Students have returned to school over roughly the last week amid the continued monitoring of COVID-19. With that in mind, what should parents do when they have questions about exposure, what symptoms indicate COVID-19 and which ones are more likely allergies, the common cold or something else, or how do you know if someone’s been exposed to COVID-19.
In the GLOW region, the only school reporting a positive case on-site, as of Wednesday, was Le Roy Jr.-Sr. High School. That was out of 369 students enrolled, plus teachers and staff. The district last reported data on Monday.
Dr. Steven Schulz, a pediatrician, Rochester Regional ambulatory practice medical director for Monroe County and a member of the New York State Finger Lakes Region School Reopening Task Force, which covers the 13-county region, answered those questions and more during a Zoom call Wednesday.
Schulz said the formal definition of “exposure” to COVID-19 is being “within 6 feet, unmasked, for greater than 15 minutes.”
Schulz said if there is a positive case, that is when the local health department will take over.
“The local health department will do contact tracing and determine high- and low-risk exposures and, if needed, reach out to additional individuals as indicated,” he said.
Schulz said that is the hard part.
“COVID in children tends to be much more mild. Its symptoms are much more broad in what they involve — runny nose, congestion, cough, shortness of breath, sore throat, nausea, vomiting, diarrhea, abdominal pain, fatigue, poor appetite are all different symptoms. There’s a whole host of conditions that can cause all those things, not just COVID,” Schulz said. “Many kids do have chronic conditions, such as seasonal allergies, that can have overlapping symptomology. In those cases, the physician, we are required to submit our physical exam for students. Those things are listed that are chronic conditions. In some cases, letters can be written to verify some of those conditions as needed.
“The real thing we’re trying to get everybody to focus on with this is new, different or worsening symptoms. Every school district has implemented a screening protocol for students and parents to go through before that student sets foot on campus. If they screen positive for any of those,focusing on new and worsening symptoms in particular, those would be reasons for an evaluation with a health care provider. Obviously, the big one would be a fever. If a child has a fever, they certainly would need to have additional evaluation,” he said. “We, of course, encourage families that if there is any concern that their child might have symptoms that are consistent with COVID, to contact a health care provider for next steps. There’s a variety of ways this is being done — through video visits, through in-person visits, car-side in some instances, so the health care provider can direct the family in the best way to proceed. A phone call will help determine the best way to see those kiddoes.”
Schulz said in large part, this is up to school district screenings and whether the answers to any of the questions asked during screening are positive and the child is sent home by a school nurse.
“They’re going to need an evaluation for determining the next steps. Always, making that phone call is the default. For instance, a kid with seasonal allergies might have watery, itchy eyes, a little bit of watery, itchy nose and some sneezing,” he said. “If they’re suddenly developing worsening cough, having some trouble breathing, or are suddenly developing fever, those would be concerns for a secondary infection. Right now, because of community prevalence, there’s a 99-percent chance that those symptoms are due to a different virus that’s not COVID and that’s a good thing and a good place that we’re starting out with. Because we don’t want COVID to spread in the schools and break out, we are being very stringent, and actually it’s been the Department of Health that’s been very stringent with their regulations on what’s required to eventually return to school.”
The doctor said the steps required to return to school, as laid out by the state Department of Health, are:
• an evaluation with the health care provider;
• a negative COVID swab;
• resolved symptoms — not just improving symptoms — with a letter from a health care provider.
“I think overall, especially in the adult world, that’s where we’re seeing the sickest patients and the folks struggling the most. I know that lots of advances in treatment have come out and improvements have been made,” Schulz said. “In the pediatric realm in general, most kids have mild symptoms. There are some that can have more severe infections and there’s Multisystem Inflammatory Syndrome of children that has been raised as a new concern but these are very limited and rare in the overall picture. Out of the thousands of deaths in the United States ... maybe we’re up to around 150 now, have been in children.”
Schulz said anytime there are any illness symptoms at all, even a positive initial screen with the child being sent home from school — that’s the time to isolate the patient to the best of the family’s ability.
“COVID can be asymptomatic. It’s not even just the degree of illness, but just the fact that there may be an illness that would indicate the need to isolate that patient until they have the evaluation,” he said. “We certainly feel better about things when we have the negative COVID test available and the vast majority of tests that we have sent out are negative. I have not had a positive myself personally, but there can still be some false negative rates. It is best to continue to limit exposure and contact, and that’s why the Department of Health has been more stringent on the return to school and putting ‘resolved symptoms.’”
“It’s primarily when that positive test comes back ... Knowing that the requirements are social distancing and wearing masks at school ... If one child comes down with a runny nose and cough and goes to the health care provider to get tested, and another sibling does not have any symptoms, that other sibling can still attend school, following those guidelines, knowing that they’re being masked and socially distanced throughout,” Schulz said. “If that initial sibling’s test comes back positive, that’s when the health department would step in and then the health department would take over and those close contacts would definitely be quarantined.”