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travel

What Parents Should Know as States Reopen

Experts urge caution and continued protective measures for playgrounds, play dates and family travel.

Levi Jacobs

By Annie Sneed | May 15, 2020

After a month or two in virtual confinement, most of us are going downright stir crazy. There’s only so much “Puffin Rock” and “Masha the Bear” we can take. Meanwhile, our kids are crawling up the walls. As most states have begun reopening amid the coronavirus pandemic, people are anxious to know what activities their kids can safely do. Can children have play dates or go to the playground? Can parents hire babysitters?

White House phase two guidelines for reopening do not include specific advice on play dates or playgrounds; and many states and localities are setting their own timetables for reopening. What’s allowed in Alaska will be different than in New York City.

Yet health experts emphasize that the virus is still very much a threat. Also, scientists still don’t have clear answers about whether people can acquire immunity or how easily kids acquire and transmit the coronavirus. All of this means that for kid-related activities, parents need to weigh what’s happening with the coronavirus in their community, what their state or locality currently allows and how much risk they’re comfortable taking with their children and other household members.

Whether your child should have a play date is a personal decision, experts say. But parents need to be fully aware of the risks involved. “I would still take a lot of caution, knowing that I’m exposing my child to another child who comes with multiple exposures from their end,” said Dr. Stanley Spinner, M.D., vice president and chief medical officer of Texas Children’s Pediatrics and Texas Children’s Urgent Care. “How much risk are you willing to take?” Parents also need to consider whether family members, relatives, or anyone else around them and their kids is older or has underlying medical conditions that might put that person at risk. A play date could potentially expose not only your child to the virus, but also those more vulnerable as well.

If you decide to have a play date, health experts recommend several protective measures. First, before anyone comes over, ask the other parents if anyone in their household has any Covid-19 symptoms — though remember that carriers can be asymptomatic. Both parents and kids should practice social distancing or wear masks if they can’t maintain six feet of distance (the Centers for Disease Control and Prevention does not recommend masks for children under 2). Experts acknowledge that this may not always happen with kids — your child may refuse to wear a mask or rip it off — and that is a risk parents need to consider.

When your child’s friend arrives, make sure children and parents wash their hands thoroughly — and continue to do so throughout the play date. Also wipe down toys that might be shared and keep each child’s plates and cups separate.

Disinfect regularly touched surfaces, like doorknobs and bathroom faucets, as much as possible, especially after the play date. Within reason. Parents should do “the best they can with all of these different interventions, which is all about risk reduction,” said Dr. Peter Chin-Hong, M.D., professor of medicine and infectious disease specialist at University of California, San Francisco.

Also, limit the size of play dates. While White House guidelines for reopening allow for groups of up to 10 people in the first phase and up to 50 people in the second, experts say this is not a safe number for play dates. One or two other kids is the most you want. “Every time you add another child, you’re exponentially increasing the risk of exposure,” explains Dr. Spinner.

At a playground, you’re dealing with a larger, open space. But it’s also a more chaotic environment — you may not know the other kids at the playground, what their exposure to the virus is and you can’t control their behavior or their numbers.

The equipment surfaces likely aren’t being disinfected regularly, nor the bathrooms. “The playground is like the Wild West compared to the controlled play date,” said Dr. Chin-Hong. He said that parents might consider other outdoor activities, like going on a walk in the woods, if they want to avoid the risk.

If you decide to take your child to the playground — check your area to make sure they are open — many of the same hygiene rules for play dates apply. As much as possible, your kid should keep social distance or wear a mask (although other children may not wear masks, which leaves your kid less protected). Wash hands or use hand sanitizer often — even more than on a play date — and wipe down equipment before your child uses it. If possible, go when there will be fewer people around.

White House guidelines say that nonessential travel is allowed during phase two, though check local guidance to see what’s permitted where you’re going. Many health experts are still concerned about leisure travel. “What worries me is that as we have more movement, people are getting the idea that this is all behind us now. It’s not,” explains Dr. David Kimberlin, M.D., professor of pediatrics at the University of Alabama at Birmingham.

