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,