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Getting you back to school: How COVID-19 is impacting children

For most students, the first day of school is less than a month away. East Tennessee Children's Hospital answered some questions about back-to-school safety.

KNOX COUNTY, Tenn. — In July, the age group with the most growth in COVID-19 cases has been kids between ages 11 to 20 in Tennessee.

As of July 17, the Tennessee Department of Health has reported nearly 8,000 cases of COVID-19 among 11-year-olds to 20-year-olds, but no deaths. Health experts say it's because kids tend to handle the virus without suffering from serious health problems. 

About 3,300 children ages 0 to 10 have been diagnosed with COVID-19 in the state; 3 of them have died.

10News received a lot of questions about safely returning to school, so we spoke with East Tennessee Children's Hospital Chief Medical Officer Dr. Joe Childs. 

Answers have been edited for clarity and length.

Q: What do we know about how COVID-19 impacts kids?

A: Well, we're learning several things. We know that it does not affect them as severely as it does adults. They don't seem to catch it as readily, and they may not spread it as easily. That's certainly what the most recent data is showing.

Q: What kind of symptoms do kids get from COVID-19?

A: Well, it ranges from no symptoms at all, but testing positive, to having a mild-to-moderate respiratory illness with fever and cough for a few days. Sometimes nausea and vomiting, headache can also be part of it. We haven't seen severe illness here [at East Tennessee Children’s Hospital] at all in kids.

Q: When parents are looking to send their kids back to school, what should they be considering from a health standpoint? 

A: That's a very tough situation because you know that your child is going to an environment where there is a risk of exposure. It's comforting to know that kids do handle this virus well if they encounter it.

The biggest concern about kids going to school, from a medical standpoint, is that if they have exposures, who are they bringing that to at home? Who's at risk in the home? That's the medical side of it. 

The educational side of it is that kid’s education is really suffering and not being in the classroom is a real problem. And the younger you are, I think it's more critical. The balance of medical decision making and what's important for our kids' growth, development and education is a really, really tough balance to strike. But hopefully, we can find successful ways for kids to be back in the classroom.

[Editor's Note: The full guidance from the American Academy of Pediatrics regarding reopening schools during COVID-19 can be found here.]

Q: For the kids who do go back to school, how important is social distancing and mask-wearing?

A: Masks are great for people who can competently wear a mask, but kids, especially as you get younger, cannot resist the temptation to touch their mask, handle their mask, take it on and off. 

It isn't assumed that you can take five-and-six-year-olds and say wear a mask all day long and that's going to work. That may actually put them at more risk. I trust the public health and school guidance on helping to make those individual classroom decisions about spacing and whether a mask is appropriate. The teachers need to be protected as well in this environment. They certainly would need to [wear a] mask in the classroom environment.

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Q: In terms of thermometers, are certain types more effective than others? How well do the touch-less ones work?

A: Thermometers that actually take an axillary or oral temperature — or in babies a rectal temperature — are definitely the most accurate. 

I see mixed data on the laser type that are just scanning the forehead. I think those can be used for screening. But if you get a result that's higher than expected, like close to 100 degrees with those screening devices, then I think a better temperature should be taken with a real thermometer.

Q: What is considered a fever? Why is 100.4 usually the standard?

A: First of all, 98.6 is an average and if you take your temperature, rarely do you actually find that it’s 98.6. Your temperature fluctuates during the day, naturally. It can be lowest in the morning and then increase later in the day.

The line of calling it fever has been debated 100.4 or 100.6 degrees. It's just based on experience in which it's not normal temperature fluctuation, but it's under the influence of an illness or medical condition that's causing that. A temperature of 99.6 or 99.8 degrees can be just normal fluctuation, especially in the heat of the summer. But, 100.4 degrees and above, that's a fever.

A: Can you get the flu and COVID-19 at the same time? Would that compound the effects of either?

A: Well, that's an interesting question. You know, the flu was still here when this coronavirus (COVID-19) came into the country and there were some reports of what we call co-infections, having both at the same time or at least testing positive for both at the same time.

There are other viruses that we know can test positive along with this COVID-19 coronavirus. But for this fall, we don't know about what strain of flu will emerge and how well our vaccine will work and whether you have to worry about having both at the same time.

The human body though, typically, you might test positive for more than one thing, but you typically only have one active infection at a time.

Q: Are face shields effective when compared to a face mask?

A: Well, let's talk about what we wear here at the hospital to protect us. We know that the virus is shed a lot by coughing and airborne spread and so we use the mask to protect our nose and mouth. Then, we want something over our eyes whether it's a shield or goggles to prevent the surface of our eyes being a place that is exposed to the virus.

If you take that outside the hospital environment, into the home environment or school environment or just out in the community, wearing something that covers the eyes is a safe practice.

A face shield is not as effective as a mask. The mask is definitely the most effective. The [face shield] would just be an add.

Q: How is COVID-19 testing going at Children’s Hospital?

A: We're testing between 100 and 200 hundred kids a day now for all the different reasons that the testing is being requested. We have seen our positive testing rates rise significantly over the last two to three weeks

Right now, it's about 6 percent positive. So, one out of 16 tests is positive. These, again, are mostly are kids that aren't very sick, some are not sick at all, but they are testing positive for the virus.

We've been testing some patients that are having surgery, in advance of the surgery, and we are going to start testing all of them soon prior to surgery as well so that we keep our environment safe here inside the walls of Children's Hospital.

[Editor's Note: A special testing site has been established outside for COVID-19 testing at Children's Hospital. Beginning Monday, it will be located on 22nd Street.]

A: Have you seen a lot of asymptomatic kids testing positive?

A: Yes, when there's a really profound exposure in the household or if it's a babysitter/daycare situation. And then, testing some patients before surgery that have no symptoms, just as a screening tool, we have certainly seen positive results to those tests.

[The positivity rate] is not as high as those who have symptoms, but yes, we have seen a significant number of positives among asymptomatic pediatric age patients.

Q: Anything else that’s important as kids start heading back to school?

A: We've only had two inpatients, two admitted patients, that have been positive for COVID-19. So all these tests and these positive results that you hear about, those are almost all on outpatients, patients that are at home. 

That's not surprising given that this virus does not seem to cause real severe disease in kids. But right now, there is a significant amount of this virus in our area.

While there is fatigue about all these safety precautions that are necessary, it's more important now than ever to protect yourself from this virus. Nobody wants this. We don't know why in some patients it causes such severe disease. But outside of the pediatric age range in the young adult and adults range, this is not all elderly patients. 

[Editor's Note: The youngest death recorded in Knox County so far has been a 29-year-old woman with chest congestion, cough and shortness of breath.]

We're concerned about people being reluctant to come to the hospital when they really need to. We've seen some examples of things being worse for certain patients than they needed to be because they delayed care.

The hospital is a very safe environment with the screening that we have before you can get into any of our buildings, the masks that we're wearing and policies requiring all our guests and visitors to wear — as well as our strict adherence to hand washing and cleaning surfaces.

We don't want people to delay seeking care because their picture in their mind is they're going to catch this virus here. The place where you're exposed to this virus is out in the community.

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