Cutting through the confusion about kids, teens and COVID-19 exposures

It’s pretty confusing to be a parent of a school-age or preschool child right now.

Are your kid’s sniffles and fever an early sign of COVID-19? Or just a cold or allergies? What should you do next?

Or what if they’re feeling fine, but your school, their friend’s parents, or the soccer coach says someone your child has been around has COVID-19?

Or what if you find out that your teen’s friend is sick but your teen didn’t think – or want – to tell you?

These questions have gotten more urgent in recent weeks. Cases of COVID-19 in children are rising fast, with nearly one-third of new cases now happening in young people. School and activities are in full swing, but COVID-related mask and quarantine policies vary from district to district. Flu season looms. And there’s still no COVID vaccine authorized for kids under 12, though one is probably coming later this fall. Meanwhile, vaccination is lagging in teens and adults in some communities, and clinics and hospitals are jammed with COVID and more.

Even if a child or teen doesn’t get seriously ill from coronavirus, they can spread it to others who could. That will make the pandemic last even longer for all of us.

Plus, whenever a child has to stay home in quarantine, that can affect their schooling. It can also affect their parents’ ability to work – especially in the frontline jobs that keep our society running.

“Because of the way this disease spreads, through the air, and because the Delta variant of this coronavirus is even easier to catch, it’s up to all of us to take steps including appropriate masking, distancing and vaccination, and to share information about infections in a timely way,” said Emily Somers, Ph.D., an epidemiologist who is a professor of internal medicine at Michigan Medicine and an advisor to her daughters’ school district on COVID-19 prevention. “The more we do, the better our children’s chances of being able to attend school in person without interruption, and the faster we can be done with this pandemic.”

So, here’s a handy guide for parents on what to do about quarantine, isolation, masking, testing and sharing information with others, based on the latest evidence.

Answer the questions below to get guidance for different situations. This guide is based on information from the Centers for Disease Control and Prevention and the Michigan Department of Health and Human Services, but local school districts may have additional or slightly different guidance; check with your school administration to be sure.

First question:

Does your child or teen have symptoms that might be COVID-19? (If not, skip down to the next section)

It’s easy to confuse the early symptom of COVID-19 with those of other illnesses and allergies: fever, chills, cough, problems breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, or diarrhea.

But right now, if they have one or more of these, think COVID-19 first – especially if they are too young to be vaccinated or they are old enough, but haven’t gotten vaccinated.

After thinking about COVID-19 first, be sure your child is not seriously ill: short of breath, confused, or unresponsive. If they seem seriously ill, bring them to the emergency room, preferably at a children’s hospital — even if you do not know yet whether this is COVID-19. Kids with another medical problem (such as bad asthma or a weakened immune system) are at particular risk of getting seriously ill from COVID-19.

If it’s coronavirus, your child is most likely to spread it just before and just after their symptoms started. What you do next could make a big difference for your family and other people around your child, especially adults who aren’t vaccinated.

Even if they’re vaccinated, there’s a low chance that it could be a ‘breakthrough’ case of COVID. If it is, they could infect other people for a few days, so you should follow these steps too.

Take these steps now:

