Opinion

Worried about children and coronavirus? Here are some strategies


Kat McLean


19/03/2020 2:20:44 PM

GPs Dr Wendy Burton and Dr Kat McLean provide some tips and resources amid the ongoing outbreak.

School children
Don’t be scared – be prepared. That is the advice from GPs Dr Wendy Burton and Dr Kat McLean.

COVID-19 is here. Don’t be scared – be prepared.
 
Panic is rising and there are numerous suggestions that are simply wrong or lacking in practical detail.
 
We have been working with a number of GP colleagues around Australia and come up with some tips we hope will help.
 
It is very important that we take action now, so we can flatten the curve and help to keep everyone safer.

Parents
When it comes to children, we cannot stress highly enough that you must take appropriate action.
 
You must keep your kids at home if they are sick, even if you think it is just a cold. You will need a plan for who is going to look after the children if they are sick or if schools close. Elderly relatives are not suitable, as the coronavirus risk climbs the older you get, especially over the age of 60.
 
Kids are highly effective at transferring germs. They can also be pretty contagious, even when they are running around bouncing off the walls.
 
If they have a fever, sore throat, runny nose or dry cough, they must stay home (but not with grandparents, of course).
 
The data we have to date indicates that the COVID-19-affected kids will be fine. There have been no reported deaths in under-10s, and we are watching reports for the 10–20-year-olds.
 
We see this with some infections. For example, chicken pox and hepatitis A are much milder in most young children than in most adults, and this appears to be the case for COVID-19.
 
Treat minor cold and/or flu symptoms just like you usually would; however, if there has been overseas travel in the past 14 days, contact with a known case or you have concerns about breathing, stay at home and use the phone to make contact with your GP or hospital emergency department (or 000 in an emergency).
 
Do not just turn up to a healthcare centre. This way we can give you the most appropriate, current advice. (More information about judging how sick children are is available online.)
 
Teach your children (and yourself) about keeping their hands below their shoulders. This way they can avoid touching their face, particularly their mouth, eyes and nose, which are easy entry points for germs. You can also teach your children that, just for now, no shaking hands, hugs, fist bumps, kisses or high 5s from friends.
 
Reconsider indoor gatherings for birthday parties, or really any gatherings, at present.

You can also ask what your school is doing. Make suggestions and get involved (many hands, light work and all that). However, be mindful of what you say and what kids might hear; little ears pick up lots of conversations.
 
Children know when we are stressed so don’t be scared, be prepared.
If the children are old enough, talk to them about what is happening. But consider filtering the news reports and be aware that there are different opinions and some seriously fake news out there.

Mental health considerations
Anxiety is also highly contagious (think our current toilet paper shortage), so try and ensure your kids don’t catch this from you.
 
Head to Health has some great online mental health resources, and there are lots of great free apps or websites you can work through with your children:

Teachers
Thank you in advance for all that you do and all that you will be doing over the months ahead.
 
There are some basics things to consider.

We recommend handwashing or cleaning before students come into the classroom. As a teacher of children, you know you will need to keep an eye on this process.
 
We also suggest using alcohol gel as they enter or sit down and before eating, and handwashing (as usual) after going to the toilet. Every time.
 
That is admittedly a lot of hand sanitiser, but necessary at the moment.
 
Rather than having students move classrooms, consider having teachers move. You can also open doors and windows, where possible/practical.
 
No sharing of food and drinks. No communal meals, for now, including no shared platters of fruit.
 
Proper handwashing takes 20 seconds. You can get creative with some favourite songs or new words to old tunes, and time the kids for 20 seconds.
 
Surfaces will need to be wiped regularly, at least twice a day: door handles, desks, shared equipment, computers (especially if they have touch screens), keyboards, tablets, your phone, etc.
 
Hand-held devices can harbour a lot of germs. If children are using these devices, clean them when they clean their hands; we use some alcohol wipes or gel on a tissue and give it a quick wipe (don’t get it wet). Apple has advice available.
 
Sick kids (and sick teachers) need to stay home or, if they get sick while at school, they need to go home. This will be disruptive as Australia heads into its cold-and-flu season, but COVID-19 can be very mild, especially in kids, and we are serious about flattening that curve.
 
An increasing number of workplaces are implementing travel policies, so now would be a good time to check yours.
 
In terms of managing a sick child, think this through ahead of time. You will need a process and good, clear communication with parents/care givers.
 
