How To Navigate The Confusing Rules Of Covid Isolation When A Little Kid Tests Positive
The guidance around isolation when it comes to families is, like so much to do with Covid, complex and nuanced.
When Phoebe Davis tested positive for Covid last September, her parents tried to keep the 7-year-old separate from her three siblings in their Louisville home. It proved nearly impossible.
Phoebe and her 8-year-old brother, Enoch, were too young to be vaccinated at the time, and are also inseparable. Their parents and two teenage siblings were all vaccinated and tried to mask within the house.
“It kind of seemed futile, though,” said her mom, Hannah. “Phoebe is always in my lap, breathing in my face, and I eat her leftover scraps from her plate. I don’t think you can get any more exposed than with a young child.” The family eventually gave up on masking and isolating within the home. Fortunately, despite multiple tests, Phoebe was the only one who ever tested positive for Covid.
The Davises are among the many parents facing impossible decisions when a child is patient zero in the household.
Omicron is incredibly contagious — burning through schools and day cares at an alarming rate. Email alerts of potential exposures are a regular occurrence now more than at any other time during the past two years. But, like much of the advice concerning the pandemic and kids, the guidance about what to do when they test positive is minimal and confusing at best. It depends on their vaccination status, age, and symptoms.
What’s the official CDC isolation guidance for when children test positive?
The Centers for Disease Control and Prevention (CDC) has outlined specific guidelines for isolation. For kids who are vaccinated, the guidelines are the same as for adults. They should isolate for five days and wear a well-fitting mask around others for an additional five days. Online guidance from Hackensack Meridian Health, a large health care network in New Jersey echoes this: “If possible, your child should stay in a separate room of the home and use a separate bathroom if available. It’s best if the child can sleep and eat in a room separate from others.”
This is the “best practice” of course, but looks wildly different in real life.
The main consideration is the age of the child and their ability to isolate themselves. And that’s where it gets confusing for many families, who have a variety of factors to consider.
Pediatrician Anita Patel, M.D., deals constantly with navigating Covid exposures and mitigating risk for her toddler, Sita. It is exhausting — the 21-month-old is not eligible yet for vaccination and too young to mask. Day care is a necessity as Patel is an attending physician in the pediatric ICU at Children’s National Hospital in Washington, D.C.
Using the CDC guidelines as the basic framework, Patel uses Instagram to offer guidance to her fellow parents to help them navigate these tough decisions — including this handy set of infographics that outline her suggested isolation procedures for families. Speaking from her own lived experience and medical knowledge, she tells families to let go of their guilt and simply do the best they can.
“I think that the way families think about what to do when their child tests positive looks like a decision tree,” she says. “That’s how I think about everything as a doctor.” No situation exists in a vacuum, she says, and each set of circumstances is totally different.
What if children are too young to isolate, or it’s just not possible?
Obviously, infants and toddlers cannot be isolated from their family, and in that scenario if even one parent can isolate with the child, says Patel, it will help to curb the spread within the house.
Beyond toddlerhood, this benchmark is different for every child based on maturity, and is not an “all or nothing” scenario. Any amount of time apart — as much as the child can handle — is beneficial. If a 4-year-old can lounge in bed with YouTube for some of the day, eat in their bedroom, and wear a mask when they need to come out, that is better than abandoning all precautions. Patel urges parents to weigh the physical and mental health considerations for kids who might already feel nervous about finally catching the thing they’ve been told to avoid for two years. “Try to limit time together as much as possible, without making the kid feel like they are ‘untouchable.’” But, she says, if a child needs comfort, comfort them.
In Washington, D.C., Jamie Davis Smith’s 15-year-old daughter was the first to test positive in their household of six. Due to her medically complex needs, she couldn’t isolate or wear a mask. Her parents decided, given their circumstances, they would just accept that they might all get sick and carry on with life in the house as usual. “She is fully dependent on us for her care, and my youngest will only sleep with me,” Davis Smith says. “There was no hope of isolating.” Five of their six family members tested positive by the time the virus ripped through their household.
Many families are in a similar situation to the Smiths — with special circumstances that make the “best-case scenario” impossible. For single parent households or homes where there isn’t the space to isolate one child, Patel advises taking the next best steps: high-quality masks within the home and good hand hygiene. In fact, per the CDC, vaccinated children within the same household as an infected person can even continue to go to school in well-fitting high quality masks as long as they are not symptomatic.
How does isolation affect children’s mental health?
One more thing to consider when deciding how much isolation is realistic: Dr. Glenn Rapsinski, a pediatric infectious disease fellow at UPMC Children’s Hospital of Pittsburgh, doesn’t discount the ongoing psychological effects of these fraught decisions. Many young kids are unable to understand the steps parents are taking to keep their families safe. “Isolating a child from siblings or parents can be very hard on the child, even if they have a parent isolating with them,” Rapsinski says.
Researchers are investigating how the pandemic may be shaping children’s brains and behavior, reports Nature, and isolation is a large part of that puzzle. That is the main reason why Davis Smith decided not to isolate herself with her eldest daughter. The emotional toll on her other children, particularly her youngest, outweighed her concerns for their physical health at that point. Her eldest is medically high-risk, but the other children are not.
Patel acknowledges how hard it can be for parents to follow strict isolation procedures and other precautions within their own home, especially when catching the virus from family members might feel inevitable. “Any physician who is a parent would understand if some parents choose to not mask,” she says.
She herself has made tough decisions that do not always follow the prescribed checklist of advice. When Sita was recently symptomatic, Patel eventually nixed the masks. “We stayed inside our house all day until our doctor’s appointment,” she shared on Instagram. “At that point, I made the decision to not mask as I had developed congestion too.” (Thankfully, both tested negative and are well now.)
Is isolating within families worth the effort if we’re all just going to get omicron anyway?
The infectious period for Covid begins two days before symptoms appear, so there is a chance that others within a household will become infected even if you do try to isolate. Given that, plus all of these impossible decision fields and stressful statistics, is it actually time for parents to throw in the towel and just assume everyone will get omicron if one kid brings the virus home?
Not yet, says Rapinski. Over the past two years since the novel coronavirus has emerged, he has been examining data and interpreting the ever-changing news for a pediatric population.
“I think parents can be a little more relaxed recognizing that the likelihood of severe infection, especially in kids, with omicron is likely very low but still present,” he says. While certainly the impact of overwhelming medical systems is significant, the individual risk for most kids is not. “Parents should make sure to give themselves some grace and recognize that they are doing the best that they can to protect their children and families from this virus, but they should not give up all precautions.”
According to a recent survey of data from the University of Florida and University of Seattle, the household transmission rate ranged from 15% to 60%, depending on the variant and the vaccination status of those in the family. And, Patel points out, the long-term effects of even mild cases are not fully known, especially in unvaccinated kids under 5, so, like Rapsinkski, she still urges families to try to avoid infections.
These decisions are exhausting, and unfortunately many households will continue to wrestle with these decisions for the foreseeable future. Families do have one consistent, solid line of defense, though. “Vaccinating all eligible family members is best to make sure that everyone is at lowest possible risk of severe infection,” Rapsinski says. “Some steps can be taken to try to prevent transmission, while recognizing that these may not work. There is really no way to eliminate risk, so risk reduction is the goal.”
Dr. Anita Patel, attending in pediatric critical care medicine at Children’s National Hospital in Washington, D.C. and assistant professor of pediatrics at George Washington School of Medicine and Health Sciences
Dr. Glenn Rapsinski, a pediatric infectious disease fellow at UPMC Children’s Hospital of Pittsburgh