Provider FAQ: COVID-19 and MIS-C

If you have any questions regarding COVID-19 or multisystem inflammatory syndrome in children (MIS-C), email us at providerquestions@lebonheur.org.

My asymptomatic patient has credible exposure to COVID-19. What should I do?

The patient (and family members) should stay at home for 14 days since last known exposure, checking temperatures twice a day. Instruct them to call your practice if they develop symptoms (see below for additional guidance).

What should I do if my patient has developed mild symptoms of COVID-19?

Provide guidance on supportive care and refer to an outpatient testing facility. Le Bonheur is not a public testing facility. Please refer to this list of pediatric public testing facilities for COVID-19

My patient has developed severe symptoms of COVID-19. What should I do?

Stabilize your patient—if present—and then refer to the Emergency Department. If unstable, call 911 or instruct family to call 911 to transport. If in your judgment the patient is stable enough to travel by their own vehicle, direct them to the Emergency Department. In either case, call the Emergency Department to alert them to the arrival of a suspected case of COVID-19.

What should I do if my office has been exposed to a known or suspected patient with COVID-19?

Health care workers who have been exposed to a known or suspected patient should monitor themselves for symptoms and measure temperature twice daily. If fever or symptoms develop, they should quarantine and get tested. The Tiger Lane testing center will test asymptomatic health care workers who have been exposed to COVID-19.

My patient may have MIS-C. When should I refer to the Emergency Department?

MIS-C, as its name states, is a multisystem inflammatory syndrome where one of the defining characteristics is hypotension. If your patient has had a prolonged fever (greater than five days) or is presenting with hypotension or any other medical emergency, refer to the Emergency Department as you normally would. Unfortunately, no predictive test is available to determine if a patient will develop MIS-C until they have multisystem involvement.

If a child presents with fever without a source and has had a confirmed COVID-19 infection within the last two to three weeks, it is not unreasonable to have this child evaluated in the ED where appropriate labs (BNP, ferritin, troponin, etc.) can be obtained.  

How can my patient avoid getting COVID-19?

The mainstays of prevention are social distancing by avoiding others from outside your household, avoid touching your face, wash your hands frequently and thoroughly when outside of your home and routine disinfection of frequently touched surfaces and objects in the home using an EPA-approved disinfectant. Some of these are more difficult for children of different ages. However, if family members are adhering to appropriate prevention strategies outside the home and the children are kept at home without visitors from other households, the family has created as good of a defense as is currently possible. Each deviation from this practice carries an undefined but real risk of infection during our current pandemic. Families should carefully consider whether a given deviation is necessary.

See the U.S. Centers for Disease Control and Prevention website for guidance on going out in public.

Can my patient go to the pool? A restaurant? A birthday party? Church?

Social distancing is crucial to preventing the spread of COVID-19 and avoiding infection. The Tennessee Department of Health and the U.S. Centers for Disease Control and Prevention have established guidelines for the opening and administration of various facilities during the current pandemic. However, these precautions can only reduce the risk of infection by attendees; they do not eliminate the risk. If your patient has an underlying health condition—especially cardiac, pulmonary, or immunologic—then strongly counsel your patients against public activities with mixed household attendance.

Can my patient go camping? To the beach?

Social distancing is crucial to preventing the spread of COVID-19 and avoiding infection. The Tennessee Department of Health and the U.S. Centers for Disease Control and Prevention have established guidelines for the opening and administration of various facilities during the current pandemic. However, these precautions can only reduce the risk of infection. The net risk to your patient depends upon the park and the family’s plans.

Counsel your patients against attending crowded parks. They should contact the venue to determine what services are available and what steps are being taken to protect visitors. They should visit parks close to home. They should adhere to social distancing even when outdoors, staying six feet away from others who do not live in their household. They should avoid playground equipment. See above for pool, hot tub, and water park activities.

Can my patient play sports?

Social distancing is crucial to preventing the spread of COVID-19 and avoiding infection. The Tennessee Department of Health and the U.S. Centers for Disease Control and Prevention have established guidelines for the opening and administration of various facilities during the current pandemic. However, these precautions can only reduce the risk of infection. The U.S. Centers for Disease Control and Prevention has published guidelines on how to assess the risk of a given sports activity.

In general, consider the closeness of other players and how long they must remain near other players or staff as well as how frequently shared equipment, including balls, are touched. Your risk increases as you move from skill drills or conditioning at home/alone to team-based practice to within team competition to competition between local teams to competition between teams from different geographic regions.