COVID-19 Information

Exposure Guidelines

What is the difference between quarantine, self-quarantine, self-isolation, and social distancing?

Social Distancing

Social distancing is ultimately about creating physical distance between people who don’t live together. At the community level, it means closing schools and workplaces and canceling events like concerts and Broadway shows. For individuals, it means keeping six feet of distance between you and others while in public and avoiding physical contact with people who do not share your home.

But one aspect of social distancing — the admonition to avoid gatherings of 10 people or more — has created a lot of confusion. It has given the impression that while public indoor events are bad, it’s OK to host up to nine people at your home or outside. That is not correct. Right now everyone should limit close contact, indoors and outdoors, to family members only. This means no dinner parties, no playdates, no birthday parties with a few friends.

Self-Quarantine

This term is used to separate and restrict the movement of someone who is well but who recently had close contact with a person who later was diagnosed with the virus. A person in self-quarantine should avoid going to stores or interacting with the public even on a limited basis for 14 days. (A friend should bring you groceries.)

Self Quarantine means staying home and away from other people, including those in your household, as much as possible, for a 14-day quarantine period. A person in self-quarantine should sleep in a separate space from family members.

Who should do this? Anyone who does not have symptoms, but who had close contact with someone who later became ill.

Self-Isolation

Isolation is used to separate a person who has a diagnosed case or someone who has distinct symptoms including a cough, fever, and shortness of breath, but hasn’t yet been tested or received test results. A person in isolation should be confined to a separate room with no or minimal contact with the rest of the household (including pets) and use a separate bathroom if possible. Most of the time, a sick person will feel a bit miserable, but he or she can pick up food trays left at the door and sanitize a shared bathroom after using it.

Who should do this? Anyone with a confirmed case of Covid-19, in consultation with their doctor, a person waiting for test results or a person with obvious symptoms who are still waiting to be tested. Everyone else in the household should self-quarantine.

Official or Mandatory Quarantine

A government-imposed lockdown on a community,  in which movements are severely restricted. People can still go out for essentials and to get fresh air, but they can do so only under strictly controlled conditions or on a specific schedule imposed by public safety officials.

Who should do this? Everyone who lives in an area under quarantine. “We haven’t seen this in the U.S.,” Dr. Bitton said. “I don’t know if it’s coming.”

Exposure Guidelines

Asymptomatic contacts are to self-quarantine 14 days. Day #1 is the last day any contact was made with the individual positive for COVID-19. Contacts who self-quarantine and continue to be asymptomatic may return to regular activity Day #15 (although we are still in a period of social isolation.)

 Any POSITIVE test requires MANDATORY isolation, whether symptomatic or not. If asymptomatic, isolation is for 14 days. If symptomatic, isolation is for 72 hours fever free without fever reducers, other symptoms have resolved AND at least 7 days have passed since symptoms first appeared. If testing is available, you can also be cleared if symptoms have resolved for 72 hours, AND you have had two negative tests 24 hours apart (there is not enough testing available right now for this to happen.)

Individuals with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue home isolation when at least 7 days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness.

If you HAVE NOT been tested, but presumably have the illness OR if you have tested positive, you may discontinue home isolation under the following conditions:

At least 7 days have passed since symptoms first appeared AND

At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath)

Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens).

 Resources for Coronavirus information:

United States Centers for Disease Control and Prevention (CDC): www.cdc.gov/COVID19

World Health Organization (WHO): www.who.int/emergencies/diseases/novel-coronavirus-2019

American Academy of Pediatrics website has many resources covering all aspects of COVID19 from testing, exposure, homeschooling, co-parenting, breastfeeding, and more.

 

How to help prevent the spread of Covid-19:

Wash your hands often with soap for at least 20 seconds.

Cover your cough or sneeze with a tissue, then throw it in the trash.

Clean and disinfect frequently touched objects.

Stay home as much as possible, and do not go out if you are sick.

Wear at least a cloth mask in certain public settings.

Contact a health worker if you have symptoms.

Respiratory viruses — like the novel coronavirus, the flu, and the common cold — can be spread via our hands. If someone is sick, a hand can touch some mucus and viral particles will stick to the hand. If someone is well, hands act like sticky traps for viruses. We can pick up droplets that contain the virus, and they’ll stay on our hands, and perhaps enter our bodies if we touch our hands to our faces.

That’s why our hands are the front lines in the war against Covid-19. The Centers for Disease Control and Prevention (CDC) recommends washing hands with soap and water as the top way to clean our hands. “But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help,” the CDC says.

A homemade dilute bleach solution- 5 tablespoons (1/3 cup) bleach per gallon of water- is good for wiping down surfaces, high touch areas.

 If your household has someone isolated in-home care for suspected or confirmed COVID-19 you should clean and disinfect high-touch surfaces daily in household common areas (e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks) in addition to any areas inhabited by/touch by the patient.

