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Red Book Online Outbreaks: 2019 Novel Coronavirus (SARS-CoV-2 that causes COVID-19) Pandemic

November 5, 2021
No

Updated 12/2/2021

Since the first cases of the novel coronavirus (SARS-CoV-2 that causes COVID-19) pandemic were identified in Wuhan, Hubei Province, China in December 2019, more than 263,689,900 cases have been confirmed and 5,228,097 deaths have been reported. The pandemic has spread within China and within more than 180 countries, including the United States. On January 30, 2020, the W.H.O. declared the outbreak to be a public health emergency of international concern, and on March 11, 2020, the W.H.O declared COVID-19 viral disease a pandemic. On January 31, 2020, the U.S. officials declared novel coronavirus to be a public health emergency. Transmission has been identified as person-to-person, and older adults/people with comorbidities are at increased risk of severe disease. All pediatric populations remain potentially at risk. As health officials continue to investigate the 2019 novel coronavirus, recommendations evolve as more is understood about the disease.

The table of contents below provides navigable links to allow users flexibility in exploring the sections most relevant and of interest to them.

Epidemiology Current Guidance for Practices Infection Control Resources

Symptoms

Hospitalization

Multisystem Inflammatory Syndrome in Children (MIS-C)

Preparing Medical Practices

COVID-19 Vaccines

Transmission of SARS-CoV-2

What to Tell Families

Travel

CDC

AAP

WHO

IDSA

Journal Articles

Additional MIS-C Resources

 

Health officials continue to investigate the 2019 novel coronavirus (SARS-CoV-2 that causes COVID-19) pandemic first recognized in December 2019 in Wuhan, Hubei Province, China. It has now spread within China and within more than 180 countries, including the United States. Recommendations evolve as more is understood about the disease.

Epidemiology

  • Chinese authorities initially reported a link in Wuhan with a large seafood and live animal market, suggesting a possible zoonotic origin to this outbreak. The market was closed on January 1, 2020. Bats are believed to be the natural reservoir and pangolins may be intermediate hosts.
  • Cases have been reported in many countries globally, including the United States. (Johns Hopkins global case map)
    • As of December 2, 2021, there have been 48,695,518 confirmed and presumptive positive cases in the United States, including 782,106 deaths. (Johns Hopkins and CDC case info)
  • As of December 1, 2021, US Children make up 15.5% of all COVID-19 cases in the US. The CDC estimates that 16% of pediatric COVID-19 infections are asymptomatic. (https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html#symptoms-severity)
  • From March 1, 2020 through April 30, 2021, approximately 1.5 million COVID-19 cases in individuals 11 to 17 years of age have been reported to the CDC (https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html#symptoms-severity)

Symptoms

  • Signs and symptoms of this illness in US children with laboratory-confirmed COVID-19 were reported as fever (subjective or documented), cough, or shortness of breath (73%), myalgia (23%), runny nose (7%), sore throat (24%), headache (28%), nausea/vomiting (11%), abdominal pain (6%), diarrhea (13%). (MMWR: "Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020")
    • During this time period, 1.7% of laboratory-confirmed cases occurred in children aged < 18 years. Median age was 11 years (range 0-17) and 57% of pediatric cases occurred in males. About 23% had at least one underlying condition, most commonly chronic lung disease (including asthma, cardiovascular disease, and immunosuppression).

Hospitalization

  • From March 1, 2020 - July 25, 2020, the rate of hospitalization of children aged <18 years was 8.0 per 100,000 population, with the highest rate among children aged <2 years (24.8 per 100,000 population). 1 in 3 hospitalized children were admitted to the ICU.
    • Non-Hispanic Black and Hispanic or Latinx children had higher rates of COVID-19-associated hospitalization (10.5 and 16.4 per 100,000 respectively) than non-Hispanic white children.
    • Of children who were hospitalized, 42.3% had at least 1 underlying medical condition, of which obesity was most prevalent (37.8%), followed by chronic lung disease (18%).
    • Gastrointestinal symptoms of nausea, vomiting, abdominal pain, and/or diarrhea was reported in 42% of hospitalized children. (Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020)
  • As of April 22, 2021 there have been 3,711,075 total child cases reported, with children comprising 13.7% of all cases (https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/)
  • Some patients develop worsening of illness during the second week of symptoms.
  • Findings of unilateral or bilateral infiltrates, multiple areas of consolidation, and ground glass opacities on chest imaging and lymphopenia have been noted in some of the hospitalized patients with COVID-19. In addition, mild abnormalities in white blood cell count, mildly elevated inflammatory markers, and mildly elevated liver enzymes have been found in children.
  • Healthcare providers should obtain a detailed exposure history for patients being evaluated with fever and acute respiratory illness. In addition, for severely ill patients with acute respiratory distress syndrome (ARDS) or pneumonia without a known pathogen, consultation with health officials is recommended. Local or state public health guidance for testing should be reviewed.
  • For initial diagnostic testing for COVID-19, see CDC guidance for specimens. Appropriate infection control practices should be followed.

