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
