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After a relatively quiet winter at Pediatric Partners in Overland Park, Kansas, the sick kids have come roaring back this spring.
They’re coughing. They have fevers. Their throats hurt. Could they have COVID-19?
Pediatrician Kristen Stuppy says she doesn’t know: Many parents are refusing to have their sick children tested for the virus.
“We’ve had parents tell us, for instance, ‘No we have a big tournament this weekend, I don’t want to have to deal with COVID,'” Stuppy told The Star on Tuesday.
“And they’re forgetting the fact that it’s still going to be COVID even if you don’t know that it’s COVID. So from a public health perspective it scares me.”
So many parents have been turning down her advice to have their kids tested for COVID-19 that her practice posted an alert on its Facebook page a few days ago exhorting parents to stay vigilant.
“Sadly many parents are now declining COVID tests,” Stuppy wrote. “I do not know why we’re seeing this—and each parent may have a different reason, but without testing, we do not know accurate local rates and COVID will be more likely to spread. …
“Which means your family is probably interacting with these kids at the store, sporting events, and school.”
The American Academy of Pediatrics recommends that children and teens who have COVID-19 symptoms should be tested immediately—”especially important if they have in-person in school, sports or jobs, so that anyone who may have been exposed can be alerted,” the pediatrics group says. If they have COVID-19, they need to isolate for 10 days, at least.
Stuppy thinks some parents aren’t willing to take the safety precautions that come with a diagnosis.
“What it should change is the behavior the family has as far as staying home, being safe inside the home, wearing masks and things like that,” she said.
“I’ve had a lot of parents I’m doing telemedicine visits with and they’re sitting on the couch next to their kid who has a fever, cough, sore throat, has been exposed to COVID, whatever the risk factors are.
“They know this kid likely has COVID and they’re sitting there holding the kid on their lap, no mask on. I think the reality is not hitting families.”
Public health officials have said for weeks that overall interest in COVID-19 testing is down, which is problematic because it makes it difficult to know how much of the virus remains in the community and prevent it from spreading by having people isolate.
At the University of Kansas Health System, infection control specialist Dr. Dana Hawkinson recently attributed some of the testing drop to “COVID weariness,” as people just assume they have the virus and don’t get tested unless their workplace requires it.
“I definitely see over the last month more and more people refusing tests,” said Stuppy. “Whereas at the beginning they were upset that we couldn’t offer a test. I think the tide has definitely changed.”
It’s not clear how common it is for parents to refuse the test for their children, say representatives of pediatric associations in Kansas and Missouri.
But on Tuesday, Stuppy tried to gauge the situation among her fellow pediatricians on Twitter.
“Is anyone else finding a significant number of parents refusing COVID19 testing when their kids have symptoms? I’m seeing it more and more. So frustrating!” she tweeted.
Some of the responses she got:
“Yes including a parent who is a pediatrician. I just can’t anymore.”
“Not necessarily refusing but I will (note) that I do a lot more explaining now about why we still have to test than I did 6 months ago.”
“Not many are refusing BUT it’s certainly a hard sell at times (esp. when we have a pretty low percent positive rate in our area right now).”
“Haven’t had many declining testing, but I have quite a few that come in on day 4-5 of symptoms, having been in school/daycare up until that point.”
“This is why the pandemic will never end.”
“Parents are concerned that if another child, or their child, is diagnosed with COVID that will put kids into quarantine, it will upset their school schedule, their recreational schedule, the parents may have to adjust their work schedule,” said Dr. William Schaffner, a professor of preventive medicine in the health policy department at the Vanderbilt University School of Medicine in Nashville.
“So they’re saying ‘Well, he’s going to get over it anyway. Let’s just not make the diagnosis, and we don’t have to go through all that hullabaloo.’
“That’s beyond unfortunate. That’s selfish. And it’s not in the public interest, it’s in your own narrow interest. It’s not in your child’s best interest.”
Dr. Angela Myers at Children’s Mercy said the hospital has seen a recent uptick in other viruses, including common colds and a couple of cases of respiratory viruses in the last week. She, too, is hearing that some parents are refusing COVID-19 testing.
“It is important to get tested if you have symptoms compatible with COVID-19 so that the appropriate actions can take place if positive,” said Myers, division director of infectious diseases.