Gloves- NOT necessary when going out for shopping, etc.  The use of gloves can lend a false sense of security, and can also transmit germs.  Be aware of what your hands are touching, and wash or apply hand disinfectant frequently instead (i.e. before entering a store, after using a credit card, leaving the store, before and after unloading groceries).  Much easier to disinfect your hands each time than to do so with gloves.

 

Masks-The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission (this includes Fairfield County!). 

Cloth masks may help the spread of small particles that transmit Coronavirus but ARE NOT A SUBSTITUTE for social distancing which is the best way of avoiding infection. We do not recommend masking your children so that they can go into more social situations. Masks may also result in your children playing with them and touching their faces more, increasing their risk of infection. Limit traveling out for essentials such as groceries to adults, and in that situation, a mask is recommended.

Why the new recommendation? While the greatest risk of infection comes from heavier respiratory droplets in the form of coughs and sneezes, we now believe that coronavirus can also spread somewhat as an aerosol (smaller particles that can float in the air for a longer period.) We also know that presymptomatic and asymptomatic people may shed virus via breathing and talking- this makes the wearing of masks in public an obvious plus. Again, your best protection is simply AVOIDING going out in public as much as possible and keep your kids at home. PLEASE do not let teens mask themselves, and feel free to safely hang with friends- masks are not infallible, and the type of cloth masks available for the public do not approach the efficiency of the masks used (and reserved for!) medical workers.

Should Children Wear Masks?

Surgical style and cloth masks are to prevent the wearer from TRANSMITTING disease- so children should not need masks if they are not doing essential public activities such as grocery shopping.  No need to wear them when playing outside or in the house, if they are not going to be exposed to people outside their isolation unit (which they should not be at this time.)  In addition, The C.D.C. has said that cloth face coverings should not be placed on children under 2, nor should they be used on anyone who has trouble breathing.


Pediatric COVID19 Inflammatory Syndrome 

By now you have likely read articles or seen on the news that there is a new possibly COVID19 related inflammatory condition affecting children: “Pediatric Multi-system Inflammatory Syndrome” or PIMS.  You are also likely to be terrified that this will happen to your child, having previously been reassured that children generally fare well with this virus.

First, please understand that this is a VERY RARE manifestation of COVID19- you are seeing these headlines because of children+COVID+ICU = terror.  However, there are likely thousands upon thousands of children who have had the virus in the areas where we are seeing this new syndrome. The small number of children developing hyper-inflammation is a tiny percentage of those who have had the virus and either not shown symptoms or recovered quickly.

What is PIMS?  One current theory is that children are getting COVID19 and either not developing symptoms or having a very mild illness, but still making protective antibodies against it (this is good!)  Unfortunately, in a tiny minority of patients, those antibodies are attacking the small blood vessels throughout the body causing a variety of symptoms.  Many of these children do not seem to have active COVID infection (negative nasal swab tests) but have positive IgG antibodies (indicating COVID illness occurred several weeks prior). This would explain why we are seeing a peak in the syndrome now after the peak of acute infections in the areas seems to have passed.  Similar trends have been noted in Europe and the UK. 

Children with PIMS typically present with 3-5 days of persistent moderate to high fever, along with abdominal pain, vomiting, diarrhea, and rashes.  Some also have reddened eyes, headaches, and dizziness.  Cough, shortness of breath, and lung involvement are much less common (usually seen with an acute COVID infection.) These children look SICK- not your toddler with a fever who is running amok after Tylenol, or your school-aged child who is feeling a bit ill but otherwise engaging in normal activities, drinking well, and urinating normally.

We believe that PIMS is similar to Kawasaki’s Disease, which is an illness characterized by persistent high fevers, rash, reddened eyes/tongue, swollen lymph nodes, and inflamed palms/soles. Kawasaki's Disease is typically treated with IVIG (intravenous immunoglobulins) steroids and supportive care (fluids, oxygen, careful monitoring in the hospital.)  Similar treatments are being tried for COVID Inflammatory Syndrome patients and have been overall quite effective with the vast majority of patients recovering completely. The sickest children also have symptoms of Toxic Shock Syndrome, where the heart and blood vessels are affected causing a high heart rate and very low blood pressure- again, these children appear obviously ill. Shock is treated with fluids, heart medications, possibly antibiotics, and ICU level care, and the vast majority of patients have recovered completely.

If you have ANY concern that your child appears severely ill, your first call should be to 911 for prompt care. If they have mild to moderate symptoms, call the office to set up a telehealth appointment. We can determine if your child needs home supportive care, a visit to our “outdoor” office, or prompt referral to a Pediatric ER.  If we suspect this inflammatory condition your child will need careful evaluation/monitoring, bloodwork, and an EKG which are best done in an ER setting.