is highly sensitive and specific (as the CCHMC NP PCR), and that testing capacity continues to meet need for children in our community.

The key takeaways for practice planning:

1.  The symptoms of COVID-19 are similar to many viral illnesses.

2.   Children with any symptoms consistent with COVID-19 will need to be evaluated by their PCP to return to in person instruction. 

3.  Those without a definite alternative cause for symptoms (ie strep) should be tested for COVID-19 to help guide return.  A low threshold for testing will help identify outbreaks early and help keep our schools safe.  Kids with symptoms consistent with COVID-19 who are not tested should be presumed positive and isolate while infectious (24 hours fever free; 10 days after onset at least). 

4.  Kids who test negative with a highly sensitive test (NP PCR) can return when fever free 24 hours and symptoms improving.

5. The definition used by our public health partners for “CLOSE CONTACTS” is being within 6 feet for more than 15 minutes.  (This may change based on context of exposure as we learn more). Asymptomatic CLOSE CONTACTS of patients with COVID-19 will need to quarantine.  CLOSE CONTACTS can be tested when they develop symptoms or on identification if supplies are adequate.  Currently, CCHMC lab can support testing asymptomatic close contacts in addition to symptomatic kids. 

5. At the current time, CCHMC lab can support testing asymptomatic close contacts via an appointment.  To ensure capacity for COVID-19 testing, additional lab tests cannot be performed during these appointments (strep/flu).  Practices can provide convenience for families and increase capacity of our regional testing by requesting CCHMC test kits to collect samples and send via courier to the CCHMC lab. 

6. Testing asymptomatic kids with no known close contacts is low yield.

If you are reviewing your office or school infection control policies, the following commentary from the WHO provides most recent understanding of the transmission of SARS-CoV-2: https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions

If you are advising your child’s school, the following document from Mass General is good to have handy as it reviews many areas school specific topics that are concerns: https://www.bit.ly/mghcovidlibrary.

Finally, students returning may experience more stress. The mental health of our patients is also a concern during these challenging times.  I had the privilege this month to meet virtually with Nancy Eigel-Miller, the founder of 1N5.  1N5 is a local non-profit dedicated to increasing knowledge and reducing stigma of mental health issues.  1N5 also provides customized programs for schools to help support healthy minds.  You can review all that they offer at 1N5.org.

Best,

Shelly F. Voet MD

Cincinnati Children’s Executive Community Physician Leader