Our waiting rooms are starting to get a little busier, with children safely coming in for their annual physicals and infants getting caught up on vaccines that they missed due to stay-at-home orders and fear of a virus that is challenging every aspect of society.
They are also getting busier with families traveling to see relatives, children sent home from reopened day-care centers, and common pediatric symptoms that previously would not bring families to their doctors, such as a mild cough, sore throat, and diarrhea. Many families need a COVID test to travel, to go back to day care, or to alleviate a parent’s anxiety. Yet, testing turnaround times for those of us in the outpatient setting can be as long as two weeks.
There are more than 200,000 students in public and charter schools in Philadelphia, and thousands more in private and parochial schools. In previous years, we have always been prepared to send children back to school after a physical exam, routine vaccinations, and maybe an in-office test such as for strep throat. But with testing laboratories so overwhelmed, this time-honored system of a back-to-school checkup is about to become much more complicated.
Without accurate and rapid testing, it will be incredibly difficult to distinguish COVID-19 from many viruses that make children sick and have similar symptoms. The Philadelphia Department of Health has rightfully insisted that each sick pupil must test negative for COVID, be diagnosed with a non-COVID illness, or stay home for 10 days. Consider that children typically get six to eight colds per year, and you’ll see the logistics issues.
A society that does not prioritize the needs of working parents and their children — let alone grandparents who care for little ones and are at greatest risk from COVID — cannot fully reopen nor sustain the economy.
As a country, we are performing 500,000 to 700,000 tests per day, when our goal for containment of this virus should be 4.3 million tests per day. Pennsylvania is currently conducting 12,000 tests daily, yet an estimated 46,000 are needed for containment. Based on reporting from seven states, children made up less than 10% of total testing. The Children’s Hospital of Philadelphia’s Policy Lab is projecting a larger increase in Philadelphia’s COVID cases in early August, just in time for schools to reopen. The expected reproductive number will be more than one — meaning that each case infects more than one other person, and the pandemic grows.
Household transmission studies have shown that the majority of children with the virus are getting sick at home from adult contacts. But remember — schools have been closed for months. Children typically develop more upper respiratory viral infections after schools reopen.
No parent should have to struggle to get their child tested without multiple calls and trips, waiting days for a telemedicine visit, or paying a $49 copay — and all that is before the long wait for the results. Testing should not be a luxury commodity.
To protect school students and staff, testing supplies, technology, and PPE must be prioritized for pediatric outpatient practices. Ideally, a Philadelphia site would be created where children can get tested with rapid results, regardless of insurance status.
Many countries around the world have reopened schools safely. The United States can, too. The measures that schools will take, such as cohorting and masking, will surely help protect our children, but inevitably they will develop illnesses and need to be tested. Further, test data will help us better understand transmission dynamics in educational settings and the true effectiveness of school safety measures.
Today, we advocate for all children, especially the children of North Philadelphia, where we practice. Today, we strongly urge for a systematic strategy for widespread, efficient, and rapid pediatric testing in Philadelphia and around the nation. The school bells are about to ring.