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Management guidelines for COVID-infected and COVID-exposed individuals

As we ring in 2022, we are, unfortunately, in the middle of yet another COVID surge. Massachusetts case counts are the highest they have been since the start of the pandemic - a trend that we are definitely seeing in our office (over 50% of our phone calls today were families with a COVID positive child).

We are anticipating a very difficult and extremely busy month of January (especially the next 2 weeks). In order to help you understand the requirements, we have outlined the management guidelines for individuals who have been diagnosed with COVID or who have been exposed to someone with COVID.

Please do not call the office for questions about what to do if your child has been exposed to COVID or has been diagnosed with COVID — refer to the guidelines below!

We hope that you will read these guidelines closely as they contain all the information needed for the majority of questions you may have.

The following guidelines represent the most recent recommendations for managing individuals with a positive COVID test, as well as identified close contacts of people with COVID.

Please see the CDC website for instructions on the difference between isolation and quarantine.

Positive COVID Test

This guideline applies to you if test positive for COVID (either by rapid antigen test or PCR test) regardless of your vaccination status.

  • a positive rapid antigen test does not need to be confirmed with a PCR test

Guidelines:

  1. Stay at home for five days.
  2. If you have no symptoms or your symptoms are resolving after five days, you can leave your house.
  3. Continue to wear a mask around others for five additional days (this includes wearing a mask at home as well as outside the home).
    1. If you are unable to wear a mask, you must isolate at home for a total of 10 days.
  4. If you have a fever, continue to stay home until your fever has resolved for 24 hours.
  5. Please send MyChart message to the office so we can document in your child’s chart.

Please note: the Department of Elementary and Secondary Education (DESE) agrees with the above isolation guidelines (five days at home, five days masked) and does not require a negative test to return to school.

Reasons to call the office for guidance:

  1. chest pain
  2. increased work of breathing/labored breathing
  3. concerns for dehydration
  4. fever (> 101) for more than 72 hours in child younger than 2 years of age
  5. fever (>101) for more than 120 hours (5 days) in child 2 years of age or older

Cardiac clearance requirements:

  1. Applies only to children over 12 years old
  2. An office visit is required at least 10 days after symptoms are resolved if:
    • greater than four days of fever > 100.4 degrees
    • greater than seven days of muscle aches, chills, or extreme fatigue
    • hospitalized
  3. For all others with asymptomatic or mild disease, you may call the office once out of isolation (see above) and a nurse will assist you in providing a clearance letter for a graduated return-to-play protocol
    • This applies if there was less than 4 days of fever >100.4 and less than seven days of muscle aches, chills, or extreme fatigue

Close contact of individual with COVID (fully vaccinated)

This guideline applies if you have been identified as a close contact of an individual with COVID and you have either:

  • received three doses of either the Pfizer or Moderna Vaccine or
  • received two doses of the J+J vaccine (or one J+J and one Pfizer/Moderna) or
  • received two doses of either the Pfizer or Moderna vaccine within the last six months or
  • received the J+J Vaccine within the last two months

Guidelines:

  1. Wear a mask around others (including at home) for 10 days
    • If you are unable to wear a mask, you must isolate at home for a total of 10 days
  2. Test on day 5 (if possible)
    • Negative rapid antigen tests should be confirmed with a PCR test
    • Positive rapid antigen tests are assumed to be positive and do not need confirmation
  3. If you develop any symptoms, get a test and stay home

Close Contact of Individual with COVID (Not Fully Vaccinated)

This guideline applies if you have been identified as a close contact of an individual with COVID and you have either:

  • Received 2 doses of either the Pfizer or Moderna Vaccine over 6 months ago and have not been boosted
  • Received 1 dose of the J+J Vaccine over 2 months ago and are not boosted
  • Received 1 dose of either the Pfizer or Moderna Vaccine
  • Not received any COVID Vaccines

Guidelines:

  1. Stay at home for 5 days. After that, continue to wear a mask around others for 5 additional days
    • If you are unable to wear a mask, you must isolate at home for a total of 10 days
  2. If you cannot quarantine, you must wear a mask for 10 days
  3. Test on Day 5 (if possible) with PCR test preferred
    • Negative rapid antigen tests should be confirmed with a PCR test
    • Positive rapid antigen tests are assumed to be positive and do not need confirmation
  4. If you develop any symptoms, get a test and stay home

A Word About Continuous Exposure:

Please note that if your exposure is continuous and you are unable to separate from someone who has COVID, you are being exposed to COVID on a daily basis. This makes the quarantine period longer since your date of last exposure is constantly changing.

