Despite schools’ efforts to prevent the spread of COVID-19, medical professionals agree the risk for exposure will likely increase as more children return to buildings this fall.
“What we know about kids is they’re not as symptomatic, and so they may spread it without knowing it, and that can become problematic in the school environment, for sure,” says Dr. Courtney Sauls, a pediatrician at Ascension St. John Pediatric and Adolescent Medicine.
Let’s say your young child has been in contact someone who has a positive COVID-19 test. Your child has no symptoms. What should you do?
As to whether testing should occur, it’s important to first determine the nature of exposure, say medical pros. The Centers for Disease Control and Prevention defines direct exposure as “contact within 6 feet for at least 15 minutes with someone who has a documented positive test.”
Timing of testing also is important. If they’re going to test positive, most people will do so four to 10 days from exposure, according to Stephanie Zumwalt, quality manager and COVID-19 site manager for OU Health Physicians Tulsa.
“If you’re exposed today, don’t come see me tomorrow because it’s not going to show up,” she says. “I need you to wait at least four days from when you’ve been exposed to be tested. So you’re going to need to quarantine for those days, for sure, until you can come in and be tested.”
How does one determine whether to test a child or just quarantine — and for how long?
Talk your child’s primary care provider, Sauls says.
“We have lots of resources and connections to get families connected to the testing environment and for COVID,” she says. “And we offer advice all day, every day for families about COVID. That’s what we do, and that's what we’re here for. So I’d urge families to reach out to their pediatrician’s office first and foremost.”
Another reason to call the child’s doctor is that most health care systems, including Saint Francis, Ascension St. John and Hillcrest, will not administer the test at one of their testing sites without a physician order.
“Your child’s pediatrician will direct you to the testing site that is most appropriate for your child,” says Sherry Fisher, clinical director for Warren Clinic.
Meredreth Maynard, director of quality for Utica Park Clinic and its incident commander over COVID response for Hillcrest, says parents should call their child’s Utica Park Clinic provider — or schedule a telehealth visit if they’re a new patient — to determine whether testing is prudent. If necessary, a test will be ordered.
“With COVID, we’ve learned that every situation is a little bit different depending on the exposure, the type of exposure, the amount of exposure, the type of symptoms,” Maynard says. “We feel like that clinical discretion piece is really important on next steps.”
If children have symptoms of any kind, it’s especially important to call their doctor since coinfection is common in children, Maynard says.
“Just because your child has an ear infection or strep throat, it doesn’t completely rule out that they don’t have COVID,” she explains. “We just don’t know enough about the virus to know, how closely are these things related? Is this a symptom of just a traditional ear infection from some other bacterial cause? Or could this truly be a complication in the COVID infection?”
Some testing sites do not require a physician order (see list below). At OU-Tulsa’s Wayman Tisdale Clinic, for example, parents can simply call the testing hotline (918-619-4980) to schedule a drive-thru test. In fact, the whole family can be tested at the same appointment.
There are some conflicting opinions on whether a negative test in the correct testing timeframe still requires quarantine, even if the child has not developed symptoms. Maynard says tests can give a false negative and suggests those with a confirmed exposure quarantine for 14 days regardless of test results.
Sauls, on the other hand, says a false negative is highly unlikely.
“Thankfully the sensitivity and the specificity of these PCR swab tests are very, very trustworthy,” she explains. “They’re in the high 90s, so that’s very reassuring that you’re going to likely not have false negatives.”
Early on in the pandemic, some questioned the accuracy of rapid testing, which is available at some Tulsa-area urgent cares. Both the rapid test and PCR tests use nasal or throat swabs.
“The problem is with these rapid tests, there just aren’t as many of them available,” Sauls says. “So that’s why most places don’t offer that as a testing modality. But I would trust both of them equally.”
If parents prefer to quarantine their children rather than have them tested, Sauls supports that decision.
“If they’re able to quarantine at home for 10-14 days safely, and it’s not an undue burden on the family with working parents, or missing school, and they don’t want to get tested, and then that’s OK, too,” she says. “But testing is going to limit the time that you would have to do that.”
Parents will want to check with their district regarding when they can send their child with no symptoms back to school after exposure.
Should very young children be tested? That depends on the situation, Zumwalt says.