In the event of a sick child, you should:
 
  • have them clean their hands – alcohol gel is quicker and should be close by
  • clean your own hands and wipe down any surfaces with which the child has been in contact
  • place them into an isolation area (eg sick bay) and ask them to initiate their ‘bubble’ and ‘force field’ (see below)
  • open doors for them and have them carry something, perhaps their school bag, in both hands, limiting how much they touch surfaces
  • try to keep sick kids/staff at least 1.5 m apart.
You should ask all children to cover their mouth when they cough (tissues, elbow, etc), and ask parents to organise a back-up plan (work from home options, family, friends, parents of classmates) to provide care for sick children.
 
It is important to note, parents should not seek care for sick children from elderly friends/relatives; people who smoke; people with diabetes, heart or lung trouble, high blood pressure, cancer or immune suppression.
 
You should also understand that doctors are currently unable to provide a clearance certificate – we simply do not have capacity to test everyone for COVID-19.
 
The current guidelines ask that we test those who have had overseas travel in the past 14 days or contact with a known positive case and those who are unwell.
 
We are doing our best, but we cannot certify someone as being clear of COVID-19. We can only say whether they are in an at-risk category based on their history and examination.
 
Please don’t waste valuable time and money asking for something we cannot provide.
 
If you need something in writing, ask for a statutory declaration.
 
If testing is underway, the child will have to be in quarantine with a carer until the result comes back (which, at present, can be anywhere from half a day to 4–5 days). The same goes for parents and staff members (or anyone) who undergoes testing.

General school measures:
 
  • No large gatherings – this means no assembly, no school plays, no packed sports fields
  • Outside play will be good for everyone, weather permitting
  • If possible, prop open the doorways to toilets – this will help to avoid the need for children to touch the door on their way in and out
  • Clean more often than usual, especially the toilets, door handles, sinks, benches, etc
  • Refill the soap containers regularly
  • Dr Todd Cameron has some helpful thoughts on sport and school closures and general measures
  • Rethink group work – can lessons be held outside?
  • Can recess be staggered to reduce the number of children gathering in one place at one time?
  • Reduce clutter such as magazines and toys, especially those that cannot be easily wiped down
  • Move away from communal pencils, scissors, etc
  • Consider virtual buddies rather than mixing classes
  • Work with your student leaders on creative ways to engage the student body in reducing the spread of infection
  • The school canteen creates issues with crowding, touching of surfaces, foods, cutlery, etc – reconsider how it is configured
Online resources:
  Social distancing
This is a another way of saying we need to keep a healthy space – at least 1.5 m – between us and the people around us. It is an act of respect for those nearby.
 
To the best of your ability, you must enact it now. That means keeping distance, but also no handshakes, hugs, fist bumps, high 5s or kisses – just for now.
 
This will help to keep people safe by reducing the spreading of germs, be they cold, flu or COVID-19.

To understand why social distancing matters, you need to understand how COVID-19 is spread. We believe it is a mixture of droplet and aerosol spread, and the closer you are the more likely it will hit you.

Droplet:
 
  • This is the snotty, grotty stuff; the mucus and the gobs of goo you blow out or that goes flying when you sneeze or cough
  • You can contain some of this by covering your mouth when you cough, ie with your elbow, or a tissue, clothing or mask
  • If this lands on your face or hands and you touch your face, it is very easy for the virus to transfer through your mucus membranes (eyes, inside the nose and mouth) and into your body
  • Skin is a much better barrier to infection and we can wash the germs off or use hand sanitiser to kill the germs
  • We can wipe down the benches where it lands, ie taps, door handles, hand-held devices, etc
Aerosol
 
  • This is the fine spray you release when you cough or sneeze or blow hard (eg when having breathing tests, having nebulised medicine)
  • You can contain some of this spray by covering your mouth when you cough, ie with your elbow, or a tissue, clothing or mask
  • Once this spray is in the air, where we believe it can linger for hours, you can breathe it in; you cannot wipe it off
  • It can also land on surfaces, such as benches, taps, door handles, hand-held devices etc, where it can be wiped off
All advice and information current as of 15 March.
 
A version of this column first appeared on GPs can.



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Dr Samuel David Pennell   20/03/2020 8:04:44 AM

There has in fact been one reported death, very recently. A 10 month old in China who also had intussiception

https://www.nejm.org/doi/full/10.1056/NEJMc2005073


Dr Peter Hugh Edwards   20/03/2020 1:12:48 PM

You wrote "The current guidelines ask that we test those who have had overseas travel in the past 14 days or contact with a known positive case and those who are unwell." I believe we are only testing UNWELL people who have had overseas travel in the past 14 days or contact with a known positive case , not all people (is that what you meant?). On the other we are asking ALL who have had overseas travel in the past 14 days or contact with a known positive case to self isolate for 14 days