For example, if a mother tests positive for COVID and is unable to separate from a baby. The baby is therefore being exposed to COVID on each day that the mother remains infectious (10 days, assuming mild symptoms). The baby then needs an additional 10 days of quarantine starting when the mother is no longer assumed to be infectious. In this scenario, the baby should be tested 5 days after the mother is no longer infectious (day 15 after her diagnosis) and needs to quarantine for 20 days total.

Happy New Year and thank you for your understanding during these challenging times.

What We Anticipate From Omicron & FAQ

It was a little less than 2 years ago when COVID arrived. We all stopped what we were doing and shut down completely - may we never have to do that again! Vaccines, masking, social distancing, and the virus's own nature have at times given us the semblance of control. However, with Omicron knocking at our door (or already over the threshold), I want to once again discuss what we need to do to protect ourselves, our family, and what we might anticipate over the next weeks to months.

The good news is that our patients have been spared the worst of COVID from a medical standpoint. In general, children and young adults have had less severe disease than their older adult counterparts. It is not to say that we don’t see severe illness in children and young adults but it is rare. That said, we have seen the mental health toll this has taken on patients and families in our practice. We understand the strong desire to return to “normal”. Please do everything you can to make “normal” as safe as possible. Although it is permitted, really think twice about walking into an indoor public space without a mask.

Omicron has shown itself to be very easily transmissible. There is some suggestion that it may be less virulent, but it is still a little too early to say that with confidence. What seems fairly clear is that although Omicron is clearly causing breakthrough infections of those who have been vaccinated or had disease, those who have been vaccinated have lesser disease and boosters seem to provide even more protection. We implore everyone who is eligible to get vaccinated and boosted. Please protect yourselves and those around you.

Immunization works best when all are immunized. There will always be subsets of the population who don’t respond to vaccination. These, in particular, are the elderly and immunocompromised. However, any individual may not respond to vaccination for reasons that are not easily identified. This is when all those other things that have been implemented - masking, social distancing, and making choices about how and what we do (our priorities) make all the difference.

Wareham Pediatrics has weathered the pandemic well. We were able to quickly go to virtual visits which allowed us to provide care throughout. As we were able to understand COVID better and obtain the PPE that we needed to practice safely in person, we have strived to bring patients back into the office whenever it makes the most sense. We have found virtual visits sometimes make the most sense, and feel fortunate to be able to offer this visit type to patients and their families. We are now giving vaccines to anyone who is eligible. These are only available to be scheduled through MyChart - Please do not call the office. They will also be offered during scheduled well visits and follow-ups. However, with this new variant, we anticipate that our staff may be more significantly affected then they have been in the past. We expect that we may have shortages of staff in all departments despite being fully vaccinated due to breakthrough infection. This may lead to appointments being rescheduled or shifted to virtual whenever appropriate. We ask that you understand our predicament and that we want to provide the best care possible in a timely fashion. We ask for patience.

Going forward, we would like to reinstate some of the protocols that kept us safe during the early days of COVID. We ask that except for newborn visits, only one parent or caregiver accompany the patient. Certainly, others may join via facetime or speakerphone. We ask that although you may not feel that mild upper respiratory symptoms (occasional cough, runny nose) are a sign of COVID, that you report it on pre-visit screening. If anything, we have all been amazed at how mild the symptoms of COVID can be in children. We have been so lucky that the vast majority of our children with COVID have had very mild disease, but we do not want to bring it home to our families and loved ones. We ask that whenever possible, you fill out pre-visit questionnaires through MyChart. Over 90 % of our patients are on MyChart and this can really help you get the most out of your visit with us.

COVID testing is becoming more challenging as well. We are currently testing more than we ever have. Current tests at our practice are taking 3-4 days to receive results. We know this provides an inconvenience for some who have minor symptoms, but it is all of our duty to quarantine until those results are known. There are other facilities that can produce results more quickly at this time. Please feel free to have your child tested at one of those facilities if it makes sense for you.

Our triage service is experiencing a high volume of calls during all hours of the day. Please be understanding of the long time for callbacks. If you feel your child is in need of urgent or emergent care, please feel free to obtain that care without waiting for a callback. To help answer some of the most frequently asked questions we receive from parents, our triage nurses have assembled some answers below. If this guidance below answers your questions, you may not need to call our office!

Frequently Asked Questions

When am I considered a close contact?

