Partner Content

The Delta Dilemma

Keeping the classroom safe from illness.
By University of Maryland Faculty Physicians

With the return of in-person learning, parents, teachers, and administrators continue to implement safeguards to protect their school communities from the coronavirus, its various evolving mutations, and the threat of an aggressive flu season.

To get the best guidance, we talked with Dr. Niharika Khanna and Dr. Natelaine Fripp, board-certified family medicine physicians from the University of Maryland who were at the forefront of the pandemic.

As family physicians, how have you been impacted by COVID-19?
Dr. Fripp: When COVID-19 made its way to the U.S., we all had a lot to learn and little time to waste. I became one the main providers evaluating, testing, educating, treating, and following up on patients with virus symptoms.

I witnessed seemingly healthy patients become sick, recover, and develop lasting kidney, lung, and heart disease. I had patients present with mild symptoms then quickly land in the hospital. I saw my own colleagues and their families become infected, and also had people close to me succumb to the infection after a long, courageous battle or decline suddenly. The impact has been stressful, exhausting, frightening, eye opening, personal, educational, and then some. I am thankful to my colleagues I have worked with during this pandemic.

Dr. Khanna: COVID-19 has turned our lives upside down! We went from crisis mode in 2020 to becoming the testing and vaccination team that our campus needs. We take pride in rising to the challenges that were posed with the pandemic in creatively providing preventive care and chronic disease care to our regular patients, and COVID-19 care, testing, and vaccination.

Are you seeing an increase in pediatric patients with positive test results?
Dr. Khanna: It’s clear that children are at risk and a slow but steady increase in the number of children in ICU has also been demonstrated. We are seeing COVID positive patients in the under 11 age group,12 to15 year-olds, and larger numbers in the 16 to 24 age range.

Dr. Fripp: I have been seeing more pediatric patients via telemedicine for testing after exposures (large family gatherings and trips mostly).  The youngest I’ve seen with positive results was 6 months old.

How can parents better protect their families against the virus?
Dr. Khanna: Though the COVID-19 vaccine is approved for children age 12+, only 34% nationally have been vaccinated (as of Sept. 2021). Families need to get the COVID-19 vaccine if appropriate to their health, avoid crowded events, monitor for high risk exposures, quarantine the entire family if one person is exposed and is living at home. Parents should encourage masking when leaving the house, grocery store trips are minimized, and physical distancing is followed. If grandparents are vaccinated, families can include them in activities while following precautions.

What should parents consider regarding the COVID-19 vaccine for their kids?
Dr. Fripp: Considerations include their child’s health status and living situation, where their child will be when not at home, who they could be exposed to, and the family’s lifestyle. Some families have multiple generations in the home and members with varied degrees of health. At this point we all have been given information about the vaccines; some credible and some not. Read information from credible sources and ask questions of credible professionals. Understand that it is a vaccine for the health of the public and the individual.

What aspects of school environments are known to increase the spread of illness?
Dr. Fripp: Communal areas, such as water fountains, bathrooms, door knobs, play structures, desks, buffet style cafeteria set ups, and school buses may be of concern.  Schools should sanitize high touch areas often, and ventilation could be an issue if the HVAC has not been updated for proper air circulation and filtration.

Younger students in particular touch, share, and invade personal space which can spread many viruses and bacteria. There may be a tendency to revert to what is familiar, including old behaviors.  It is up to the teachers and aides to enforce the school’s COVID-19 precautions.

Is there a clear distinction between flu symptoms and COVID-19 symptoms?
Dr. Fripp:  Flu symptom onset tends to be sudden and hallmarked by high temperatures and body aches. COVID-19 is hallmarked by the loss of taste or smell, dry cough, shortness of breath, and can come on suddenly or gradually, as well as escalate into life threatening symptoms without warning. I have seen several patients present with sneezing or scratchy throat only and were COVID positive.

Dr. Khanna: All respiratory symptoms should be taken seriously since COVID-19 presents with the gamut of symptoms severity, from asymptomatic to mild and seriously ill.

Do certain symptoms appear more often in children than in adults? 
Dr. Khanna: The most common symptoms in children are cough and fever, while 16% may have no symptoms at all. Thus, parents of children who have had a recent exposure should seek testing, and children going to school should also be tested regularly with or without symptoms

Dr. Fripp: Children are more susceptible to a condition called MIS-C (multisystem inflammatory syndrome in children).  Although rare, it can involve several organ systems like lungs, brain, heart, kidneys, eyes, etc., and be very serious, if not deadly.

Where should parents seek care if they suspect COVID-19 transmission?
Dr. Khanna: For symptomatic children, parents should first call their family physician, pediatrician, or their local health department and ask for advice. Usually they can offer a telehealth appointment and discuss the need for COVID-19 testing.

Dr. Fripp: If you have any concerns your child may be infected – quarantine or isolate. You do not want to accidentally spread this disease to others.  Several urgent care centers, including University of Maryland Urgent Care in Columbia, are equipped with PCR testing (the gold standard in COVID-19 testing) and can also treat acute symptoms, such as with the use of monoclonal antibodies.

Is research being done at the University of Maryland regarding COVID-19 and other viruses?
Dr. Khanna: The UM School of Medicine has been involved in significant research, including how coronaviruses function and interact with the host, development of new therapies and vaccines, clinical trials, community outreach, testing and surveillance.

Personally, I’ve been involved with several of these initiatives, one being data-guided mapping of COVID-19 cases and vaccination rates to better reach certain communities. Another includes educating and vaccinating vulnerable populations in Maryland, Virginia, West Virginia and Delaware. And also, the Novavax and Moderna vaccine clinical trials and post-vaccination assessment for all respiratory illnesses.

We’ve heard medical experts anticipate a “bad” upcoming flu season. Why is that?
Dr. Fripp: The last flu season may have at least appeared to be mild because of an increase in measures like distancing, masking, washing our hands, and covering our coughs. Many people (especially children) stayed home and COVID-19 was the focus. As fewer people were infected with or exposed to the virus last season, fewer people also acquired immunity.

Another theory relates to the vaccine and how it is made. Since fewer influenza was detected in the previous season, designing the recipe for this season’s vaccine may become a challenge.

Dr. Khanna: My suggestion is to schedule flu vaccines for your family, and ask your doctor if you are eligible for the third dose of the COVID-19 vaccine. Parents should also utilize this opportunity to catch-up their children on any vaccines missed due to the pandemic.