Multisystem Inflammatory Syndrome in Children (MIS-C)

  • MIS-C is a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). It is reported to appear about 2-4 weeks after the onset of COVID-19 in children and adolescents.  https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e2.htm?s_cid=mm6932e2_w
  • It was first reported by the UK at the end of April. While cases were noted to have common overlapping clinical features with toxic shock syndrome and atypical Kawasaki disease, there was evidence of very high inflammatory markers. In addition, cases typically had an association with COVID-19. Abdominal pain (with gastrointestinal symptoms) as well as evidence of cardiac inflammation were frequently noted.
  • As of July 29, 2020, 570 patients that have met the MIS-C case definition have been reported to the CDC. Median hospital stay was 6 days, 63.9% of patients required care in the ICU, and 1.8% of patients died.
    • Median patient age was 8 years (range = 2 weeks–20 years); 55.4% were male. Obesity was the most commonly reported underlying medical condition.
    • Approximately two-thirds did not have pre-existing underlying medical conditions before MIS-C onset.
    • MIS-C affected four or more organ systems in 86% of cases. Most patients had gastrointestinal (90.9%), cardiovascular (86.5%), or dermatologic or mucocutaneous (70.9%) involvement.
    • The most common signs and symptoms reported during the illness course were abdominal pain (61.9%), vomiting (61.8%), skin rash (55.3%), diarrhea (53.2%), hypotension (49.5%), and conjunctival injection (48.4%).
    • Substantial numbers of MIS-C patients had severe complications, including cardiac dysfunction (40.6%), shock (35.4%), myocarditis (22.8%), coronary artery dilatation or aneurysm (18.6%), and acute kidney injury (18.4%).
    • The majority of patients (63.9%) were admitted to an ICU. The median length of ICU stay was 5 days (interquartile range = 3–7 days) (COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020)
  • Patients with this syndrome tested positive far more often for past SARS-CoV-2 infection (i.e., antibody test) than acute infection (i.e., RT-PCR or antigen test).
  • Case definition, as per the CDC:
    • An individual aged <21 years presenting with:
      • fever (24 hours or more),
      • laboratory evidence of inflammation (CRP, ESR, fibrinogen; procalcitonin, d-dimer, ferritin, LDH, or IL-6, neutrophilia, lymphopenia, low albumin),
      • evidence of clinically severe illness requiring hospitalization,
      • with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
    • No alternative plausible diagnoses; AND
    • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms.
  • CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.
  • CDC Health Alert: "Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)"
  • Some children appear to have a milder form of this syndrome.
  • Testing for MIS-C
    • A child who presents with a persistent fever (>3 days) and who is moderately to severely ill with clinical signs of organ dysfunction should be evaluated.
    • For optimal testing and management, infectious disease or rheumatology specialists and pediatric referral centers should be consulted.
    • Initial laboratory screening may include a complete blood cell count (CBC) with differential, urine analysis, ESR, CRP, ferritin, LDH, comprehensive metabolic panel, pro-BNP, troponin, and fibrinogen. Laboratory screening for systemic inflammation may also be considered.
    • Hospitalized children may need an expanded laboratory and cardiac workup.
  • Evaluation and treatment of MIS-C in a child should utilize a multidisciplinary approach of many pediatric specialists, including but not limited to cardiology, infectious disease, immunology, hematology, rheumatology, pediatric hospital medicine, and critical care.
    • Patients with MIS-C have been treated with IVIG, 1 to 2 grams/kg. Cardiac function and fluid status influence the timing of therapy.
    • Patients have been treated with steroid therapy (from 2 to 30 mg/kg/day of methylprednisolone) and biologics (such as anakinra, 2 to 10 mg/kg/day subcutaneously or intravenously, divided every 6 to 12 hours).
    • Patients treated with steroids and/or biologics will undergo a 3-week taper of steroids and/or biologics at home.
    • Many patients have received concurrent antibiotic therapy given the need for early intervention and the need to initiate treatment for multiple possible etiologies
    • Assessment of clotting risk and treatment/prophylaxis (eg, low-dose aspirin for patients with Kawasaki disease-like syndrome or enoxaparin in patients with thrombosis) is recommended, with consultation from cardiology and/or hermatology.
  • Prevention and Control Strategies
    • Patients hospitalized and presenting with MIS-C should be considered as COVID-19 patients.
    • RT-PCR & antibody testing for COVID-19 should be performed.
    • Local infection control policies should be followed.
  • Follow-up for MIS-C patients: Outpatient pediatric cardiology follow-up should begin 2-3 weeks after diagnosis (https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance/)

