Over the past couple of weeks, New York State has seen a significant increase in children testing positive for Covid-19. There is usually a spike in positive cases among adults after most holidays, but for the first time notable parallel positive results have been seen in children. Perhaps this increase can also be attributed to holiday gatherings or exposure at school. Whatever the reason, the numbers are alarming. Pediatric hospitalizations were up 395% in December. During these uncertain times parents may be overwhelmed and unsure how to keep their children safe.

Epicenter-NYC reporter Andrea Pineda-Salgado spoke with Dr. Mannan Razzak, a New Jersey pediatrician with nearly two decades of experience about how we can keep children safe from exposure to Covid-19. The following has been condensed and edited for clarity. 

Dr. Mannan Razzak

Epicenter-NYC: There is a surge in cases of kids with Covid-19, why is it happening now?

Dr. Razzak: The Omicron variant does seem like it is more transmissible. Our younger kids who aren’t vaccinated and those who are eligible and aren’t vaccinated are getting Covid and they’re transmitting it to other people.

Epicenter-NYC: What kinds of cases are you seeing? Are kids in critical condition? Are they hospitalized?

Dr. Razzak: Over the last holiday weekend of December, we’ve seen a dramatic increase in Covid positive patients. The rapid tests and the PCRs do not identify whether it’s the Omicron variant or not, it just comes out as positive, but it is the leading strain that’s out there in the United States now. Yesterday, I saw a four-month-old who was exposed to Covid. The child did not have any symptoms, but the exposure history in the daycare was a factor. But then we have other kids who had 103, 104 degree fevers, and these are 18-month-olds and two-year-olds. So the under five group is really getting hit with this variant. We haven’t had many hospitalizations — maybe a handful of hospitalizations because children are not eating or drinking and they’re getting dehydrated and that’s really the hospital component, but otherwise it’s been really more fever and cough.

Epicenter-NYC: What symptoms do kids with Covid-19 usually have?

Dr. Razzak: It could be fever and it could be something low grade from a 101 to even a temperature of 103, 104. Cough, runny nose, the typical things that we’d see during the winter now already — those are some of the symptoms. We’re even seeing some vomiting and diarrhea in some of the kids. One thing to note is that the Omicron variant seems to be doing something similar to what we call ‘croup,’ which is another viral infection that causes swelling in the upper airway and causes a barking cough. And we’re seeing some of the Covid-19 infected kids with that type of symptom as well.

Epicenter-NYC: If a child gets Covid-19, and the symptoms are not severe enough to warrant hospitalization, what can parents do to alleviate symptoms?

Dr. Razzak: Most important: fever control and hydration. Whether it’s Tylenol or Motrin, Tylenol every four hours as needed and Motrin every six hours as needed. Your pediatrician will tell you exactly how much to give depending on the weight of the child. I recommend Pedialyte and I recommend that for even grownups, or parents and teenagers. Water doesn’t have the electrolytes we need to keep hydrated. Even if it’s just sips here and there, you can take a medication syringe and squirt it in the mouth like medication. Administer 5ml every few minutes just to keep them hydrated.

Testing

Epicenter-NYC: What should parents do if someone in their child’s class tested positive for Covid-19 but their child tested negative?

Dr. Razzak: The CDC is recommending a five-day quarantine period to see if anything is developing. If you’re not having any symptoms, you should take a test at the five-day mark, and if it’s negative, your child can return to school. Symptomatic kids need to stay home for that 10-day period.

Epicenter-NYC: If a child has Covid-19, how often should they test before going back to school?

Dr. Razzak: The recommendation is five days into any symptoms. And they should definitely test two days or 48 hours before going back to school. Even with all the tests, nothing is 100%. If the child is feeling symptoms after the test, I would test again. 

Kids and the Covid-19 vaccine

Epicenter-NYC: Why is it important for children to get vaccinated?

