COVID-19 update: Le Bonheur and UTHSC pediatric experts offer guidance amidst spread of Omicron variant

COVID-19 update: Le Bonheur and UTHSC pediatric experts offer guidance amidst spread of Omicron variant

The new year has brought  a flood of new information from health officials regarding the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) and Tennessee Department of Health (TDH) have updated guidance, subject to change, regarding isolation and quarantine.  Additionally, the U.S. Food and Drug Administration (FDA) has authorized vaccination boosters for children ages 12 and older. The pediatric experts at Le Bonheur Children’s Hospital and The University of Tennessee Health Science Center (UTHSC) offer answers to frequently asked questions in order to help parents and educators better understand the latest health and safety recommendations. 

What is happening with COVID-19 right now?

As of January 2022, the Omicron variant of COVID-19 is the dominant variant in the United States. This variant spreads faster and is infecting more people in a shorter period of time compared with the original strain and previous variants. While there are other respiratory viruses circulating, the Omicron variant of SARS-CoV-2 (the virus that causes COVID-19) is the virus currently causing most respiratory tract infections in our community. Because so many people are becoming ill, it is currently difficult to get a COVID-19 test. If you develop any respiratory symptoms, even if the symptoms are mild, you should immediately isolate yourself from others as much as possible.

If you can get a COVID-19 test, you can do so as it could be possible you have another virus; however, if you cannot find a place to be tested, assume you have COVID-19 (odds are that you do) and continue isolating. It’s important to note that if you take a home test or have a rapid antigen test, a negative test could be a false negative, and you should continue your isolation until your symptoms improve.

How long do I isolate from others when I have COVID-19?

Isolation is the term used to describe staying away from others when you have COVID-19, either with or without symptoms. The isolation period begins on the first day you have symptoms or on the day of a positive test (day the test was done, not the day the result was received). Since the start of the pandemic, it has been required that isolation be a minimum of 10 days and that the individual have no fever for at least 24 hours and is feeling better before resuming contact with others. New guidance from the CDC and TDH says that isolation can be reduced to 5 days instead of 10 as long as the individual has been fever-free for 24 hours and is feeling better. You must, however, continue to wear a well-fitted mask for an additional 5 days whenever you are around others.

After completing the isolation period for COVID-19, you do not need to have a negative test or note from your doctor to return to work or school.

What is the definition of a “close contact” of COVID-19?

A close contact of COVID-19 is defined as someone who:

  • Was within 6 feet of someone with COVID-19 for 15 minutes or more in a 24 hour period
  • Was coughed or sneezed on by someone with COVID-19
  • Provided care at home for someone sick with COVID-19
  • Had direct physical contact with someone with COVID-19
  • Shared eating or drinking utensils with someone with COVID-19

If your exposure occurred in the 48 hours before someone developed symptoms of COVID-19, even if they did not have symptoms when you were with them, you are considered a close contact.

Based on studies of COVID-19 spread in schools, the transmission from children to others in schools occurs at a similar rate if they are kept 6 feet apart OR 3 feet apart when the children are wearing masks. For this reason, in a school setting, the distance for a close contact for children is defined as less than 3 feet apart. This does not apply to adults in the classroom setting.

You are not considered a close contact if you have had a documented COVID-19 infection in the past 3 months.

If I have had close contact with someone with COVID-19, how long do I need to quarantine at home?

The answer to this question depends on your vaccination status.

  • If you have received a booster of COVID-19 vaccine or completed your primary series within the last 6 months (2 doses of Pfizer or Moderna vaccines) or 2 months (1 dose of Johnson & Johnson vaccine), you may continue your daily activities and wear a well-fitted mask at all times for 10 days after the exposure. Ideally, you should get a COVID-19 test after 5 days but since testing is scarce right now, this is not required.
  • If you completed your primary series more than 6 months (Pfizer, Moderna) or 2 months (Johnson & Johnson) and have not received a booster or you are unvaccinated, you must stay home and away from others in your home for 5 days, then wear a mask around others for 5 more days. Please note that these recommendations are new and subject to change. Ideally, you should get a COVID-19 test after 5 days but since testing is scarce right now, this is not required. If you cannot quarantine away from others in your home, you should wear a mask for 10 days.
  • If anytime during the quarantine period you develop symptoms of COVID-19, you should immediately isolate (according to guidelines above) and assume you have COVID-19. It is a good idea to get a test if you can, but this is not necessary.

The total duration of quarantine is longer if you have ongoing exposure to the infected person (for example, if you are caring for a young child who has COVID-19). Your quarantine includes the full isolation period for the child plus 5 additional days.

Why have the CDC and the Tennessee Department of Health changed their guidance on duration of isolation and quarantine?

This guidance has been updated based on new research that says that most transmission of SARS-CoV-2 (the virus that causes COVID-19) occurs in the 1-2 days before the onset of symptoms and the first 2-3 days after symptoms begin. Some people will continue to be contagious after this 5 day period, so it is required that if you come out of isolation after 5 days, you wear a well-fitted mask whenever you are around others for an additional 5 days, including in your home.

What kind of mask should I be wearing to protect myself from COVID-19?

