Saturday, November 27, 2021

Holiday 2021 update

 

Happy Holidays to all!

I cannot believe it has been a whole year since I last posted. While we’ve experienced so much change over the past year, much of what I wrote last year has not changed, not the least of which is the uncertainty. I remain grateful for your continued trust in me to provide health and safety guidance for your centers. The pandemic continues to be challenging and throw many curveballs, for sure, and you have remained resilient through it all.

We finally got somewhat comfortable with decision-making around exclusion and return to center guidelines relative to COVID, and then vaccine availability and pooled testing created new confusion. There are differences among management of symptomatic individuals with no known COVID-19 exposure, known exposure to COVID-positive individuals, individuals who test positive for COVID-19 (symptomatic or not), COVID-positive household members who cannot isolate, and whether or not individuals are fully vaccinated. It is so important to clearly identify the situation. Links below will assist with decision-making.

Just to add to these challenges, the new vaccine exemption law went into effect on September 1st, which means only medical exemptions are allowed (no more religious or philosophical exemptions), and the licensing rules were updated. No wonder our heads are spinning!

I hope you can all take some well-deserved time for rest and rejuvenation with your families over the holidays. My hope for 2022 remains the same – hope for much-needed relief!

Warm regards,

Deb

 

Monday, December 21, 2020

December 2020 updates

 Happy Holidays to all!

As we approach the end of this year filled with uncertainty and frequent, rapid changes, I just want to take this opportunity to express my gratitude for your entrusting me with the health and safety guidance for your centers. It has not been without its challenges, for sure, and yet you have all been resilient and persevered through it all. I’m sure your families and staff are grateful for the care you take to provide a healthful and safe environment for all.

Many of the telephone, text, and email messages I’ve been receiving lately reveal continued lack of clarity around exclusion and return to school/day care, which is no surprise given frequent updates from the Maine CDC and American Academy of Pediatrics. There are differences between management of symptomatic individuals with no known COVID-19 exposure, known exposure to COVID-positive individuals, and individuals who test positive for COVID-19 (symptomatic or not). It is so important to clearly identify the situation. Links below will assist with decision-making.

I have tried to respond to all outreach as quickly as possible, including early mornings, late evenings, and weekends. I ask for your patience if I cannot respond immediately due to my teaching or administrative obligations or personal family responsibilities.

I hope you can all take some well-deserved time for rest and rejuvenation with your families over the holidays, albeit with modifications. Let’s hope that 2021 will bring much-needed relief!

Warm regards,

Deb

Sunday, November 22, 2020

November updates

It’s hard to believe almost two months have passed since I last posted. As COVID-19 cases have risen sharply over the past few weeks, many of you have questions and concerns about possible exposures and how to manage all those “what ifs”. Every situation is nuanced with grey areas, so it is challenging to provide a blanket answer to cover every possible scenario. The Maine Chapter of the American Academy of Pediatrics (AAP) guideline for assessment of children with symptoms and no known exposure have not changed from the child care perspective (https://www.maineaap.org/assets/docs/Eval-for-Sick-Child-in-Schools-with-PCR-Antigen-Testing-10.30.20-update.pdf):

Symptoms with NO KNOWN EXPOSURE (Defined as within 6 feet for 15 minutes to a COVID positive individual.  If exposure, follow CDC guidelines. Even if tested, an exposed person will need 14-day quarantine.)

Lower risk

·         New headache

·         Body aches

·         Runny nose/congestion

·         Nausea/vomiting/diarrhea

·         Any of above symptoms present beyond typical symptoms (i.e., allergies)

1 lower risk symptom AND not exposed to COVID-19 - may return to school/child care after 24 hours if symptom improving (including fever-free without fever-reducing medication) without a provider note. If child is not improving after 24 hours, family should contact primary care provider for consultation and documentation.

Higher risk

·         New, uncontrolled cough

·         Shortness of breath or difficulty breathing (not exercise-induced asthma)

·         New loss of taste or smell

·         Fever (100.4 F or higher), chills, shakes

·         Sore throat

2 or more lower risk symptoms OR 1 higher risk symptom AND not exposed to COVID-19 - family should contact primary care provider; decision made by provider on whether or not to test for COVID-19 AND when return to school/child care can occur with provider note. Symptoms need to be improving for at least 24 hours (including fever-free without fever-reducing medication).

If family declines to contact their primary care provider and obtain documentation as requested according to the above guidelines, suggest return to school/child care after 10 days from beginning of symptoms, 24 hours fever-free without fever-reducing medication, AND symptoms improving.

This is the link to the Maine AAP COVID-19 Resources and Links page: https://www.maineaap.org/news/2020/resources-and-links-covid-19

For questions about exposure, according to the Maine CDC: (https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/documents/frequently-asked-questions.pdf),

·         If you had close contact (within 6 feet for 15 total minutes or more in a 24-hour period) with a COVID-19 case while they were symptomatic or within 48 hours before their symptoms started (or if asymptomatic then starting 48 hours prior to specimen collection):

o   You need to quarantine at home for 14 days from last exposure. Take your temperature 2x per day and monitor for fever, cough, or difficulty breathing.

o   You can have contact with people in your household and they can continue to leave home if you are not symptomatic.