• Keep them home until you can get them tested and you know the test results:
  • Keep them in their own room with the door closed as much as possible, and windows open. (if they usually share a bedroom, get the other person’s clothes and other essentials out, and have them sleep on the couch or in another room).
  • If it’s a school day, keep the sick child home from school; also keep them home from sports, activities, playing with friends, religious services, events and gatherings. No matter how much they or you might want to go or what fun outings or important school tests they might have to miss, they need to stay home right now.
  • Both you and they should wear a mask when you’re in a room or car together.
  • Keep siblings and others away from them.
  • Have them wear a mask if they leave their room, and use a separate bathroom if that’s possible.
  • Give them fever-reducing medicine according to the instructions on the label if they have a high temperature.
  • Encourage them to rest, and bring them food and water. 
  • Keep them entertained with TV, digital devices, books and drawing while they’re alone in their room.
  • Even though this is called being in “isolation”, give them love and encouragement, even if it’s mostly through text messages, video chats or conversations through the door.
• Call their doctor or nurse practitioner to let them know, or send an electronic message to them through your patient portal if you have one. Follow their advice for treating mild symptoms.
• If symptoms get worse, call your child’s health provider. Any shortness of breath, confusion or lack of responsiveness should be treated as an emergency.
• Get them tested. These days you have two choices, but you may want to use them both at once.
  • Rapid tests are now available for a low cost at stores, and for free from some schools and health departments. They are very accurate for people with symptoms and give results in about 15 minutes. These are called antigen tests and look something like a home pregnancy test. You may want to buy one even if your child doesn’t have symptoms,  just to have it on hand and not have to go to the store if they wake up not feeling well.
  • PCR tests, also called viral tests, are the “gold standard” for accuracy. They’re free to everyone, but it can take days to get the results. Your child can get tested at drug stores, urgent care centers, health clinics and other locations, but you may need an appointment and not all locations test very young children. Find a testing location.
  • If you choose to do a rapid test, consider also taking your child for a PCR test. Official health statistics usually focus on PCR test results reported by testing labs to local health departments. If your child gets severely ill or has a medical condition that puts them at high risk of severe illness, having a PCR test result already available could mean they get faster access to specialized treatments such as monoclonal antibodies, which are most effective when used early.
• Tell your child’s school and anyone your child was near in the past few days that there’s a chance your child has COVID. Promise to update them either way when you get a test result. This kind of timely notification is critical if it turns out it is COVID-19, especially if your child was around an unvaccinated or medically vulnerable friend, relative or teammate.
• Don’t feel ashamed or guilty that your child might have COVID-19, or think that this is something you shouldn’t share information about. Schools, daycare centers, and coaches will likely appreciate that you have done a responsible thing for others. The Delta form of the coronavirus is super easy to catch, especially when there are a lot of cases in your area. But do think about possible places they might have been exposed in the past few days.
• Once you get your test results:
  • If the rapid test or PCR test is negative:
    • This means your child most likely doesn’t have COVID-19.
    • If you used a rapid test, your kit likely came with a second swab that should be used within 36 hours to double-check the result because COVID infections can take a day or more to show on such tests. Use this second swab as directed and if it shows a positive result, keep your child isolated.
    • If your child has no fever, tell everyone you contacted that your child is probably COVID-free and send them back to school when they feel well enough.
    • If they have a fever, keep them home until 24 hours have passed after the last high temperature, even if they were otherwise feeling well.
    • If they’re old enough to get vaccinated, and they aren’t yet, start their vaccination process.
  • If the rapid test or PCR test is positive:
    • This means your child likely has COVID-19
    • Keep them in isolation at home until 10 days after their symptoms started. See more information about what this means above.
    • Tell their school, their doctor’s office and everyone who was around your child starting two days before their symptoms that your child has COVID.
    • Anyone who was within 6 feet of your child for more than 15 minutes starting two days before their symptoms began is now considered a “close contact” of a person with COVID. They now need to follow directions depending on whether they are vaccinated, had a mask on, or neither. This includes anyone who lives with the child and was in the same room with them for 15 minutes or more starting two days before the symptoms started.
    • Even if your child feels better while their 10-day isolation goes on, they could still spread the virus, so they can’t “test out” of this isolation period.
    • Ask their school about options for keeping up with schoolwork remotely.
    • Encourage your child to have video chats with friends but do not allow friends to come inside the house. You could ask the friend’s parents if it would be OK for them to talk with your child from outside through an open window or door, as long as they keep a distance of at least six feet.
    • After 10 days, if your child’s fever is gone, they can return to school and normal activities. But keep them home if they still have a fever, until 24 hours after it goes away without the help of medicine.
    • If they’re old enough to get vaccinated, and they aren’t yet, start their vaccination process after they get better and their fever is gone.

Second question:

Is your child vaccinated? (If not, skip down to the next question)

Vaccination makes a big difference in the risk of catching and spreading the coronavirus, so the rules for what vaccinated teens and adults have to do after an exposure to COVID-19 are much different. And once children under 12 are able to be vaccinated, the same will be true for them.

Simply put, vaccinated people don’t have to quarantine (stay home) after having close contact with someone who has COVID.

Close contact means being with 6 feet of someone, with or without a mask on, for at least 15 minutes when the other person has COVID symptoms, or when the other person has no symptoms but they went on to develop symptoms or test positive within two days after the close contact.

If a teen or adult is fully vaccinated and finds out that they recently had a close contact with such a person:

• They don’t have to quarantine (stay home) unless they develop symptoms
  • If they develop symptoms, they should stay home and go into isolation (see above).
  • Remember that vaccination doesn’t protect against all cases of COVID-19, but it does make it much less likely that someone will have severe COVID-19 if they do develop a “breakthrough” case.
• They DO need to:
  • Wear a mask when they are at school, work or anywhere in public indoors, for 14 days after the close contact. If they need to remove their mask at school, for instance to eat lunch at school, they should stay more than six feet away from other people just in case they later test positive with a ‘breakthrough’ case.
  • Get tested three to five days after the close contact with the person who has COVID-19, even if that contact was a few days before that person started feeling symptoms. Because rapid tests are less accurate in people without symptoms, it’s probably best to get a PCR test, but they don’t have to quarantine while they wait for the results.