Current Guidance for Medical Practices

Preparing Medical Practices

  • Prepare your practice and encourage everyone to follow national guidance during the COVID-19 pandemic. (https://www.cdc.gov/coronavirus/2019-ncov/community/index.html.
  • Optimize telehealth and other non-direct contact care, when available and appropriate. To make telehealth services easier to implement and access, see https://telehealth.hhs.gov/providers/
  • If a practice can provide only limited well child visits, health care providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible. Screenings and anticipatory guidance can be provided virtually.
  • Determine contact history of your patients coming from affected areas or contact with person(s) confirmed with COVID-19, especially in those patients with fever and respiratory illness. In some areas in the United States, there are cases occurring in the community without identified exposures. Criteria for evaluation can be found at https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html, or check your local or state health department website.
  • Suspect cases (PUI: persons under investigation) and RT-PCR positive cases must be documented for state or local health officials (if testing is not done at the public health laboratory). Clinics should continue to review outpatient care procedures with infection preventionists. Clusters of cases should be discussed immediately with state or local health officials
  • All patients and staff should be screened for COVID-19 like symptoms before entering the health care facility to address asymptomatic and pre-symptomatic transmission. Source control should be implemented for everyone regardless of symptoms.
  • Providers must clean their hands, including before entering and when leaving the room; make sure their eyes, nose. and mouth are fully covered before room entry; and remove face protection before room exit.
  • All patients and visitors should wear a face covering if they are over the age of 2 years old. If a face covering is not available and PPE supply is sufficient, a facemask may be used.
  • Patients with respiratory illness should be placed in a private room with the door closed as soon as possible. If an aerosol-generating procedure is done, an airborne infection isolation room should be used.
  • N95 respirators or equivalent or higher-level respirators are indicated for all aerosol-generating procedures and all surgical procedures that might pose higher risk for transmission if the patient has COVID-19.
    • Obtaining a nasal or nasopharyngeal swab is not considered an aerosol-generating procedure.
    • From a manufacturer of N95 masks “There is no time limit to wearing an FFR (filtering facepiece respirator). Respirators can be worn until they are dirty, damaged, or difficult to breathe through”
  • For source control while in the facility and for protection during patient care encounters, one of the following should be worn by HCP: 
    • An N95 respirator or
    • Respirator approved under standards used in other countries similar to NIOSH-approved N95 filtering facepiece respirators or 
    • A well-fitting facemask
    • Eye protection should be worn during patient care to protect from exposure to respiratory secretions
  • HCP who enter the room of a patient with suspected or confirmed SARS-CoV-2 infection should adhere to Standard Precautions and use a NIOSH-approved N95 or equivalent or higher-level respirator, gown, gloves, and eye protection
  • CDC recommends Standard, Contact, and Airborne Precautions and eye protections (face shield or goggles) for healthcare providers. If N95s are in short supply, and an aerosol-generating procedure is not being done, a facemask may be used. See:  https://www.cdc.gov/coronavirus/2019-nCoV/infection-control.html.