·         If you had contact (within 6 feet for less than 15 total minutes in a 24-hour period) with a COVID-19 case while they were symptomatic or within 48 hours before their symptoms started (or if asymptomatic then starting 48 hours prior to specimen collection):

o   No quarantine is recommended. Monitor for symptoms for 14 days and contact healthcare provider if symptoms develop.

·         If you have been in the same room (more than 6 feet away) at the same time as a COVID-19 case:

o   No quarantine is recommended. Monitor yourself for symptoms for 14 days and contact a healthcare provider if symptoms develop.

·         If you have been in a room at a different time than a COVID-19 case:

o   No action is needed. You are not considered a contact.

·         If you have had contact with someone who has been in contact (no direct contact) with a COVID-19 case:

o   No action is needed.

o   You can monitor yourself for symptoms and contact a healthcare provider if symptoms develop.

·         If you have had any contact with someone who is sick but is not a known COVID-19 case:

o   No quarantine is recommended. Monitor yourself for symptoms for 14 days and contact a healthcare provider if symptoms develop.

I understand how challenging it is to keep up with the frequent changes in guidelines, and I applaud your diligence in trying to keep your staff and children safe and healthy. I’ll do my best to answer your questions as they arise.

Best wishes to you all for a happy, healthy Thanksgiving,

Deb

Wednesday, September 30, 2020

Updated Guidelines 9/30/2020

Well, another month has passed! I’m hearing from many of you about new challenges as children have returned to school and the usual allergies and viral illnesses have emerged. I’ve been made aware of recent updates to practice guidelines for health care providers in addressing children with potential COVID-19 symptoms.

Symptoms with NO KNOWN EXPOSURE (Defined as within 6 feet for 15 minutes to a COVID positive individual.  If exposure, follow CDC guidelines. Even if tested, an exposed person will need 14-day quarantine.)

Lower risk

·         New headache

·         Body aches

·         Runny nose/congestion

·         Nausea/vomiting/diarrhea

·         Any of above symptoms present beyond typical symptoms (i.e., allergies)

1 lower risk symptom AND not exposed to COVID-19 - may return to school/child care after 24 hours if symptom improving (including fever-free without fever-reducing medication) without a provider note. If child is not improving after 24 hours, family should contact primary care provider for consultation and documentation.

Higher risk

·         New, uncontrolled cough

·         Shortness of breath or difficulty breathing (not exercise-induced asthma)

·         New loss of taste or smell

·         Fever (100.4 F or higher), chills, shakes

·         Sore throat

2 or more lower risk symptoms OR 1 higher risk symptom AND not exposed to COVID-19 - family should contact primary care provider; decision made by provider on whether or not to test for COVID-19 AND when return to school/child care can occur with provider note. Symptoms need to be improving for at least 24 hours (including fever-free without fever-reducing medication).

If family declines to contact their primary care provider and obtain documentation as requested according to the above guidelines, suggest return to school/child care after 10 days from beginning of symptoms, 24 hours fever-free without fever-reducing medication, AND symptoms improving.

These guidelines do not apply to individuals potentially exposed to a COVID positive individual.

It seems that COVID is without symptoms in about 1/2 of children and most of the remaining have mild symptoms. It is a challenging situation for health care providers as well as child care providers.  It will take an abundance of caution to prevent shutdowns from outbreaks in our child care centers and schools, and for that reason Maine’s pediatricians are recommending increased discussions with parents prior to sending children with symptoms back to community settings like child care. Primary care providers are in the best position to determine if testing is required or if symptoms fit alternative diagnoses that do not require testing (such as strep throat, common cold, flu, asthma, allergies, GI illness, ear infection, etc.).

Please realize that these are practice guidelines only, not mandates, and do not replace the expert judgment of licensed health care providers. It is reasonable for you to ask parents to provide documentation that the child is cleared to return to school/child care. The documentation may or may not include a specific diagnosis and may generally indicate when the child may return.

Please also realize that these guidelines will likely change over time as more evidence about the virus becomes available.

I understand your concerns and frustrations, and I wish I could provide answers to every possible scenario you might encounter. You should continue to exclude children with new symptoms as listed above. For children with documented chronic conditions, such as asthma, talk with parents about being proactive with updated health plans to avoid repeat exclusion for typical symptoms.

I will continue to try to stay on top of changes in recommendations. I do not receive notices from the Office of Child and Family Services, so please share any new information you might receive from your licensing specialist. In the meantime, try to hang in there - I know you are all doing extraordinary work to keep the children in your care and your own staff healthy and safe.

All my best,

Deb

Saturday, August 22, 2020

August update

 

I cannot believe another five weeks have passed since my last post, and in that time many new guidelines and mandates for child care have been issued. I attended an excellent live webinar hosted by the Maine Parent Federation with Dr. Laura Blaisdell, a Pediatrician and Vice President of the Maine Chapter of the American Academy of Pediatrics, on navigating the social distancing recommendations as they pertain to school and in-person learning as well as any updated research on how COVID 19 impacts children. Much of what Dr. Blaisdell shared is relevant to child care settings. This is the Facebook link to the recorded webinar:

https://www.facebook.com/maineparentfederation/videos/306369963782138/

The webinar recording should be available on the MPF website soon (http://mpf.org/index.html).

I am trying to stay abreast of any new child care and school guidelines from the Office of Child and Family Services and Department of Education so I can be prepared with any questions you may have from a health care perspective. Questions regarding these guidelines should be directed to your state licensing professional. 

Stay safe and be well!

Deb