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COVID-19 town hall: Experts address schools, testing, quarantine, therapies

September 3, 2021

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Pediatrician experts at an AAP virtual COVID-19 town hall shared information on mitigating risks as school resumes, testing and quarantine, monoclonal antibody therapy and combating misinformation. Following are highlights.

Monoclonal antibody therapy
Vaccination should be the primary way to avoid severe illness from COVID-19, but pediatricians also may have questions about use of monoclonal antibody therapy for COVID-19 treatment and post-exposure prophylaxis, said Yvonne A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases.

The Food and Drug Administration has approved monoclonal antibody therapy for emergency use in children over age 12.

For treatment, a patient receives an hour-long infusion and is kept for observation. Facilities must be capable of accommodating a patient for several hours. Although it has high efficacy in reducing hospitalizations from COVID-19, Dr. Maldonado said therapy can be expensive.

Post-exposure prophylaxis requires a shorter visit. A monoclonal cocktail is given subcutaneously in a smaller amount than infusion therapy. It has been successful in reducing infections by about 80% if given within 96 hours of exposure, according to Dr. Maldonado.

Effectiveness of mitigation measures
During the 2020-’21 school year, COVID-19 transmission levels in a community played a large role in decisions to stay open or to close. This school year is different, with the availability of vaccines and improved understanding of effective mitigations (e.g., masking, 3 to 6 feet of distance, staying home when sick).

Preliminary data show mitigation measures can prevent significant spread of the virus, including the delta variant, within classrooms, said Sara Bode, M.D., FAAP, chair-elect of the AAP Council on School Health Executive Committee.

Dr. Maldonado pointed to a recent study that showed during a surge of SARS-CoV-2 in North Carolina, outbreaks were uncommon within schools where masking was routine. “The risk of infection in them was really very low,” she said.

Joelle Simpson, M.D., M.P.H., FAAP, a member of the AAP Council on Children and Disasters Executive Committee, said patients she sees in the emergency department (ED) are a “pulse check of what’s going on in the community.” EDs are seeing a surge of critical care patients, mostly from other viral illnesses such as respiratory syncytial virus.

Dr. Simpson also has noticed an increase in anxiety and uncertainty among families regarding school-related decisions on testing and quarantine. This has prompted them to reach out to their primary care pediatrician or come to the ED.

Pediatricians in communities where schools aren’t using mitigation measures are answering more calls from families and helping to guide them through exposure, testing and return to school. “Navigating all of that complexity is still a challenge for many communities right now,” Dr. Bode said.

Consistent communication
Clear communication across an entire pediatric group or institution is crucial, Dr. Simpson said. This includes knowing what is recommended regarding testing, quarantine and other common topics. When there is a disconnect in the institution, she said, it contributes to misinformation. She suggested posting guidelines online and regularly communicating across teams to ensure that consistent information is carried throughout the organization.

“There’s already so much divisive news and misinformation going on, even for us as trained providers … I found that virus of misinformation is one of the most challenging things to tackle through all of this,” Dr. Simpson said.

Dr. Bode agreed and urged pediatricians to be creative in starting conversations with parents to provide accurate information. “At any point that they’re coming in, if you can start that conversation, it’s a good time to start it.”

Dr. Maldonado encouraged pediatricians to keep communicating with each another. “We’re well past the time when we thought this pandemic would be over,” she said. “The hardest part is to really remember to practice self-care because it's hard to feel like you can stop because (the pandemic) hasn’t stopped.” She reminded everyone to support each other, “not only for the good of your patients, but your own wellbeing.”

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