COVID-19 Vaccines

  • Pfizer-BioNTech, Moderna, and the Johnson & Johnson’s Janssen COVID-19 vaccines have been authorized by the FDA for emergency use in preventing COVID-19 in the United States 
  • All three vaccines have a high efficacy at preventing hospitalization and death in people who become infected
  • Pfizer-BioNTech and Moderna COVID-19 vaccines have efficacy rates of 95% and 94.1% respectively 
  • The Johnson & Johnson vaccine was reported to be 66.3% effective in clinical trials
  • None of the currently authorized COVID-19 vaccines are live virus vaccines.
  • Both Pfizer-BioNTech and Moderna vaccines utilize messenger RNA (mRNA) to encode the spike protein of the virus that causes COVID-19. Your immune system will recognize these foreign proteins and begin launching an immune response by making antibodies that will protect against COVID-19 infection
  • Johnson & Johnson’s Janssen COVID-19 vaccine uses a traditional viral vector delivery mechanism. The vector which is not a virus, enters the cell and uses the cell’s machinery to produce a harmless piece of the spike protein virus that causes COVID-19. The production of the spike protein causes an immune response which triggers the production of antibodies. This process enables our bodies to learn how to protect itself from future, harmful COVID-19 infection.
  • After reports of severe cases of blood clots after administration of the Johnson & Johnson’s Janssen vaccine, vaccine distribution was halted temporarily.
    • Effective April 23, 2021, the CDC and FDA recommended that use of Johnson & Johnson’s Janssen COVID-19 Vaccine resume in the United States. However, women younger than 50 years old especially should be aware of the rare risk of blood clots with low platelets after vaccination, and that other COVID-19 vaccines are available where this risk has not been seen
    • Visit the CDC’s website to learn more about the safety of and updates on the J&J vaccine: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html
  • As of May 10, 2021, the FDA authorized Pfizer-BioNTech COVID-19 vaccine for emergency use in adolescents ages 12-15.
    • The Pfizer-BioNTech COVID-19 vaccine is administered as a series of two doses, three weeks apart, the same dosage and dosing regimen for 16 years of age and older
    • The FDA determined that the benefits of vaccination significantly outweigh the potential risks 
    • In a clinical trial, seven days after administration of the second dose of the Pfizer-BioNTech vaccine, among participants without evidence of prior SARS-CoV-2 infection no cases of COVID-19 occurred among 1,005 vaccine recipients and 16 cases of COVID-19 occurred among 978 placebo recipients - thus the vaccine was 100% effective in preventing COVID-19 in adolescents ages 12-15 years old
    • Visit the FDA website to read the full statement: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use
  • Authorized age groups:
    • Pfizer-BioNTech: ages ≥12 years
    • Moderna: ages ≥18 years
    • Johnson & Johnson: ages ≥18 years
  • Administration:
    • Pfizer-BioNTech: (30 µg, 0.3 ml each) three weeks (21 days) apart
    • Moderna: (100 µg, 0.5 ml each) one month (28 days) apart
    • Johnson & Johnson: (5×1010 viral particles) one single 0.5mL dose
  • As of April 27, 2021 the need for and timing of COVID-19 booster doses have not been established. No additional doses are recommended at this time