If you decide to travel, you should consider the different levels of risk involved in where you’re going and how you’re getting there. Traveling by plane or train is riskier than by car. Similarly, a city is less safe than, say, a cabin in the woods. And experts emphasize that if you decide to travel, you should learn about the coronavirus status of the destination, making sure that case numbers are consistently decreasing.

Bringing a person from the outside into your house is a risk. Look for a babysitter you trust and whose lifestyle puts them at a lower risk of exposure to the virus. Avoid someone who is hanging out with friends, living with a bunch of roommates or hitting the beach every day. Instead, search for someone who is staying home for the most part, and who lives alone or with a partner who also has minimal risk of exposure. “I would look for someone who has pretty much quarantined themselves so that their risk of being exposed is incredibly low, before you bring them into your house,” said Dr. Spinner.

You also want to make sure your babysitter is symptom-free before coming into your house and have them wash their hands thoroughly when they arrive. Some experts advise that babysitters wear a mask. Dr. Chin-Hong said parents might run potential babysitters through a “coronavirus I.Q. test” before they’re hired. Ask them questions such as: How do you keep yourself safe from Covid-19? What activities are you currently doing? What is your social life like right now? Who do you live with? How will you help prevent my child’s exposure to the virus?

“You can look for red flags,” Dr. Chin-Hong said. “You want to not only assess the risk of that person, but also whether or not the babysitter will help keep your child safe.”

The short answer: probably not. Currently, coronavirus antibody tests give you very little useful information. In general, antibody tests find evidence that the immune system has encountered a particular pathogen. But it’s unclear if many of the commercially available tests are accurate or not. A handful have been authorized by the Food and Drug Administration, which experts say provides some mark of quality, but it still doesn’t mean those tests will give an accurate result for an individual.

Even then, scientists don’t know whether having coronavirus antibodies actually confers immunity — or if so, how long it might last. Moreover, even high-performing tests can give false results.

“Even if you have a pretty good test and you apply it to a community with a low prevalence of the virus, more positives that you get on the test are from false positives than for true positives,” Dr. Kimberlin explained. “The meaning of a positive or a negative is extremely challenging both because of the performance characteristics and because we don’t have a good sense as to how common the virus is in a community.”

If you still want your family to be tested, contact a health care provider you trust rather than a random clinic. Ask your provider about the limitations of coronavirus antibody tests, and request one that has had F.D.A. oversight. But even if someone in your family gets a positive result — meaning it appears that they’ve had a previous infection with the virus — it shouldn’t change your self-protection measures (social distancing, masks, etc.). “Parents can do it for curiosity,” said Dr. Chin-Hong. “But it is not your passport to start interacting like crazy. It wouldn’t change my behavior at all.”

Recently, doctors in the United States and Europe began seeing children with symptoms such as a fever, a rash, abdominal pain, vomiting and nausea, diarrhea, redness of the eyes, shock or cardiovascular issues, among other symptoms. Doctors are calling the condition pediatric multisystem inflammatory syndrome.

“This is a newly recognized condition that appears to be a hyperinflammatory response involving multiple organ systems and blood vessels,” Dr. Kimberlin said. The syndrome appears similar to a rare childhood illness called Kawasaki disease, though experts say there are differences between the two conditions, such as in the way they affect the heart.

Experts say that parents shouldn’t agonize over the condition because it appears to be very rare. However, this syndrome is still very much a mystery. Doctors think it may be related to Covid-19, though no definitive link has been established. A significant number of children with the condition did not test positive for active coronavirus, but did test positive for coronavirus antibodies.

“The theory here is that if this is Covid related, the child is recovering from Covid and the immune response overreacts with inflammation,” Dr. Kimberlin said. “But that’s only a theory — it’s not a proven one yet.”

While the condition appears very uncommon, and deaths are even more rare, there have been fatalities. About 100 cases have been reported in New York, with three fatalities as of mid-May, according to Gov. Andrew M. Cuomo.

Dr. Chin-Hong recommended that parents get in touch with their pediatrician if their child develops a fever and a rash.

He said dramatic cases will be obvious to a parent. “Their child would be listless, not have an appetite, and in the most serious cases, they would collapse.”

But he and other experts stressed that parents don’t need to be overly worried about the inflammatory condition — just pay attention to your child and watch for symptoms. “It is important to keep in mind that it is a very rare condition,” Dr. Spinner said.

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