According to the Centers for Disease Control and Prevention (CDC), COVID-19 cases, hospitalizations, and deaths across the United States are rising. With the socialization that comes with the holiday season and the arrival of cold weather driving more people indoors, this rise in COVID cases will not likely improve any time soon. Due to the concern of a worsening COVID surge, the possibility of a “twindemic” with the arrival of influenza, and continued limited testing capacity at our hospitals and EDs, medical leadership from Emergency Medicine and Infection Prevention at Children’s Healthcare of Atlanta created an algorithm to help determine how to best utilize available tests for SARS-CoV-2.
This testing algorithm, which takes into account CDC recommendations, provides a general framework for testing in our emergency departments. Basic considerations of the algorithm include:
Has the patient had a recent positive COVID PCR or antigen test?
Does the patient exhibit symptoms of COVID-19?
Will the results of the COVID test directly impact acute clinical care or medical management of this patient?
Will the results of the COVID test help in management of a child with a chronic or underlying medical condition?
Will testing impact a child or parent’s ability to return to school or work?
These are the questions our ED providers will have in mind if a child presents or is referred to any of our emergency departments with a concern of COVID-19.
The first consideration is whether or not the child has had a positive COVID PCR or antigen test in the past 3 months. Since it has been shown that patients may test positive for up to 3 months after recovering from an acute COVID infection and not be contagious to others, COVID testing is not routinely recommended during this time frame. Testing for other etiologies including influenza and Multisystem Inflammatory Syndrome in Children (MIS-C) may need to be considered.
The year 2020 has presented tremendous challenges and changes to all fields of medicine. As this pandemic has grown in size and impact, there has been growing concern about the impact of social, economic and political stressors on mental health (MH). Early data from the CDC has shown rising prevalence of symptoms of anxiety, substance abuse, suicidal ideations, and depressive disorders across all ages, with a disproportionate prevalence amongst young adults (62.9% in 18-24yo vs 30.9% in all ages) and racial minorities.1 Data on children and teens is still being collected, but thus far points to similar increases in children and teens.2 As COVID continues to affect our communities, physicians must be on alert for these growing psychiatric concerns.
One of the major changes for youth has been the closure of schools and subsequent shift to online education. Children of all ages across the state are now learning virtually and screen time is surpassing the limits recommended by AAP. While public opinion often considers social media as having a negative impact on MH, the data around this is mixed.4,5 Rather than focusing on social media use itself, it may be more helpful to look at specific exposures to negative aspects of social media, such as online bullying, sexual exploitation, and trauma exposure.5,6 An example that has received considerable media attention this year is the prevalence across social media platforms of videos depicting police brutality of minorities. The American Academy of Child and Adolescent Psychiatry (AACAP) recommends parents have an active, hands on role in helping children process information they have learned from the news about tragedies.3 When children view these images on social media, they often lack the parental support and context, and may experience higher stress related responses.7 As screen time increases, parents should be advised to remain engaged in what their children are viewing and how they are processing that information. Physicians should also be ready to discuss in detail how patients are using their screen time and how it may be affecting their mood and thoughts.