  • Visit the CDC’s website for clinical considerations for use of COVID-19 Vaccines: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html
  • Refer to the emergency use authorization fact sheets for healthcare providers about the administration of both COVID-19 Vaccines:
  • COVID-Vaccines are not interchangeable
    • The safety and efficacy of a mixed-product series have not been evaluated. If you have received either the Pfizer-BioNTech or the Moderna vaccine, both doses should be completed with the same product
  • People vaccinated with COVID-19 vaccines not authorized in the United States
    • No data are available on the safety or efficacy of receiving a COVID-19 vaccine currently authorized in the United States after receipt of a non-FDA-authorized COVID-19 vaccine. 
    • In some circumstances people who received a COVID-19 vaccine not currently authorized in the United States may be offered revaccination with an FDA-authorized vaccine:
      • COVID-19 vaccines not authorized by FDA but authorized for emergency use by WHO
      • People who completed a COVID-19 vaccination series with a vaccine that has been authorized for emergency use by the WHO do not need any additional doses with an FDA-authorized COVID-19 vaccine.
    • COVID-19 vaccines not authorized by FDA or not authorized for emergency use by WHO
      • People who completed or partially completed a COVID-19 vaccine series with a vaccine that is not authorized by FDA or not authorized for emergency use by WHO may be offered an FDA-authorized COVID-19 vaccine series
  • Vaccinating people with prior or current SARS-CoV-2 infection
    • People should be offered vaccination regardless of their history of symptomatic or asymptomatic SARS-CoV-2 infection, including people with prolonged post-COVID-19 symptoms.
    • Vaccination of people with known current SARS-CoV-2 infection should be deferred until the person has recovered from the acute illness
      • This recommendation applies to people who experience SARS-CoV-2 infection before receiving any vaccine dose and those who experience SARS-CoV-2 infection after the first dose of an mRNA vaccine but before receipt of the second dose
  • Vaccinating people who people who previously received passive antibody therapy
    • Currently, there are no data on the safety and efficacy of COVID-19 vaccines in people who received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment. 
    • Based on the estimated half-life of such therapies and evidence suggesting that reinfection is uncommon in the 90 days after initial infection, vaccination should be deferred for at least 90 day
  • Vaccinated people who develop COVID-19
    • For vaccinated people who subsequently experience COVID-19, prior vaccination should not affect treatment decisions or timing (including use of monoclonal antibodies, convalescent plasma, antiviral treatment, or corticosteroid administration)
    • If a person is fully vaccinated and tests positive for SARS-CoV-2, healthcare providers and local health departments are encouraged to request the specimen be held and to report the case to their state health department
      • CDC will work with the state health department to collect information about the case. In addition, information about these cases should be reported to VAERS.
  • Please visit the CDC website for update guidance and clinical considerations: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

