We spoke to Toronto paediatrician Dina Kulik about how to deal with a sick kid during the coronavirus crisis, and why it’s hard to get your kid tested.
The news is moving quickly this week, and parents—understandably—have a lot of questions about coronavirus right now. Knowing when to go to your family doctor, or opt for a walk-in clinic, or brave the ER, is tricky enough, even without a growing pandemic. We spoke to Toronto paediatrician Dina Kulik about what she’s seeing in her clinic and what parents are supposed to do if their kid is sick.
Parents are wondering—if my kid is sick, if they have a cough, or they have a fever, what am I supposed to do?
Luckily, the vast majority of people with COVID-19 have no real significant symptoms that we’re worried about. They might have cough, fever or cold symptoms. And we know that kids in particular have been relatively protected from COVID-19. They may get it, but they’re not dying, and they’re not getting as sick as some of these elderly people that we’ve seen. So I remain pretty optimistic about kids and for the most part, they can ride the illness out at home.
But if you have contacts in your life that are at increased risk of COVID-19, like an immunocompromised person, the elderly or people with chronic health conditions then it’s more important for you to know if your child actually has COVID-19. Also, if you’ve travelled, that’s another reason to get tested.
How can you get tested?
At the moment, the only way to test for the virus in Ontario is by going to a hospital. There are some community testing opportunities in other provinces that we’ve seen, like in Alberta. But in Ontario at the moment, all we’ve got is the hospital. Not everyone needs to be tested—we don’t have the resources for that. But if you’ve been travelling, or your kid is really unwell, you should take them to the hospital.
Exactly at what point would you take your kid to the hospital?
It’s hard to be really prescriptive. It’s hard to say something like, if your kid is breathing at a certain rate, or if the fever is a certain temperature, because that’s not really how that goes. Parents have a difficult time knowing how fast the kid is breathing, and the height of a fever is actually not indicative of the severity of illness. There are many very simple viral infections that are not dangerous at all, that can give very high fevers.
I always tell families that if you’re concerned about the health of your child, you should see your primary care physician. And if that person isn’t available to you, go to the emergency room. Persistence of fever is important for me too. So even if your child looks well, if they are on day two or three of a fever, I do think that child should be examined, because a parent can’t tell if their child has a chest infection or an ear infection or a strep throat infection just by looking at them.
But otherwise, it’s a “trust your gut” thing. If you have a runny nose and a mild cough, should you go to emerge? Probably not.
If a kid has a cough and fever, but it’s manageable at home, how long should we keep them away from other people?
We don’t have clear guidelines on that at the moment. Personally, I think everyone that’s sick right now should be self-quarantining for 14 days after the beginning of illness, or after returning from any travelling out of Canada. That’s not an official recommendation. But that would be ideal. Of course, not many people can afford to do that or have the resources to do that.
In general, if kids are sick or have a fever, I strongly recommend all year round, coronavirus or otherwise, that they’re not exposing themselves to other people.
Are you seeing kids with coronavirus?
We don’t know the real stats, because most people are not getting tested. We’re assuming that most cases we’ve seen in the last several weeks have been influenza, and we’re not necessarily testing those people. It’s quite possible, and I think it’s likely, that there’s thousands of more cases of COVID-19 in Canada, in the US and everywhere, and because we’re not testing everyone, we don’t know.
Those people are doing just fine. It’s really a matter of, are we being careful not to expose the people that are at higher risk?
If your kid did have coronavirus, how would it be treated?
There isn’t any treatment It’s symptomatic care. So making sure that they’re comfortable, using things like acetaminophen, ibuprofen and making sure they’re drinking enough. Some people will get very sick, and need things like oxygen and antibiotics for pneumonia. But that’s not typical in children.
Should you call ahead before going to your family doctor, a clinic or the hospital, if you think your kid might have coronavirus?
Calling the emergency room doesn’t do anything. They’ll just triage you when you get there. But for example, at my clinic in Toronto, when you’re booking appointments, you have to be pre-screened. We have to talk to you on the phone or send you an email that you answer saying that you have not been exposed to anyone outside of Canada in the last two weeks or yourself haven’t been outside of Canada in the last two weeks. If you have, and the parents want their child to be seen, we’re directing you to the hospital.
Who should be self-isolating right now?
I strongly recommend people do not travel outside of Canada right now. All these people who are going away for March Break—which they shouldn’t, in my humble opinion—when they come back, they should be prepared to self isolate for two weeks, or this is going to spread very rapidly. Or if you’ve been exposed to someone who has tested positive, you need to self-isolate.