Is there a need to mask in school? Can my child wear a mask? Will wearing a mask cause an exacerbation? Can we get a mask exemption letter for my child?
The best available evidence shows that wearing a mask in public reduces the spread of COVID-19 and also offers some protection to the wearer. In addition, studies have shown that oxygen and carbon dioxide levels remain stable among people wearing masks. It is very unlikely for oxygen levels to decrease or carbon dioxide levels to rise while wearing the type of masks recommended by the CDC. In general, people with asthma, both young and old, are not at risk of trouble breathing by wearing facial coverings. Therefore, the providers and nurses at CRCCS will not provide mask exemption letters. There are very few legitimate medical reasons why a person cannot mask. The CDC’s exemptions are children under age 2 years, and anyone who is having trouble breathing, is unconscious, is incapacitated, or otherwise unable to remove the mask without assistance. Although “anyone with trouble breathing” is included in this list, the vast majority of our patients are able to safely wear a mask. Patients with very severe lung disease and very low lung function (below 30%), or those in the midst of an exacerbation, may not be able to mask. We recognize there are some patients in our practice with special behavioral and developmental reasons that make masking impossible. In that case we ask that you reach out to your primary care provider for guidance. If you or your child really cannot wear a mask because of the severity of lung disease, we recommend you strictly avoid situations where wearing a mask is recommended, such as going out in public, as this would inherently be too high risk for someone with such severe lung disease.
The most common reason that people have trouble with masks are the material or fit of the mask. You may have to try different options to find the best mask for you or your child. When choosing a mask it does not have to be tight-fitting. Many can wear a loose-fitting mask that covers the nose and mouth, but does not fall off. It should not be so tight around the ears and neck that it makes breathing uncomfortable. A loose-fitting mask does not really protect the wearer, but does decrease spread of respiratory droplets and protects others. Wearing a mask for extended periods of time can be uncomfortable for anyone. If this is the case for you or your child, our desensitization protocol can be found on our clinic website at https://www.crccs.com/news/
If your child cannot wear a mask because it interferes with breathing, and you have tried implementing our desensitization protocol, please schedule an in-person appointment with your CRCCS provider. Your child will need to keep their mask on for the duration of the visit. We will examine them while the mask is on and monitor their oxygen saturation. If necessary, a 6-minute walk test that measures their oxygen level with activity may be ordered.
Should my child go to school? Is my child considered high risk?
Every child who comes to our clinic can technically fit under the high-risk umbrella because they have lung disease, however, despite this most of our patients should be able to go to school. Fortunately, most children, even those with underlying health problems/special needs, who have been diagnosed with COVID-19, have done well. In a meta-analysis published in early July that looked at over 7,800 children, more than 90% were either asymptomatic or had mild-moderate symptoms that could be managed at home. Less than 10% of children required hospitalization, and less than 1% required intensive care. Could your child get COVID-19 if they go to school? Yes. But the data we have to date suggests that even if they do, they will do well, and they will recover. Children with mild to moderate lung disease (mild intermittent asthma, mild persistent asthma, moderate persistent asthma, cystic fibrosis, recurrent bronchiolitis, recurrent croup, reactive airways disease) should be able to attend school. Data suggests that they are not at increased risk for severe disease. Those with severe/advanced lung disease likely can also attend school, but they MAY be at increased risk of having more severe symptoms. Patients with severe lung disease should review their risk with their pulmonologist. Again, based on our clinics experience and the available literature, most children should be able to attend school safely. That being said, we recommend that all families do a global risk assessment for their family. If your child goes to school and brings the SARS-COV2 virus home, are there other people in your home or with whom your child frequently has contact with that are higher risk because of age or underlying health conditions? If the answer to that question is yes, and those individuals are staying safe at home and are not out and about in the community, then you should consider keeping your child home.
Should my child participate in sports/activities?
The answer to this question is similar to whether or not your child should go to school. We believe physical activity is important and for many of our patients it is important for maintaining their lung health. If your child’s sport/activity is outdoors and measures have been taken to limit close contact and promote socially distance, and they do not have severe or advanced lung disease, then they can likely participate. We recommend using caution with indoor activities, particularly if participants are not wearing masks or face coverings. As is the case with school if your child participates in these activities and brings the SARS-COV2 virus home, you should consider if there are other people in your home or with whom your child frequently has contact with that are higher risk because of age or underlying health conditions? If the answer to that question is yes, and those individuals are staying safe at home and are not out and about in the community, then you should consider keeping your child out of sports/activities.