Infection Control

Transmission of SARS-CoV-2

  • SARS-CoV-2 is a novel betacoronavirus causing the current pandemic of COVID-19 disease.
  • To date, the epidemiology of the COVID-19 pandemic indicates that the transmission of SARS-CoV-2 occurs via unprotected direct, indirect, or close contact with (within about 6 feet) with infected secretions, respiratory droplets, small particles or contaminated surfaces and objects when an infected individual coughs, sneezes, sings, talks, or breathes.
  • The particles can be inhaled into the nose, mouth, airways, and lungs which cause infection.
  • Airborne SARS-CoV-2 particles can remain suspended in the air and breathed in, and travel distances greater than 6 feet.
  • Airborne transmission of SARS-CoV-2 can occur during medical procedures that generate aerosols. 
  • Although suspected to not be the main mode of virus spread, touching contaminated surfaces or objects and then touching your mouth, nose, or eyes can lead to infection.
  • Indoor environments, such as restaurants or fitness classes, without good ventilation increase this risk. 
  • Several studies indicate that the transmission of COVID-19 is affected by temperature. An inverse correlation was found between temperature and the daily number of infections. 
  • Recent studies have examined aerosol and surface stability of SARS-CoV-2.
    • On copper, no viable SARS-CoV-2 was measured after 4 hours.
    • On cardboard, no viable SARS-CoV-2 was measured after 24 hours.
    • On stainless steel, the virus titer was greatly reduced by 48 hours.
    • On plastic, the virus titer was greatly reduced by 72 hours.
    • The estimated median half-life of Sars-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic.
    • SARS-CoV-2 remained viable in aerosols throughout the duration of the experiment (3 hours).
    • (Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1; 2020. Available: https://www.nejm.org/doi/pdf/10.1056/NEJMc2004973?articleTools=true)
  • Although cases of COVID-19 among health care workers (HCW) have been described, nosocomial transmission does not appear to be a major method of spread with the proper use of PPE.
    • In China, a large number of case clusters have been described with almost two-thirds via family spread. (Wu, JAMA, February 24, 2020)
  • Transmission of SARS-CoV-1 (agent of Severe Acute Respiratory Syndrome-SARS) to HCW was primarily via direct contact with respiratory droplets. Aerosol-generating procedures such as tracheal intubation were also shown to pose increased risk of transmission of SARS-CoV-1 to HCW.
  • Knowledge to date suggests several similarities between the transmission characteristics of SARS-CoV-2 and SARS-CoV-1.
    • Direct contact with large droplets or contaminated objects is the major mode of transmission with an added risk to HCW from high-risk aerosol generating procedures.
    • The proper use of PPE and hand hygiene is the appropriate step to protect HCW from infection with these agents.
  • People without symptoms could infect others. The extent of truly asymptomatic infection in the community continues to be studied using information gathered from detailed contact tracing efforts and epidemiologic investigations among cases and contacts.
  • One study has indicated that infectiousness peaks before the onset of symptoms of the disease.
  • There is a risk that a newborn tests positive for SARS-CoV-2 in the hours or days after birth to a mother with COVID-19 at the time of delivery. 
    • The Perinatal COVID-19 Registry reports that approximately 2% of infants born to mothers who test positive for SARS-CoV-2 tested positive within 24-96 hours after birth.
    • Highest risk of infection to newborns is suggested to be when a mother has onset of COVID-19 near the time of delivery.
    • There is currently no clear risk distinction between maternal symptomatic and asymptomatic infection; a mother’s ability to transmit the SARS-CoV-2 virus can only be certain when there is an onset of symptoms.
  • Updated interim guidance for the management of infants born to mothers with confirmed and suspected COVID-19 has been released. (https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/)
  • Compared with children and adolescents (aged <18) who tested negative for the virus that causes COVID-19, children who tested positive were more likely to have attended gatherings, but were not more likely to have attended childcare or school in person
    • Most close contact exposures were more likely to be a family member and less likely to be school or childcare classmates
    • To prevent the spread of COVID-19, school and program administrators and parents should continue to encourage consistent use of masks, social distancing, frequent handwashing, isolation of infected persons, and quarantine of those who are exposed to the virus 
  • To prevent the spread of COVID-19 at home if a family member is ill, additional prevention measures can be taken to reduce transmission, such as wearing masks, reducing shared meals and items, cleaning and disinfecting the home, and wearing gloves for those with and without known COVID-19 in the household
    • (Hobbs CV, Martin LM, Kim SS, et al. Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years — Mississippi, September–November 2020. MMWR Morb Mortal Wkly Rep 2020;69:1925-1929. DOI: http://dx.doi.org/10.15585/mmwr.mm6950e3)
  • Households are favorable environments for SARS-CoV-2 transmission, as they are enclosed spaces where family members may crowd in close contact with reduced use of personal protective equipment in comparison to other settings 
    • Spouses are at higher risk of transmission than other family contacts 
    • Household crowding (e.g., number of people per room) may be more important to transmission than the total number of people per household
    • Given that people with suspected or confirmed infections isolate at home, households will continue to be venues of transmission 
    • To combat household transmission, increased mask-wearing at home, improved ventilation, and voluntary isolation should be considered 
      • (Madewell ZJ, Yang Y, Longini IM, Halloran ME, Dean NE. Household Transmission of SARS-CoV-2: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2031756. doi:10.1001/jamanetworkopen.2020.31756)
    • Separate a household member who is sick and separate people at higher risk from them. Have only one person in the household take care of the person who is sick, if possible. 