Dr. Razzak: One is reducing infection for themselves. If they’re vaccinated, we know that this vaccine can help prevent them from getting something serious. Vaccination would help them to reduce the morbidity, which is the suffering that we think about from the infection itself. That would be the big thing. And of course, mortality, we’ve had over 750,000 people die of Covid and vaccinations will help prevent that also.

Epicenter-NYC: What is your opinion on a possible Covid-19 vaccine mandate for NYC schools?

Dr. Razzak: Vaccines are important. Just as we vaccinated against tetanus diphtheria, measles and chickenpox, we’ve been able to reduce some of this and almost eradicate diseases like diphtheria and polio. Covid is a virus where we see that the infection rate is high. I would recommend a vaccine mandate.

Epicenter-NYC: What about boosters?

Dr. Razzak: Last week the CDC and the FDA approved booster vaccines for children 12 and up, five months after the second dose. I recommend that everyone eligible get the booster vaccines. 

Keeping your child safe

Epicenter-NYC: What can parents do to keep their kids safe while in school?

Dr. Razzak: The most important thing to do if your child is sick, if you have had exposure, is to please keep your child home. We don’t need the child to go out whether to school or daycare and infect other kids — so that’s most important. If they’re old enough to wear a mask, please mask them up. Masks do reduce the transmissibility of this virus. One note, I’d also add the latest resources, cloth masks are not helping to reduce transmission of Omicron. So I’d use something different than cloth masks.

Epicenter-NYC: If a child is not old enough to be vaccinated, should the parent, even if vaccinated, continue to wear a mask indoors/outdoors to protect their child?

Dr. Razzak: Yes. Outdoors yes, definitely. Indoors, if the parents are exhibiting some symptoms, yes, I would recommend that they wear masks even indoors.

Epicenter-NYC: Should parents tell their unvaccinated nannies or babysitters to get vaccinated?

Dr. Razzak: I would recommend that the nanny and the caregiver get vaccinated especially with the interaction and the close interaction they’re going to have with the child. It will increase the risk that the child may get Covid.

Epicenter-NYC: How can children safely participate in extracurricular activities and sports? Should they even be participating?

Dr. Razzak: I think it is important for them to be out and participate in sports, not only physical activity, but their psychological component that we forget about. The kids have been resilient in wearing these masks — I think they’re better at it than us grownups. I think they should be out there playing, they should participate in sports. In our own household, my daughter is in middle school and she’s on the basketball team and she wears a mask during practice, so I believe it’s going to also be worn during the games. 

Epicenter-NYC: How do you feel about sleepovers? 

Dr. Razzak: Sleepovers are wonderful, but it depends on the families that you’re interacting with and having the sleepovers with. Make sure that everyone is vaccinated, but then also, a few days before the sleepover, ask where have these families been. I think it’s important to ask what has that exposure level been for that family. If they had Covid or came in contact with someone, yes, definitely avoid it. 

Epicenter-NYC: At what age can kids begin wearing masks?

Dr. Razzak: Two-year-olds are coming into the office and wearing masks, and they like it. Although, some two-year-olds may find it a little difficult. Three-year-olds, for sure. 

Remote learning

Epicenter-NYC: How do you feel about remote learning?

Dr. Razzak: I think the kids need to be in class. With remote learning you have certain distractions in front of you and for a child to sit there for 50 minutes for each class, even half an hour for each class, it’s difficult. Even if they’re wearing masks and they’re in school, they’re seeing their friends and they’re having some interactions. It is psychologically important for them to go back to school. Also, the learning component of it — you’re going to be able to learn and interact and receive this information better if you’re in class.

Epicenter-NYC: Have children’s mental health and socialization been affected by remote learning?

Dr. Razzak: Yes, they’re more isolated and we have seen that in our practice. We have referred patients to counseling. Teenagers are really affected by this. The overall interaction and the socialization of kids is reduced. We need to help support them, get them back into class and if they need counseling, of course there’s no stigma with this. 

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