Joint Recommendations on Caring for Children and Adolescents with COVID-19 at Home by The Hong Kong Paediatric Society, The Hong Kong Society for Paediatric Immunology Allergy and Infectious Diseases, Hong Kong College of Paediatric Nursing and Hong Kong Paediatric Nurses Association
Route of transmission and the incubation period of COVID-19
The novel coronavirus can spread through droplets and contact. The transmissibility of the Omicron variant strain of SARS-CoV2 is very high. Symptoms appear 2 to 14 days after exposure to the novel coronavirus.
Symptoms of COVID-19
The main symptoms of novel coronavirus infection are fever, cough, runny nose, sore throat, chills and rigors, nausea, vomiting, diarrhea, malaise and headache. The virus can cause severe respiratory infection resulting in shortness of breath.
Scientific evidence has shown that Omicron can be transmitted by airborne route in certain physical environments. Runny nose, sneezing, sore throat, headache and malaise are reported to be more prevalent in patients infected with Omicron.
Based on the current scientific literature, the vulnerable groups to have severe illness once infected with the coronavirus are the elderly, people suffering from chronic disease and people with congenital or acquired immunodeficiency. There have been fatal cases reported in children and adolescents infected with Omicron.
Recommendations on Caring for Children and Adolescents with COVID-19 at Home:
1. Onset of the symptom(s) of infection:
• Parent / carer needs to record the date and time when the child starts to have symptom(s) of infection.
2. Regular observation:
• Monitor the body temperature of the child.
• Record the amount of oral intake and the frequency of urination and bowel opening.
• Be aware of any new symptoms such as: cough, runny nose, sore throat and vomiting.
• Be highly alert to any symptoms indicating deterioration in the child’s condition, such as: confusion, pallor or difficulty in breathing.
3. Measure and record body temperature(Normal body temperature is 36.5 - 37.5°C)
• Use an ear (tympanic) thermometer and record the child’s temperature every four hours.
• Feeling the forehead as a form of temperature measurement is extremely inaccurate and unreliable.
• Parent / carer may use paracetamol to relieve fever, headache, and sore throat in the child.
4. Food and fluid intake
• Maintain a healthy lifestyle by eating more fresh vegetables and fruits, drinking more water and maintaining regular exercise. Remember to have adequate rest and sleep. All these can enhance the body's immunity to fight against the coronavirus.
5. Children's Personal Hygiene
• Follow the Centre for Health Protection's instructions to stay at home. Parent / carer and the child should stay away from other family members. Whenever possible, the parent / carer and the child should stay and eat in the same room and avoid having contact with other family members.
• Parent / Carer must wear a surgical mask and help the child to wear an appropriate-sized mask to reduce the possibility of cross-infection. The mask must cover both the mouth and nose. After use, the surgical masks should be folded and disposed of in a covered rubbish bin. Remember to clean both hands thoroughly after disposal.
• Teach the child to observe personal hygiene and wash his / her hands frequently. Wash both hands with soap and water for at least 20 seconds before and after eating, after using the toilet, or after touching soiled objects. Remember to clean the fingers and wrists as well.
• If the environment does not allow hand washing and the hands are not visibly dirty, parent / carer and child should clean the hands using a 70-80% alcohol-based hand sanitizer.
• Avoid touching the eyes, nose and mouth before thorough hand washing.
• Arrange a dedicated toilet / bathroom for the child if possible. If there is no designated toilet / bathroom for the child, other family member should not place their towels and personal hygiene items in the bathroom when not in use. The child should also be taught to cover the toilet before flushing and wash their hands thoroughly after using the toilet.
• Toilets used by the child should be regularly cleaned with 1:49 diluted household bleach.
• Teach the child to cover his / her mouth and nose with tissue paper when coughing or sneezing, and then carefully dispose of the tissue in a covered rubbish bin, followed by cleaning his / her hands thoroughly.
6. Home hygiene
• Maintain good ventilation at home. Open more windows because good ventilation can effectively allow the virus to be carried away with the airflow. A HEPA filter is useful to filter off the virus.
• The child should have personal cutlery, drinking glasses, mouthwash cups, toothbrushes and towels. Children with COVID-19 infection should not share personal items with other children or adults.
• Clean your home daily with 1:99 diluted household bleach.
• Use 1:49 diluted household bleach to clean the child’s toys thoroughly every day. Objects contaminated with the child’s secretions while sneezing or coughing should be disinfected with 1:49 diluted household bleach.
• Ensure that the U-shaped drain is filled with water regularly to prevent the spread of the virus.
7. If the child’s COVID-19 rapid antigen test is positive, further confirmatory test (deep throat saliva test) is required to confirm the diagnosis according to the guideline by the Centre for Health Protection. Family members should help to arrange the deep throat saliva test by collecting the specimen bottle for the child and returning it for analysis.
• Parent / carer needs to follow the instructions in the COVID-19 rapid antigen test kit to complete all steps and dispose the used test kit properly in a covered rubbish bin.
8. Natural course of COVID-19
• Parent / carer should stay calm as most children infected with COVID-19 will eventually recover. Most of the infected children do not need to be prescribed with antiviral drugs. The fever will last for about 2 to 3 days and other symptoms will usually subside within a week.
• Wait patiently for the relevant parties to make the arrangements for hospital admission or transfer to community isolation facilities.
9. What are the warning signs requiring immediate medical attention?