What to Tell Families

  • CDC recommends delaying international travel until you are fully vaccinated. Those who are fully vaccinated should get tested with a viral test 3-5 days after travel, self-monitor their health for COVID-19 symptoms, and follow all state and local recommendations or requirements after travel. Those who are not vaccinated should get tested with a viral test 3-5 days after travel AND stay home and self-quarantine for a full 7 days after travel. (https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html)
  • CDC has provided information on travel within the United States (https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html)
  • Check public health recommendations frequently regarding travel recommendations and restrictions.
  • Your state or local health department may have additional recommendations on containing the virus in your community. Check their website and follow their guidance.
  • CDC has information for families on preparing and responding to COVID-19 cases in their community. (https://www.cdc.gov/coronavirus/2019-ncov/community/index.html)
  • Children who have medical conditions should discuss recommendations for changes in activities with their pediatrician. (People Who are at Higher Risk | Groups at Higher Risk for Severe Illness)
  • Signs and symptoms of illness include fever, chills, dry cough, difficulty breathing, and tiredness (fatigue). Some patients also have muscle aches (myalgias), nasal congestion, runny nose, sore throat, headache, nausea, vomiting, diarrhea, and loss of smell or taste.
  • Most children and adolescents infected by SARS-CoV-2 present with mild symptoms. In general, pediatric patients have had a good prognosis and recovered within 1 to 2 weeks after disease onset. (https://jamanetwork.com/journals/jamapediatrics/fullarticle/2765169)
  • Children are at similar risk of infection as the general population.
  • Standard recommendations to prevent infection spread include regular and meticulous hand washing, and covering mouth and nose when coughing and sneezing.
  • In limited studies, COVID-19 has not been detected in breast milk.
  • Breastfeeding is still recommended, although care should be taken to prevent the transmission of virus from mother to baby through proper hygiene. (https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html)
  • Avoid close contact with anyone showing signs or symptoms of respiratory illness, such as coughing and sneezing.
  • If you feel sick with fever, cough, or difficulty breathing, or other symptoms of COVID-19:
    • Do not go to work or school. Except for seeking medical care, avoid contact with others.
    • Consult your doctor, or if you are being monitored consult the health department. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel or exposure and your symptoms.
    • Avoid touching your face, and cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
    • Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
  • CDC is additionally advising the use of simple cloth face coverings in public places to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html)
    • Those with symptoms should additionally wear masks inside the house.
    • Masks should not be worn by children younger than 2 years old or by individuals who are unable to remove the mask by themselves or are unconscious.
    • No matter the material of the mask, it should have two layers of washable breathable fabric, fit well without any gaps, completely cover the nose and mouth, and not restrict the wearer’s ability to breathe. (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html)
    • Before putting on a face mask, wash your hands for 20 seconds or use an alcohol-based hand sanitizer. Without touching the front of the mask, secure the ties behind your ears or head. While wearing the mask, do not touch the mask or your face. When removing the mask, take off the ear loops or ties. Do not touch the front of the mask or your face when removing the mask. After removing the mask, wash your hands with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer.
    • Face masks should be washed routinely with soap and water or laundry detergent to prevent contamination (https://www.jamanetwork.com/journals/jama/fullarticle/2764955?resultClick=1).
  • CDC has updated mask guidelines for those who are fully vaccinated, but you should still continue to wear a mask that fits snugly against the sides of your face and doesn’t have gaps whenever you are: in indoor settings, gathering indoors with unvaccinated people from more than one other household, and visiting indoors with an unvaccinated person who is at increased risk of severe illness or death from COVID-19 or who lives with a person at increased risk (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html)
  • Fully vaccinated people can:
    • Visit with other fully vaccinated people indoors without wearing masks or physical distancing
    • Visit with unvaccinated people (including children) from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing
    • Participate in outdoor activities and recreation without a mask, except in certain crowded settings and venues (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html)
  • On May 13, 2021, the CDC announced that fully vaccinated individuals can:
    • Resume activities that they did prior to the pandemic
    • Resume activities without wearing a mask or staying 6 feet apart, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance
    • Do not need to get tested before or after travel or self-quarantine after travel within the United States
    • Do not need to stay away from others or get tested unless they have symptoms after being around someone who has COVID-19
    • Visit the CDC website to learn more about what you can now start do and should continue to do as a vaccinated person (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html)
  • Visit AAP’s parenting website for COVID-19 information: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/2019-Novel-Coronavirus.aspx

Travel

  • Check the CDC website frequently for updates (https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html).
  • The US Department of State has lifted the level 4 travel alert for international travel as of August 6, 2020.
  • US citizens and legal permanent residents will be permitted to return from the United Kingdom, Ireland, and the European Schengen area. The Department of Homeland Security has issued instructions requiring U.S. passengers that have been in the United Kingdom, Ireland, and the European Schengen area in the past 14 days to travel through a select 13 airports where the US government has implemented enhanced screening procedures.
  • Foreign nationals who have visited one of these countries in the past 14 days may not enter the United States: China, Iran, European Schengen area (Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City), United Kingdom (England, Scotland, Wales, Northern Ireland), Republic of Ireland and Brazil.
  • CDC has issued the following travel guidance related to COVID-19:
    • A Level 3, Avoid Nonessential Travel warnings has been issued for most global travel where COVID-19 risk is high, recommending that travelers avoid nonessential international travel.
    • CDC recommends that older adults and people of any age with serious chronic medical conditions should consider postponing nonessential travel.
    • CDC also recommends that U.S. citizens, particularly travelers with underlying health conditions, should not travel by cruise ship at this time.
    • All international travelers should stay home for 14 days after returning from travel, monitor their health, and practice social distancing.
  • Multiple locations in the United States as well as in multiple countries have ongoing community transmission. Check for updates on reports of areas experiencing rapid increases in cases. (Travel Health Notices)
 

Resources

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AAP

WHO

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