With the rise of infections in our area, we wanted to reach out and provide some ongoing guidance for our patients and their families. Our office has been extremely busy with triage calls, questions, and visits of all kinds. We have appreciated your patience as we deal with the increased volume of caregiver concerns.
Most of our phone conversations are centered around COVID-19 exposure, symptoms, and testing. The community’s situation regarding testing options is extremely variable, and has changed multiple times this fall.
Please carefully read through the following scenarios, and let us help you with any additional questions that you may have. We also ask that you keep this on hand for reference in the coming months, though information may need to be updated as we move forward into cold and influenza season.
"My child has symptoms of illness."
- Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) report that people with COVID-19 may experience one or more of the following symptoms: 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; and nausea, vomiting, or diarrhea.
- If your child has one or some of the symptoms above, testing is recommended, in order to 1) identify cases, 2) isolate known cases to prevent ongoing spread, and 3) allow for tracing of close contacts to help inform them that they may develop illness and discuss quarantine measures with them. Certain symptoms (e.g. loss of taste or smell) are so characteristic of COVID-19 that we would recommend testing even if no other symptoms are present.
- If your child is tested, a POSITIVE result will mean that the child needs to isolate for 10 days from the onset of symptoms. In order to return to a public setting, such as daycare or school, symptoms also need to be improving.
- If your child is tested, a NEGATIVE result clears the patient for return to the public setting once symptoms are improving.
- If you choose NOT to test your child, we have to recommend that we treat the illness as if it is COVID-19. In that case, the child must remain home for a minimum of 10 days from onset of symptoms.
"My child has been exposed to COVID-19."
- NH Division of Public Health Services (DPHS) defines a “close contact” as a person being within 6 feet of someone with COVID-19 for a cumulative time of 10 minutes or longer during the person’s infectious period; this exposure can occur over multiple separate contacts or even days.
- An exposure also includes sharing the same living space (such as kitchen, bathroom, etc).
- Unfortunately, even masking does not completely eliminate the risk of spread between individuals.
- A “secondary contact” is NOT considered high risk, and does not prompt the need for testing or quarantine. An example of this would be:
- The mother of a child who goes to your child’s daycare tests positive.
- The sibling of a child in your child’s classroom tests positive.
- If you are notified that your child has been exposed to a positive case, it is recommended that they be tested in order to isolate them properly and prevent spread of the disease. Testing prior to 2-5 days from exposure is NOT recommended.
- Following exposure, a POSITIVE test (whether asymptomatic or following the development of symptoms) would lead to a necessary isolation period of 10 days from the onset of symptoms (if symptomatic), or from the day of the swab collection (if not symptomatic).
- Following exposure, a NEGATIVE test does not shorten the quarantine period, as a test may not become positive for up to 14 days following a known exposure. So, an exposed individual must quarantine for at least 10 days, regardless of a negative test result.* Also, new symptoms that occur within the quarantine period and AFTER a prior negative test should absolutely be re-tested, and a positive test would prompt a new 10-day isolation period.
- If you choose NOT to test your child after exposure, it is recommended that you presume that they do have it, to avoid further spread. The child must quarantine for at least 10 days, and continue social distancing and masking while monitoring for development of symptoms through Day 14. Should symptoms develop, testing is absolutely recommended, as this will affect the quarantine period for household members (parents and siblings).
*NH DPHS has decreased the required quarantine period for people potentially exposed to COVID-19 from 14 to 10 days, which is consistent with CDC new quarantine guidance. Symptom monitoring and masking must continue for a full 14 days after exposure. With this new strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.
Household Member Factors
- Quarantine periods are based on the last known date of contact. So, unless a family member is able to move to an alternative living space (independent eating, sleeping, and grooming/bathroom spaces), then there is ongoing contact throughout an individual’s isolation period. For example, consider the following:
- Father is home on a 10-day isolation for testing positive. The children are still living in the same home and sharing a restroom and food preparation spaces.
- Due to the fact that a person with COVID-19 can spread the virus for up to 10 days, father is home for 10 days.
- Family members may not contract the illness until the 10th day of his quarantine. Then, they may not show symptoms up to a maximum of 14 days.
- So, while the father is isolating for 10 days, the family members who continue to have contact with him must stay home during his isolation period PLUS an additional 10-14 days, in order to monitor themselves for symptom development. If they personally develop symptoms, they should then be tested.
- This is the same situation that occurs when any family member (parent, sibling, child, etc) is positive for COVID-19 UNLESS isolation of their living spaces is performed.
- If a household member is quarantining due to exposure (NOT isolating due to known COVID-19 illness), other individuals who live with them do not need to take extra precautions. IF the exposed individual develops symptoms during their quarantine, a test is recommended, and all household contacts should stay home until that result is obtained.
Testing Options
- Locally, we have several locations performing testing (click here to see a list of NH testing sites). The availability of testing with and without an order has been variable, so that will not be commented on here, and can be discussed with your healthcare provider when testing is deemed necessary. We also have the ability to perform on-site COVID testing for our patients; please call our triage line to discuss whether this is the most appropriate option for your child.
- There are two major types of swabs being done locally: nasopharyngeal (the deep, “back of the nose” swab), and an anterior nares swab (collecting nasal discharge from the front of the nose). The type of swab that is done will depend on the availability at the location where you seek testing.
- There is a rapid test available in some cases to symptomatic patients. These are highly accurate when POSITIVE, however, a negative result has a much higher possibility of being a false negative. In those cases, you and your healthcare provider should weigh the probability of COVID-19 illness and consider a secondary PCR swab, which can take 2+ days (in many cases, several days) to return and confirm the result.
Helpful Links
NH DPHS – Coronavirus Disease 2019 Self-Quarantine Guide
NH DPHS – Coronavirus Disease 2019 Self-Isolation Guide
Many thanks to our colleague Dr. Stephanie Sisler of Lovelight Pediatrics in Oakland, MD for her excellent summary.
