Health Advisory
TESTING FOR COVID-19 IN CHILDREN

The Delaware Division of Public Health (DPH) is re-issuing this health advisory with updated information to provide those in the medical community who care for children, an update on testing for SARS-CoV-2 in children with suspected coronavirus disease 2019 (COVID-19).

Summary

DPH is aware of confusion and concerns surrounding testing children for SARS-CoV-2 after direct exposure or exposure to an individual with confirmed COVID-19. Testing can identify cases of COVID-19, particularly among asymptomatic individuals, and assist in controlling the spread of the disease.

Background

The American Academy of Pediatrics (AAP) supports the implementation of public health surveillance that tests at a population level to identify local outbreaks of coronavirus disease 2019 (COVID-19) in communities, in partnership with health care providers and local public health departments. Testing can inform local levels of community transmission of SARS-CoV-2.

Testing for SARS-CoV-2 in practice can inform individual patient care and testing at a population level and assists in determining what interventions may need to be put in place to control the spread of disease within a community.

The AAP recommends using molecular tests such as reverse transcription polymerase chain reaction tests that have been approved by the Food and Drug Administration (FDA). Other FDA-approved tests may be considered if necessary.

Recommendations:

The most common scenarios in which to consider testing for all patients, including children, include:

• Weekly testing for unvaccinated individuals.
• DPH is partnering with the Department of Education and Quidel Corporation to offer comprehensive COVID-19 testing, processing and reporting in Delaware schools. Quidel will utilize its rapid antigen tests to provide results in as little as 10 minutes.
  • This service which is free to schools and staff, is a complete turn-key solution that includes Quidel staff to conduct the tests in-person, analyze results and report them to families and the State, taking the burden off of schools.
  • This testing service is meant to be a routine process that is aimed at testing asymptomatic staff and students. Staff and students who have symptoms of COVID-19 are reminded to stay home and seek testing at one of Delaware’s available sites.
  • Schools and families that want to learn more about the program can visit COVID-19 School Testing.
• Patients with symptoms consistent with COVID-19
• Patients who were in close contact with a person with confirmed or probable SARS-CoV-2 infection.
  • Asymptomatic children who had close contact with someone with COVID-19 are recommended to wait at least 4 days after exposure to be tested.
  • Fully vaccinated patients are also recommended to seek testing 3-5 days after exposure to a person with COVID-19, and wear a face covering for 14 days or until the test comes back negative. However, they are not required to quarantine after exposure unless they develop symptoms.
  • Any close contact of someone with COVID-19 experiencing symptoms should isolate immediately and seek testing.
  • Close contact means having been less than 6 feet for a total of at least 15 minutes over a 24-hour period from a person with confirmed or probable case of COVID-19. Exception: In the K-12 indoor classroom setting, the close contact definition excludes students who were within 3 to 6 feet of an infected student (laboratory-confirmed or a clinically compatible illness) if both the infected student and the exposed student(s) correctly and consistently wore well-fitting masks the entire time.
• In general, asymptomatic children who are fully vaccinated (i.e., are ≥ 2 weeks following the second dose of an mRNA vaccine) do not require routine testing for screening purposes.
• The decision to test does not differ by the age of the child, although some symptoms such as body aches, shortness of breath, and loss of taste/smell are more prevalent in young adults than in school-aged children.
• When patients are symptomatic, clinicians should use their clinical judgment and consider co-infection with COVID-19 when faced with a pathogen presenting similarly.  For patients with respiratory symptoms, pediatricians may consider testing for SARS-CoV-2, influenza, respiratory syncytial virus [RSV], and/or other diseases, depending on local epidemiology. Some studies have found high levels of co-infection.

Testing

Providers who are not currently testing for COVID-19 are encouraged to either write a prescription/referral for testing, or direct patients to de.gov/gettested to identify a testing location near them. 

Additional Considerations:

• Testing for SARS-CoV-2 infection in the clinic setting is not recommended routinely in the context of other illnesses that lack shared symptoms (such as cellulitis or urinary tract infections) but may be performed for children being hospitalized to allow for additional isolation precautions if a child is SARS-CoV-2 positive, unrelated to the admission diagnosis.
• Testing is not generally recommended for indirect exposure such as exposure to a close contact as opposed to exposure directly to the infected person unless the close contact subsequently tests positive or develops symptoms.
• Testing is also not generally recommended for asymptomatic patients who have previously tested positive within the past three months or who are fully vaccinated against SARS-CoV-2
• Given current testing limitations, the AAP does not recommend "on demand" testing such as prior to travel, particularly if patients are asymptomatic.
• Patients should stay in isolation while awaiting test results unless they are part of a routine screening program. Children who are symptomatic and positive should stay isolated until they have been afebrile for 24 hours without the use of antipyretics, at least 10 days have passed since symptom onset and symptoms have improved.
• Children who are symptomatic and negative should stay isolated until symptoms resolve. Families should be counseled that the test result shows only a moment in time and the child still can contract the virus.
• Children who are asymptomatic and positive should be isolated for 10 days depending on local public health recommendations.

Reporting

Providers are reminded to report all confirmed and suspected cases of COVID-19 to the DPH Office of Infectious Disease Epidemiology (OIDE) at 302-744-4990 (normal business hours) or 1-888-295-5156 (outside of normal business hours), fax to 302-223-1540, or email to reportdisease@delaware.gov.

You may also complete a Notifiable Disease Report PDF Form and mail the form as directed, fax the form to DPH at 302-223-7540, or email to reportdisease@delaware.gov. The form and list of notifiable diseases can be found online at https://dhss.delaware.gov/dhss/dph/dpc/rptdisease.html.

Additional Information

• Overview of Testing for SARS-CoV-2 (CDC)

• COVID-19 Viral Testing Tool (CDC)

• COVID-19 Testing Guidance (aap.org)