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.

•  Maine CDC FAQ page: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/documents/frequently-asked-questions.pdf 
  
•  Maine CDC infographic “Who can be in my facility?”: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/documents/Childcare-in-facility-2.pdf
• Maine CDC infographic “What if a child or staff member tests positive?: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/documents/Childcare-positive-test-1.pdf
• Child Care COVID-19 positive packet: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/documents/Childcare-COVID-Packet-1.pdf
• Maine Chapter of the American Academy of Pediatrics information for the school community: https://www.maineaap.org/assets/docs/Return-to-School_v2_12-9-2020.pdf

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

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

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

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

Midsummer check-in

I hope this finds you all well! It’s been awhile since I last checked in. For those of you who closed in the spring, I hear your concerns about safely reopening in the fall. Others who stayed open (or closed only temporarily) have ongoing concerns about common childhood illnesses in the context of the pandemic, especially given that people with COVID-19 have had a wide range of symptoms reported, ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. According to the CDC, people with these symptoms may have COVID-19:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

Guidelines suggest that centers should continue to follow their usual inclusion/exclusion criteria for managing fever (temp greater than 100.4 F) and other symptoms. Some centers have modified their policy to require a child to remain fever-free without fever-reducing medication and be symptom-free for up to 72 hours before return to the center. Symptomatic staff should be held to the same standards as the children. Some are also requiring provider documentation before the child can return. The CDC Decision Tree can help with decisions about exclusion and school closure: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-schools.html#schools-prepare. School closure is indicated only if an infected person has been in the building (not someone who may have been in contact with an infected person), and then only for 2-5 days to allow for deep cleaning and disinfecting.

This site provides additional guidance: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html

Decisions regarding COVID-19 testing are guided by the CDC, contact tracing, and family discussions with providers about whether testing is warranted, based on symptoms and likelihood of exposure. There are no recommendations for testing as a screening/preventive approach. This is the Keep Maine Healthy web page that addresses testing: https://www.maine.gov/covid19/restartingmaine/keepmainehealthy/testing. The Maine standing order can be found at  https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/documents/MEDHHS_StandingOrder_COVID19testing_06-08-2020.pdf. Eligibility requirements for testing need to be met. Testing facilities can be found at https://get-tested-covid19.org/ - type in your zip code, and you will get a list of testing sites within a 40-mile radius. As I understand it, insurance companies are waiving fees for COVID testing and it is free for uninsured persons.

The CDC website states the following regarding quarantine at home for positive COVID-19:

Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
• At least 10 days have passed since symptoms first appeared.

This guidance is just that – guidelines, not mandates – as each center has unique environments and situations. Any decisions made about modification of health policies need to be clearly communicated to families in writing and consistently implemented.

Please share any newly developed or modified practices and guidelines that you’ve found to be effective in maintaining a safe environment during this pandemic – you can comment directly to this post. I continue to marvel at your courage, resilience, and flexibility to ensure the wellbeing of the children you serve as well as your own staff.

Stay safe and be well!

Deb