  • A “close contact” is someone who you were in close contact with (within 6 feet for more than 15 minutes while indoors) for the 2 days before they got sick or the two days before their positive test was taken if they don’t have symptoms.
  • For K-12 Schools, a close contact is slightly different, “within 3 feet for more than 15 minutes while indoors”. This is due to more regulated mask use and compliance.
  • If you are fully vaccinated you do not need to quarantine following a close contact. You should be tested 5-7 days after exposure, or if symptoms develop. You must wear a mask in all indoor settings for 14 days, and should actively monitor for symptoms.

I was recently identified as a close contact (either at school or at home), what should I do?

  • If you were identified as a close contact at school and your child is eligible to be a part of the “Test and Stay” program, please reach out to your school for more information. If you have already done so, and just require a test, please call our office and we can schedule an appointment for you. You do not need to wait on hold for a nurse to schedule this appointment. We just ask that you verify with the school nurse ahead of time, the date that you should be tested.
  • If you were identified as a close contact at home, please follow the guidance below from DPH depending on your vaccination status and symptoms: MA DPH Exposure Guidelines

A household family member just tested positive, when do I need to be tested?

  • If a member of your household tests positive for COVID-19, and is able to isolate (be separate from the rest of the family, with no contact), then the rest of the family should be tested 5-7 days after their last contact with the positive individual. If they are unable to isolate, the other family members should be tested 5-7 days after the positive family member exits quarantine (in most cases this is 10 days after symptom onset, or 10 days after they had a positive test). In both cases, if a household family member becomes symptomatic, they should be tested immediately.

We were planning on seeing our parents/grandparents/high-risk relatives for the holidays, what should we do?

  • Everyone should think about what is important to them this holiday season. Family is so important - we want to share this time with those who mean the most to us. Grandparents want to see grandchildren, we want to travel to wherever family and home may be. If you decide that this is important to you this year - get vaccinated, get boosted if you are eligible, mask, improve the ventilation when you gather ( Outside? Open windows?), consider eating separately from those who may be more at risk and rejoin masked after the meal, and if you have the ability - test prior to gathering.

Is it ok to get the COVID-19 Vaccine if I am sick? What if I was recently exposed?

  • If your child is currently symptomatic, but fever free and generally feeling “ok”, they may receive the vaccine with a recent negative COVID-19 test. “Recent” - meaning the test was done during this same course of illness. In terms of exposure, if your child is currently in the Test and Stay program (and testing negative), they may receive the vaccine. If your child was exposed outside of school and is quarantining, but asymptomatic, our staff will take proper precautions to administer the vaccine safely.

Where can I get tested?

Our office continues to utilize Quest Laboratories for COVID-19 PCR Testing. While these tests are the gold-standard for reliable testing, with the increase in case rates across the country, they are experiencing delays in turn-around times for results. At the moment, we are seeing upwards of 3-4 days for results. We offer convenient self-swabbing for patients at all 3 offices, with open availability. If these turnaround times are not acceptable for your individual circumstances, please click the link below to find other local testing facilities that may offer faster results.

COVID-19 Testing Locations MA

I was tested earlier this week, where are my results?

  • We are currently being quoted 3-4 days of turn-around time for results to be posted from the lab. While we understand that this can be disruptive due to the quarantine requirements, we have no control over the speed in which these tests are run. When a COVID-19 test is resulted, you will be notified immediately via MyChart, we ask that you do not call our office for a result. Oftentimes you will receive the result before our staff is even aware it has been sent to us.

My child just tested positive for COVID-19, what should I do?

  • If your child receives a positive test result they should immediately isolate themselves with a caregiver for 10 days from the rest of their family. 10 days after the positive test or onset of symptoms, so long as symptoms are improving, and your child has been fever free for 24 hours, they may exit isolation and be around others. If your child develops any difficulty breathing, prolonged fever greater than 72 hours, or acute illness concerns arise, please call our office.
  • For information regarding exposure to the other members of your family, please reference Question #3 above.

My child just received a COVID-19 Vaccine and is experiencing symptoms. What should I do?

  • The most common side effects after Pfizer’s COVID vaccine in clinical trials for children ages 5-11 were:
    • Injection site pain or Arm Pain
    • Fatigue
    • Headache
    • Muscle pain
    • Chills
    • Fever
  • If your child is experiencing symptoms listed above and received the vaccine within the past 48hrs, you may treat with rest, fluids, and Motrin/Tylenol as needed for fever. For prolonged symptoms, lasting longer than 48hrs, or for symptoms not listed above, please call our office.

These next several weeks will likely be challenging for all. We all need to do our best to keep each other safe. We know you are tired and want this to be over. We do too!

Sincerely,

Jason E. Reynolds, MD, PhD

On behalf of all of Wareham Pediatric Associates