“If your (test is) positive, your husband’s positive, little Johnny’s positive, and little Maria is 2 years old and is just throwing the biggest fit in the world — we’re going to have to hog tie her down to test her — don’t test her. Because if the three of you are positive, guess what, so is she. So at that point, just quarantine.”
Getting your minor child’s PCR test results is generally taking between one and three days in the Tulsa area. Once results are available, “The provider that ordered the test notifies the parent” (of the results), says Fisher of Saint Francis/Warren Clinic. Rapid test results can be available within an hour after testing.
Maynard suggests parents go ahead and connect their electronic medical records to their children’s EMRs to reduce time and frustration in getting test results electronically. For most health systems, including Hillcrest and Saint Francis, which utilize MyChart, this requires filling out a form online or in person and waiting up to several days for the connection to be activated.
Optimally this connection should already be made prior COVID testing.
“That way you’re not trying to navigate through that whole process plus the stress of knowing you had an exposure,” Maynard says. Whether to connect the EMRs of parents and their college student children is a conversation that also should occur in advance, she adds. This process requires more steps when the child is age 18 or older.
Sauls of Ascension St. John corroborates data that shows COVID-19 doesn’t affect children quite as much as adults. However, she cautions that for certain children, it can be deadly.
“In terms of serious respiratory compromise, we’re seeing a low caseload of children with COVID in our hospital system, which is really great,” Sauls says. “The unfortunate thing about these kinds of serious cases of COVID and children is that it doesn’t really have a rhyme or reason to it. It doesn’t only choose children with asthma or diabetes or whatever. We don’t really know why some children get really bad, and then most children don’t get symptoms at all. So it’s definitely something to take seriously.”
Zumwalt advises parents of returning students to expect calls about potential exposures and says they should take these calls seriously.
“Don’t get mad at the teachers and the nurses and everybody at the school because they’re trying to protect that entire school population,” she says.
Pediatric testing for COVID-19 is not as accessible as it is for adults, Sauls says, possibly due to a lack of data. For example, adults can obtain a drive-thru test at CVS or Walgreens, which do not test minors under 12. The Tulsa Health Department also does not test children under 12.
“I think children make people nervous, and a lot of other testing facilities or urgent cares don’t have a lot of experience with children,” Sauls says.
But Sauls agrees that if we’re not testing children, we can’t fully understand how COVID-19 is spreading among them, or how they could be spreading the virus to adults.
“In battling this pandemic, we need more knowns — we need to know more,” she says. “And so (testing) only serves to better our understanding of how this has spread and our children’s role in it.”
Accessible COVID-19 testing for children under 12
The following testing sites test children for COVID-19 without physician orders. Children must be accompanied by a parent or legal guardian.
Due to the CARES Act, most COVID-19 testing is provided free of charge or is reimbursable by health insurance.
*If you know of a testing site that should be added to this list, please email details to email@example.com.
Access Medical Care
Various locations in Tulsa metro; curbside testing may be available.
Appointment required at https://amc.nextcare.com/locations.
University of Tulsa Lorton Performance Center, 550 S. Gary Place
Indoor testing for children 12 months or older
Testing available 10 a.m.-3:55 p.m., Sunday-Thursday.
Appointment required at https://portal.immylabs.com/appointment.
MCI Diagnostic Center
7018 S. Utica Ave.
Online registration required at https://mcicovid.com.
Morton Comprehensive Health Services
1334 N. Lansing Ave.
Appointment required: Call 918-295-9308.
OSU Center for Health Sciences campus parking lot
1111 W. 17th St.
Testing available 8 a.m.-5 p.m., Monday-Friday.
Appointment required: Schedule at https://medicine.okstate.edu/covid/covid-19-schedule-online.html or call 918-281-2750.
OU-Tulsa Wayman Tisdale Specialty Health Clinic
591 E. 36th St N.
Appointment required: Call 918-619-4980.
Appointments available 8 a.m.-4 p.m., Mondays and Thursdays (closed for lunch from 12-1 pm).
Tulsa ER and Hospital
717 W. 71st St. S.
Designated, separate area for patients who are concerned that they may have COVID-19
No appointments will be made. Call from the parking lot: 918-517-6300.
Testing available 10 a.m.-6 p.m., Monday-Thursday; 9 a.m.-2 p.m., Friday. Saturday and Sunday testing is reserved for emergent, symptomatic patients.