Kids & COVID-19: Should My Child Go Back to School?

Richard Heller, MD, MBA, a pediatric radiologist in Chicago, IL, contributed this post.

Dr. Richard Heller, MBA

September is here. That means back-to-school season. My wife, who is not in medicine, recently came to me with questions regarding the possibility of our two children returning to in-person classes. Specifically, she read comments online that children don’t really get sick with COVID-19 and are not a significant concern to spread the disease.

I believe that the decision to return a child to in-person schooling (or not) is a family matter. There are unequivocal benefits to in-person learning, but that must be balanced against the risks of infection to children, school workers, families and others. That personal decision should be based on facts. With the understanding that our knowledge continues to evolve as more studies are published, here are the major facts that I discussed with my wife:

  • Children usually get mild (or no) symptoms: The data to date show that most pediatric cases of COVID-19 are relatively mild, and many children may exhibit no noticeable symptoms. Symptoms are often non-specific and include fever and cough but could include abdominal pain and diarrhea. Children also have a much lower hospitalization rate than adults.

  • Some children develop severe illness: Although most children with COVID-19 do not get very sick, some do. A third of children that get hospitalized will require care in the ICU. Earlier in the pandemic, it was noted that some children developed a Kawasaki disease-like illness, which tended to develop a few weeks after infection. As of Aug. 20, nearly 700 cases of this new illness, termed Multisystem Inflammatory Syndrome in Children had been reported to the Centers for Disease Control and Prevention (CDC). This includes 11 pediatric deaths in 42 states and the District of Columbia. Most of these children were Hispanic/Latino or non-Hispanic Black. There seem to be broader racial disparities with severity of COVID-19 infection in children, with higher rates of hospitalization in Hispanic/Latino and non-Hispanic Black children.

    Children are likely silent spreaders: While not proving they are more infectious, a study from Chicago showed that, compared to older kids and adults, young children with mild to moderate COVID-19 have higher amounts of viral RNA in their nasopharynx. In other pediatrics infections, like Respiratory Syncytial Virus, higher viral loads translate to a greater risk of being infectious. A Korean study showed that many children with COVID-19 were asymptomatic and that, of children who became symptomatic, most had symptoms that went unrecognized prior to diagnosis. This means that it is difficult, if not impossible, to recognize all children that are infected and potentially acting as silent spreaders. Thus, as noted in JAMA Pediatrics, a surveillance strategy based exclusively on testing those with symptoms will miss many cases. Of note, in that Korean study, asymptomatic children had detectable virus for an average of 14 days after initially testing positive; children with symptoms were positive even longer.

The bottom line is that children can get sick with COVID-19. They usually will develop only mild symptoms, if any. That good fortune is a double-edged sword when it comes to limiting the disease.

Children with COVID-19 can easily go undiagnosed, potentially spreading disease to others. That’s why children over two years of age should wear masks and why hand-washing is so important.

The American Academy of Pediatrics and the CDC, among others, have placed useful data online. As for sending kids back to school — that is a family issue. As I told my wife, this is a personal decision, but hopefully one that is grounded in science.

  • How has COVID-19 impacted radiology private practices and families? Attend the Parenting and Radiology Practice in the COVID-19 Era webinar on Sept. 9 at 7pm ET, hosted by the American Association for Women in Radiology and the American College of Radiology® Commissions on Diversity and Human Resources, as we continue this discussion on childcare, academics and economics.

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Young Radiologists Will Shape the Future Success of our Specialty

PatelAmyAmy K. Patel, MD, a breast radiologist and chair of the ACR Young and Early Career Professional Section, contributed this post. You can connect with her on Twitter @amykpatel.

Now more than ever, our radiology community must support and offer resources to young radiologists who will shape the future of our specialty. During these unprecedented times, I feel it is imperative that we find additional ways to connect and ensure we are working on behalf of and advocating for young radiologists’ best interests.

The American College of Radiology® (ACR®) Young and Early Career Professional Section (YPS) Executive Committee supports this initiative, and we are striving to engage our demographic this year in novel and innovative ways. For example, we are proud to announce the unveiling of the ACR YPS Webinar Series, an array of webinars throughout the year focusing on timely topics affecting young radiologists in this country. Upcoming webinars include “Job Hunting During an Economic Crisis,” which is in collaboration with the ACR Resident and Fellow Section and the American Association for Women in Radiology, and “Practice Leadership During COVID-19,” in collaboration with the Radiology Leadership Institute®, focusing on young radiologists navigating leadership roles during times of crisis.

The ACR YPS is also proud to partner with Cody Quirk, MD, and The Hounsfield Unit podcast. This podcast will feature bite-sized, meaningful, relevant and honest discussions about topics affecting young radiologists in this country, such as addressing health inequities in our patient populations, wellness, venture capital groups and radiology.

We must equip young radiologists with the tools for success for growth, both professionally and personally. In a time where many focus on the doom and gloom of what the future holds in health care — and particularly for our workforce demographic — we must make a concerted effort to support, mentor and sponsor in any way we can, to overcome the challenges we face and continue to build on the success of our specialty for a brighter tomorrow.

  • Visit the ACR YPS webpage to learn more about the webinar series and find out how you can get further involved.

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Empowering Patients, Improving Healthcare

Krishnaraj, ArunArun Krishnaraj, MD, MPH, chair of the ACR Commission on Patient- and Family-Centered Care, and associate professor of Radiology and Medical Imaging at the University of Virginia, contributed this post.

When it comes to providing high-quality patient care, we are all in this together. That belief helps guide the ACR Commission on Patient- and Family-Centered Care (PFCC), which works to ensure that radiologic care is provided in a manner that incorporates the needs, wants and values of our patients and communities.

Over the past five years, numerous PFCC advocates have joined the Commission and formed six critical committees to help radiologists approach the planning, delivery and evaluation of healthcare and encourage partnerships between providers, patients and families. Earlier this week, we were pleased to release our new report, Patient Empowerment: Transforming Patients Into Partners, which highlights the remarkable achievements since the Commission was established in 2015.

One example worth highlighting is the development of Patient-Friendly Summaries of the ACR Appropriateness Criteria®.

The ACR Appropriateness Criteria includes recommendations and information to help providers make the most appropriate imaging or treatment decision for specific medical conditions. The recommendations focus on which imaging tests physicians should, or should not, order based on various patient symptoms, medical histories and health status. The guidelines are reviewed annually by a panel of different medical specialists who take into account the latest research.

The Patient-Friendly Summaries were created by the ACR Appropriateness Criteria Patient Subcommittee in collaboration with the Journal of the American College of Radiology (JACR) to include patients in the conversation. These summaries — which are written by patients, for patients — are intended to help patients understand what imaging tests are most appropriate for their situation, and help ordering physicians and radiologists better communicate with their patients. Recently, the collection reached a milestone of over 50 different clinical scenarios published since its inception.

Our Commission continues to work to increase the involvement of patients and families in their own care while also supporting radiologists and referring providers. We’d love for you to join us. Please visit www.acr.org/PFCCCommission or email PFCC@acr.org to learn more.

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