Remember: “Fully vaccinated” means it had been at least two weeks since your child got the second dose of a vaccine when they were exposed to someone with COVID-19.

Some local health departments and school districts also allow children who recovered from a confirmed case of COVID-19 in the past three months to follow the same guidance as vaccinated people when it comes to being allowed to come to schoo, because of the temporary “natural immunity” that comes from a previous COVID-19 infection. If your child has had COVID-19 recently, and you have a record of their positive PCR test, see if your district will count this. Scientists are still learning how natural immunity is different from immunity from vaccines.

Third question:

Was your unvaccinated child in a classroom when they were near someone who now has COVID-19? (If they weren’t in a classroom skip down to the next question)

Cloth masks and other masks such as KN95s definitely reduce the chance that the coronavirus will enter the body of someone who’s wearing a mask when they get near a person with COVID.

And if the person with COVID is also wearing a mask, that can really cut down the amount of coronavirus that reaches other people.

But masks are not perfect and work best in combination with vaccination and testing when people feel ill.

Thanks to increasing knowledge about coronavirus in classroom settings, there are special rules for children in school, when both the child with COVID and the child without are wearing good-fitting masks that cover the nose and mouth:

• If your unvaccinated child was masked, and so was the person with COVID, and they were more than 3 feet away from one another in a classroom setting:
  • Your child does not need to quarantine (stay home).
  • You should monitor them for symptoms for 14 days after the exposure.
  • If they develop symptoms, put them in isolation at home and follow the instructions above.
• If your unvaccinated child was masked, and so was the person with COVID, and they were less than 3 feet away from one another in a classroom setting:
  • Your child does NOT need to quarantine (stay home) if they can get tested daily for seven days and if they stay symptom-free for 14 days. Talk to your school or county/city health department about options for testing.
  • If you can’t get them tested daily, they need to quarantine (stay home) for at least 10 days.
  • If they test positive or develop symptoms at any time, they need to follow the isolation guidance above.
• If your unvaccinated child was masked, but the person with COVID was not, or if they both weren’t masked, and they were within 6 feet of one another inside a classroom or in any setting where they were within 6 feet of one another:
  • Your child needs to quarantine at home for 10 days.
  • But you may be able to shorten this time: If your child stays symptom-free for seven days, and they take a PCR test on day six or seven that comes back negative, they may be able to return to school and activities. (Check with your school district to make sure.)
  • If they test positive or develop symptoms at any time during quarantine, they need to follow the isolation guidance above.

Final question:

Did your child or teen get within 6 feet of a person with COVID-19, indoors or outdoors, for 15 minutes or more, anywhere outside of a classroom?

In any setting outside a classroom, the 6 feet/15 minutes rule gives a rule of thumb for figuring out if someone is considered a “close contact” of someone with COVID-19. This is true for kids, teens and adults too.

If they are, they should take steps to reduce the risk of spreading coronavirus. This is true even if they were close together outdoors, and even if one or both of them were wearing a mask.

But just as above, vaccination status makes a difference:

• If a teen or adult is vaccinated:
  • They do not have to quarantine after a close contact.
  • They should get tested three to five days after they were near the person with COVID.
  • They should keep monitoring for symptoms for 14 days. If they develop symptoms they should go into isolation.
• If the child is too young to get vaccinated, or the teen or adult isn’t fully vaccinated:
  • They need to quarantine at home for 14 days and watch for symptoms.
  • While they don’t need to go into full isolation if they stay symptom-free, they should avoid anyone in their household who has a weak immune system because of a medical condition or treatment.
  • If they develop symptoms they should get tested and go into isolation.

The bottom line

Vaccination, testing people with symptoms, distancing and masking by everyone in classrooms and other settings can make the difference between having to miss school, work, activities and events, and being able to avoid or shorten quarantine. And early notification, good use of tests and staying home when sick, or possibly contagious, can keep the spread of COVID-19 down.

Special thanks to Emily Somers, Ph.D., and Jonathan Golob, M.D., Ph.D., for reviewing this article for accuracy.