There is no vaccine yet for children younger than 16, though Children’s Mercy is part of a national trial testing for one for younger kids.
Stuppy uses the PCR test, considered the “gold standard” in detecting if someone has an active infection.
“We don’t do the one that you stick all the way back to the brain,” she said, exaggerating just a bit. “We just (swab) the anterior nose, so it’s not traumatic for most kids. Most of the time it’s just a tickle in the nose.
“One of my patients said it felt like a caterpillar crawling up her nose.”
Like Schaffner, Stuppy thinks parents are turning down tests because a diagnosis would require them to change their behavior—if they follow public health advice, that is, which she knows not all have done.
“I think they’re forgetting the component of then we need to isolate,” if a child tests positive, said Stuppy.
“They’re coming in with cough, sore throat, and parents want them tested for strep but they don’t want them tested for COVID. … They only want something they can treat.”
The most common symptoms of COVID-19 in children are cough and/or fever, according to the Centers of Disease Control and Prevention. But there can be other signs, including fatigue, headache, nasal congestion, diarrhea and poor appetite or poor feeding. However, like adults, children can be asymptomatic.
“While children infected with SARS-CoV-2 are less likely to develop severe illness compared with adults, children are still at risk of developing severe illness and complications,” the CDC says.
“Weekly COVID-19 hospitalization surveillance data show that the rate of hospitalization among children is low compared with that of adults, but hospitalization rates among children are increasing.”
“For many kids it seems like it’s a mild disease and I think they’re banking on that,” Stuppy said of parents. “But they’re forgetting that some kids get really sick. There are long-term complications that even if they weren’t hospitalized they can suffer from prolonged issues. And we don’t know the late effects.
“We want to feel like, ‘Oh, most of the people are fine.’ So a lot of ‘ostrich head in the sand’ kind of stuff going on.”
That more kids are getting sick right now is a sign to Stuppy that parents are “dropping their guard” and “not staying away from others unmasked.”
“Kids all the time, they’re going to birthday parties in those indoor bounce house places. They’re going to restaurants, they’re going to all these places, they’re putting themselves at risk,” she said.
“If they end up catching strep, which is what parents are always hopeful for because you can treat it, or you’re exposed to COVID … it means you’re letting your guard down.
“Lots and lots of kids are getting sick, and sometimes it’s hard to tell. It could be allergies if it’s just the sniffles and it’s pollen season and everything else. But, it could also be, especially if they have the fever and they feel sick, more likely some sort of an infection.”
She said undiagnosed coronavirus “increases all of our risks because if these kids truly have COVID and they’re going back out to school, they’re going to their sports, they’re going to friends’ houses to play in the basement without their masks on, they’re increasing the risks to the community.
“Because we know with COVID you have to stay home longer than a typical cold because there’s not that herd immunity that we have with other viruses,” said Stuppy.
“If you’re treating it like another virus and just continuing your life, then you’re putting everybody else at risk, especially those who have not been vaccinated, which includes the other kids that they’re playing with.”
Med school 101: It’s always better to know what the illness is than not know, said Schaffner. “Because you can’t predict if your particular patient is going to have complications down the road,” he said.
“And if you didn’t do the test and you don’t know that your child does or does not have COVID, that will put you off on a different trail trying to deal with whatever complication might come up. So having the information is in your child’s best medical interest.”
The American Academy of Pediatrics says that for children who had close contact with someone who has COVID-19 but don’t have symptoms, “it’s best to wait at least four days after exposure to be tested.”
Close contact is defined as having been less than six feet, for a total of at least 15 minutes over a 24-hour period, from someone with a confirmed or probable case of COVID.
Stuppy believes people in general are just tired of COVID and “want it to go away. And ignorance is bliss,” she said.
“I think a lot of parents have actually had their vaccine, at least the first of the vaccine, so they feel less worried that it’s in their house now.”
She thinks some families feel secure because parents and grandparents have been vaccinated. “So they feel like with kids, COVID has not been an issue. They’re not concerned if the kid has COVID,” she said.
“But the reality is kids can get sick, and we have no idea which kids for certain are going to be one of those 80% who don’t need hospitalization, who don’t need anything, and we don’t know the late effects.
“And I still think we can’t discount that this virus is going to do things in the future. We just don’t know.”
Lisa Gutierrez, The Kansas City Star