How do I treat my child if they become ill?
Signs and symptoms of COVID19 can include fever, cough, shortness of breath, chills, headache, muscle pain, sore throat, fatigue, congestion, or loss of taste or smell. Other less common symptoms include gastrointestinal symptoms like nausea, vomiting, or diarrhea. These symptoms may appear 2-14 days after exposure to the virus that causes COVID-19. Not everyone with COVID-19 has all of these symptoms, and some people may not have any symptoms. If symptoms are present your child should be self isolated/quarantined at home, away from others. They should not leave your home for any reason until 10 days after symptom onset and 1 day after resolution of fever and respiratory symptoms (whichever lasts longer). If leaving the house less than 14 days after symptom onset, they should wear a mask. Self treatment includes tylenol (acetaminophen) for fever, pain or myalgia. If your child has an asthma control plan or respiratory control plan you should diligently follow their plan for worsening respiratory symptoms. If sick, check their temperature daily and monitor for symptoms of respiratory distress. If they need emergent care you should come to Children’s emergency department.
Should I get my child tested? How can I get my child tested?
People who have symptoms of COVID-19 should get tested. In general, people who do not have symptoms should not be tested for COVID-19. This Minnesota Department of Health website has a screening tool that will help you determine if you or your child should be tested for COVID-19. Should I Get Tested for COVID-19?
Most clinics and hospitals across the state have the ability to collect samples for testing. To protect our patients we are not seeing sick children in person in our offices. We recommend you contact your primary care provider to determine where they are referring patients for testing. Call ahead before going to the clinic or hospital to be tested. Not all clinics test people who do not have symptoms. The Minnesota Department of Health website also offers a list of testing locations.
Antibody testing to identify the presence of an immune response to SARS-CoV-2 (the virus that causes COVID19) is available at Children’s. That being said we have been discouraged from ordering testing unless children are critically ill and there is concern for Multisystem Inflammatory Syndrome in Children (MIS-C). The serology testing is intended only to detect antibodies to the virus, not to diagnose recent or active infection, and it cannot pinpoint the date of exposure. Some individuals, particularly those who are immunosuppressed, may never develop detectable antibodies. A positive serology result suggests a patient is less likely to get infected or re-infected compared to individuals who do not have any antibodies in their blood. However, we are continuing to learn about the level and duration of protective immunity, and can’t definitively say how long or how protective that immunity is. We also do not know if the test will be covered by insurance.
Can my child still travel?
We recommend visiting the CDC website and reviewing the considerations for travelers page (https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html). COVID-19 cases and deaths have been reported in all 50 states, and the situation is constantly changing. Because travel increases your chances of getting infected and spreading COVID-19, staying home is the best way to protect yourself and others from getting sick. If you are thinking about traveling away from your local community, ask: Is COVID-19 spreading where you’re going? You can get infected while traveling. Is COVID-19 spreading in your community? Even if you don’t have symptoms, you can spread COVID-19 to others while traveling. Will you or those you are traveling with be within 6 feet of others during or after your trip? Being within 6 feet of others increases your chances of getting infected and infecting others. Are you or those you are traveling with more likely to get very ill from COVID-19? Individuals who have an increased risk of severe illness from COVID-19 should limit their travel. Do you live with someone who is more likely to get very ill from COVID-19? If you get infected while traveling you can spread COVID-19 to loved ones when you return, even if you don’t have symptoms. Does the state or local government where you live or at your destination require you to stay home for 14 days after traveling? Some state and local governments may require people who have recently traveled to stay home for 14 days. If you get sick with COVID-19, will you have to miss work or school? People with COVID-19 disease need to stay home until they are no longer considered infectious. Do not travel if you are sick, or if you have been around someone with COVID-19 in the past 14 days. Do not travel with someone who is sick. If You Travel Protect yourself and others during your trip: Clean your hands often, avoid touching your eyes, nose, or mouth, avoid close contact with others, keep 6 feet of physical distance from others, wear a cloth face covering in public, cover coughs and sneezes, and pick up food at drive-throughs, curbside restaurant service, or stores.