Masks are still very effective in preventing the spread of COVID-19, if well-fitted and worn properly. With the spread of the highly contagious Omicron variant in our area, we all need to step up our mask game. Masks work best if everyone wears one and will offer you the greatest protection if it fits your face snugly, minimizing gaps that let respiratory droplets in or out of the mask edges. The other best practice is to use a mask that has multiple layers of fabric, a 3-ply surgical mask or a KN95 or N95 mask. The CDC outlines their recommendations for optimal mask wearing here: https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html

  • Choose a mask with a nose wire (metal strip along the top of the mask) which keeps air from leaking out the top of the mask. This helps keep glasses from fogging up as well. Make sure to bend the nose wire to fit over your nose.
  • Use a mask fitter or brace. Mask braces hold the mask to your face to prevent air leakage around the edges. They can be purchased or homemade.
  • Check for gaps in the mask by holding your hands around the outside edges and breathe in and out to feel for warm air. You want the warm air coming through the front of the mask rather than around the edges. If the material of the mask moves toward your face when you breathe in and away from your face when you breathe out, this is a good sign that you have a good fit.
  • Add layers of material. A multilayered cloth mask or a cloth mask worn over a disposable mask is a good way to do this.
  • Knot ear loops and tuck the extra material under the edges of a 3-ply mask. See this video for a demonstration on how to do this (https://youtu.be/GzTAZDsNBe0)
  • If you have a beard you can shave or keep it short, use a mask fitter/brace or use a cloth mask over a disposable mask for a snug fit.
  • Don’t wear two disposable masks as it will not improve the fit.
  • Don’t combine a KN95 mask with another mask.

What are the symptoms of COVID-19?

The symptoms of COVID-19 are similar to a cold or flu. They include fever or chills, cough, shortness of breath, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion/runny nose, nausea, vomiting and diarrhea. Many people have mild symptoms, especially if vaccinated and boosted. With the Omicron variant, many people complain of a scratchy or sore throat as the first symptom. Runny nose/congestion are also common, so people may assume, incorrectly, that the symptoms are from allergies or a common cold.

What should I do if I develop symptoms of COVID-19? Do I need to get a test for COVID-19?

If you develop any of the symptoms listed above, you should assume you have COVID-19 as it is the most common virus circulating in the U.S.right now. As soon as you develop symptoms, you should isolate because even if you get a test, it could take a couple days to get the result and you could be spreading COVID-19 to others while you wait.

  • If you have a PCR test and it is negative, then it is highly unlikely your illness is due to COVID-19, and you can come out of isolation.
  • If you have experienced symptoms and take a home test or have a rapid antigen test, a negative test could be a false negative and you should continue your isolation.

Should I get a COVID-19 vaccine booster? 

If you have been vaccinated against COVID-19, you should get a booster if it has been more than 5 months since your second dose of mRNA vaccine (Pfizer or Moderna) or more than 2 months since your dose of J & J vaccine. Getting a booster will bump up your antibody levels to provide better protection against the Omicron variant. It also helps to improve the memory your immune system has for the virus. Immune memory kicks in a few days into infection and prevents the development of severe infection.

Many people who have been vaccinated and even boosted are getting COVID-19 infection, but it is unusual for someone who has had a booster to become very ill and require hospitalization.

The FDA just approved (Jan. 3, 2022) boosters for children 12 to 15 years of age as soon as 5 months after the second dose of Pfizer vaccine.

The FDA approved the Pfizer vaccine for children 5-11 years of age in November 2021. Additionally, the CDC is recommending that moderately or severely immunocompromised 5–11-year-olds receive an additional primary dose of vaccine 28 days after their second shot.

Le Bonheur strongly recommends vaccination and boosters for all who qualify. COVID-19 vaccination prevents severe illness among vaccine recipients. Even though COVID-19 is generally milder in children, many children do become ill enough to require hospitalization and more than 800 children have died from COVID-19 since the onset of the pandemic. Additionally, almost 6,000 children have suffered from multisystem inflammatory syndrome (MIS-C), a condition that occurs following COVID-19 infection in some children and adolescents. This includes 52 deaths.

Are the definitions of exposure and rules for quarantine different in schools?

  • In school, a close contact of COVID-19 is considered to occur at less than 3 feet of distance when mask-wearing students are involved. For adults in a school, the distance to be considered a close contact is 6 feet.
  • For children who are fully vaccinated (3 doses if it has been more than 5 months since the second dose of Pfizer vaccine; 2 doses if < 5 months), no quarantine is required after a close contact; however, these children must wear a well-fitted mask at all times.
  • Waiving quarantine for fully-vaccinated individuals requires producing documentation of vaccination for the school.
  • For children who are not fully vaccinated, the “test to stay” strategy can be implemented in order to minimize missed days of school.
  • Any child allowed in school during the 10 day quarantine period (either fully vaccinated or using a “test to stay” strategy) should be isolated immediately if symptoms develop. The rules for isolation then apply.

What is the “test to stay” school strategy?

If unvaccinated close contacts (students less than 3 feet from COVID-positive classmates) have been properly masked throughout the period of contact, then the contacts may remain in school as long as they are wearing masks properly, are asymptomatic and test negative for COVID-19 repeatedly over the course of 10 days. In the studies of this strategy, testing was recommended on alternate days but, in reality, testing was performed at a variety of intervals.

What are the potential issues with the “test to stay” strategy?

  • Requires consistent mask wearing by children and staff to be eligible.
  • Requires frequent testing which is currently in short supply and therefore, difficult to implement at this time.
  • Children will need to remove their masks to eat. Note: children who have returned to school after 5 days in isolation can all eat together because they are protected against reinfection for approximately 3 months. Children for whom home quarantine has been waived using the “test to stay” strategy should be able to eat in the same areas as other children as long as they are being tested regularly.

Want to learn more about Infectious Diseases at Le Bonheur?

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