Back to School: A Boston Children's Hospital Pediatric Pulmonologist's Essential Precautions for Covid-19, Asthma, Flu and More.
Ready for Back To School Season? This school year is certainly different than ever before. With some schools in person, hybrid, or completely remote and everchanging guidelines, parents and pediatricians are grappling with questions regarding their children’s safety. Today’s woman dreamer, Dr. Meera Subramaniam, a Pediatric Pulmonologist, shares her medical insights for children and families on how to prepare kids for school during this time, the precautions schools and families need to follow, and her answers to all your essential questions. Check out her story below.
1. Most schools are considering some level of in-person school for kids down the road. What are some precautions & symptoms for parents and kids to consider with the current pandemic?
You are right that most schools are staring with a hybrid model so that they can maintain social distancing and marshal their resources to keep students, staff and teachers safe. This will also allow them to observe how the pandemic progresses during the coming months during fall and winter. I would urge parents to have discussions with school administrators and teachers, about all the practices they have put in place to create a safe environment. They should ask if their school’s mask wearing policies are in accordance with the CDC guidelines. They should also check if children will be wearing masks all through the day (exceptions include children under 2 yrs. of age an anyone with trouble breathing, unconscious, incapacitated or unable to remove mask). Other such questions include: Does the school allow mask breaks in safe areas as children may have a hard time keeping their masks on for long periods? Do they have proper social distancing in the class rooms and in cafeterias? Do they have adequate supplies to maintain hand hygiene? Schools should clean, disinfect and sanitize surfaces on a regular basis. Children should wear masks, wash or sanitize their hands frequently and keep a safe distance from others.
Parents, teachers, staff and children should be aware of the symptoms of COVID 19 so that they can detect them in time and take necessary actions. Symptoms that are associated with COVID 19 are: fever or chills, cough, shortness of breath, fatigue, muscle aches, headache, loss of taste or smell, sore throat, congestion, nausea, vomiting and diarrhea. Children who are aware of these symptoms are likely to also report their illness sooner. When parents notice these symptoms, then should get in touch with their health care providers to discuss the illness. If there is trouble breathing, persistent chest pain, new confusion, drowsiness and lethargy, or bluish lips or face – parents must arrange for immediate emergency medical care. Health care providers can advise whether the child needs COVID-19 testing. It is very important that a child who has tested positive does not go to school as this will expose numerous children, and staff to the virus. This has happened before in a MA school when children who have tested positive joined school when it reopened – this led to avoidable exposures to the virus among others and avoidable quarantines. Also it is important to wait for the test results to come back before the child goes back to school. If your child is COVID-19 positive follow the CDC guidelines on when the child can return to school as it could differs for people who are symptomatic, asymptomatic or have been severely ill or are immunocompromised. If your child gets exposed to COVID-19 the child should be quarantined at home for 14 days after the last contact with the person who was COVID-19 positive. This holds even if the child tests negative, since the symptoms could take 2-14 days to appear after exposure. Parents should check their children for COVID-19 symptoms every morning before going to school and if they have symptoms they should not go to school and pediatrician should be consulted.
2. As we are fast approaching the fall, can you give some suggestions to differentiate fall allergies / asthma type symptoms from those of COVID 19?
There are a lot of symptoms that overlap between allergies/asthma and COVID-19. It is therefore hard to distinguish them sometimes. If you have any concerns it is best to call your health care provider for advice. The more important thing is to keep your allergies and asthma in good control. This is also very important from the point of view of keeping your lungs free of inflammation. There have been many expert panels and discussions on this topic and it appears that children who have mild well controlled asthma, fare better. CDC does list moderate and severe asthma patients to be at greater risk - but this is for both adults and children. We are all new to this virus and are continuously keeping an eye on how this virus behaves when people have underlying lung disease. The good news so far has been that the severity of illness has been less in children. Keeping your asthma in good control will avoid visits to the emergency room and admissions due to asthma symptoms. Apart from taking all medications children should also avoid triggers that precipitate their asthma such as allergens, smoke, toxic fumes and stress. Also it is very crucial to take the influenza vaccine as you certainly don’t want to be sick with 2 viral infections.
3. What are your thoughts / some considerations on "at home education" especially those with asthma and other immuno-compromised conditions?
There are many tradeoff between in person schooling and remote learning. Schools not only provide education but they are also important for the mental health and social wellbeing of the children. Parents may have to think of several things while making this decision. There are considerations regarding how well the school is prepared, the work situation of the parents, access to school meals and day care for the children, access to social services and special services for special needs children, high risk individuals at home and many such factors. Above all, several parents are faced with tough decisions due to the health conditions of their children. CDC website lists immunocompromised population due to organ transplant in the high risk category and moderate to severe asthma and immunocompromised due to other conditions in the may be at risk category. However, these guidelines are for both adults and children. Children in general have been less severely affected and have had less hospitalizations and ICU admissions. Individual cases may need an individual plan and this is best discussed with your health care specialist. As mentioned before, I cannot adequately stress the importance of taking medications regularly, keeping your disease under control and living a healthy life style.
4. Can you discuss the impact of COVID on the pediatric population?
As a pediatric pulmonologist at Boston Children’s Hospital I grapple with this every single day since the COVID-19 pandemic started. We have been in touch with adult and pediatric centers in Boston as well as around the country and also have had virtual conversations with physicians all over the world. It is amazing how the medical and scientific community has come together with a common goal of doing the best for our patients. Our group has also put together a drug trial with a drug that reduces inflammation and mucous in the severely sick children at Children’s and adults at the Brigham and Women’s hospital (BWH) with our colleagues at BWH (https://hms.harvard.edu/news/lung-link). Although children do get infected, I have to be very thankful that the pediatric population so far has fared much better with less severe symptoms, fewer hospitalizations and less Intensive care needs. We are working together with our staff to help Children both for their medical health and mental health needs. We are all in this together with the children and their families and will continue to provide the best possible care.