COVID-caused conjunctivitis

[ruby_jane, BSN, RN]

I learned yesterday that in (less than) 5% of our kiddos, goopy bloodshot eyes may actually be COVID-related. As in, this is a new symptom we've discovered.

But that opened up the can o' worms: If I send a kid out for diagnosis and the doctor does not do a COVID test but just treats the viral or bacterial conjunctivitis and I let the kid back in....I don't want to think about what that looks like.

Good thing that conjunctivitis must be ruled out before return in my district.

But I already suspect a lot of the local clinics (not the  pediatricians specifically but the doc-in-the-boxes) are merely swabbing kids' sore throats for strep and not doing a COVID test. Last year said clinics were not even testing kids for the flu but just swabbing for strep.

Anyone have any lived experience with this?

[JenTheSchoolRN, BSN, RN]

17 minutes ago, ruby_jane said:

I learned yesterday that in (less than) 5% of our kiddos, goopy bloodshot eyes may actually be COVID-related. As in, this is a new symptom we've discovered.

But that opened up the can o' worms: If I send a kid out for diagnosis and the doctor does not do a COVID test but just treats the viral or bacterial conjunctivitis and I let the kid back in....I don't want to think about what that looks like.

Good thing that conjunctivitis must be ruled out before return in my district.

But I already suspect a lot of the local clinics (not the  pediatricians specifically but the doc-in-the-boxes) are merely swabbing kids' sore throats for strep and not doing a COVID test. Last year said clinics were not even testing kids for the flu but just swabbing for strep.

Anyone have any lived experience with this?

My state actually started cracking down on stuff like this and send out a state memo specific to pediatricians that were not running COVID tests that should be on kids.

I cannot tell you how many COVID positive kids whose families I've talked to sore throat - the strep-like one with pain upon swallowing - is the primary symptom. I tell them all to please insist on both a strep AND a COVID swab. For any in person kid, I need a negative swab before I consider letting that kid back in - but I haven't seen one go that way yet, they have ALL been COVID positive. 

I have heard about conjunctivitis but haven't seen first hand myself yet. But I immediately exclude for it anyway here. 

[Flare, ASN, BSN]

I have a student in the ICU right now with MIS-C.  His dad told me that he became very weak, tired, fever, and eyes were very red.  Student has covid back in Dec.  so scary!!

[Jedrnurse, BSN, RN]

I'm surprised that kiddos aren't being COVID swabbed irrespective of specific symptoms- it'd be helpful to catch those asymptomatic spreaders...

[NutmeggeRN, BSN]

25 minutes ago, Flare said:

I have a student in the ICU right now with MIS-C.  His dad told me that he became very weak, tired, fever, and eyes were very red.  Student has covid back in Dec.  so scary!!

Oh no...thinking nothing but positive wishes for him (and you)

[JenTheSchoolRN, BSN, RN]

15 minutes ago, Jedrnurse said:

I'm surprised that kiddos aren't being COVID swabbed irrespective of specific symptoms- it'd be helpful to catch those asymptomatic spreaders...

A lot of pediatricians aren't even seeing kids in person right now - starts with a virtual visit. Though if you have any symptoms and test positive for COVID, you are asymptomatic, it just may be a new symptom added the list.

We catch asymptomatic folks during school surveillance testing programs best, I think.

Though, to be honest, I've been running one of those since after Thanksgiving. I've caught 1 truly asymptomatic student; all others were pre-symptomatic. Symptoms will all thankfully mild, but presented within 24-48 after positive test came back.  

[Jedrnurse, BSN, RN]

6 minutes ago, JenTheSchoolRN said:

A lot of pediatricians aren't even seeing kids in person right now - starts with a virtual visit. Though if you have any symptoms and test positive for COVID, you are asymptomatic, it just may be a new symptom added the list.

We catch asymptomatic folks during school surveillance testing programs best, I think.

Though, to be honest, I've been running one of those since after Thanksgiving. I've caught 1 truly asymptomatic student; all others were pre-symptomatic. Symptoms will all thankfully mild, but presented within 24-48 after positive test came back.  

How has the staff rate of illness/infection been?

[JenTheSchoolRN, BSN, RN]

3 minutes ago, Jedrnurse said:

How has the staff rate of illness/infection been?

That one is way more interesting. 

Through this testing program, We've had 6 staff test positive (my regular in person staff testing pool is ~65 staff). 4 were asymptomatic. 2 were pre-symptomatic and experienced what I'd define as a more moderate illness course. 

I can confirm spread from a staff member to another staff member - but likely not due to work specifically, these staff members spend a lot of time together outside of work as friends. 

Now, I will also share this.

We tested the Monday after Christmas break - Jan 4th. All in person students and staff - students only on site for testing that day (in/out in less than 10 minutes). 1 positive student found. 0 staff!! (That one actually surprised me A LOT.)

We waited 2 days after testing to re-launch our in person on purpose. During those two days, another 2 students that tested negative on Jan 4th had family members test positive/develop symptoms on Jan 5th and 6th. Both tested positive on re-test. Because we waited on purpose, avoided any close contacts in school. 

[NurseInTheHall, ADN, RN]

We recently had a high school student report eye pain, no other symptoms, no redness or discharge, just pain. Mom took him in to get it checked out and the NP told him that it could be a sign of COVID, did a swab and sure enough: COVID.

Are there any symptoms that aren't COVID?  At this point, I've lost count of how many times I've told people that "COVID is different for everybody. Different in onset, different in progression and different in duration". I'm so thankful that the majority of our local clinics run the trifecta (strep/flu/covid) with all visits. There are only 1 or 2 local doc-in-the-boxes that simply run a rapid and send them on their way. I was appalled last week when a pair of sibs returned from urgent care with a rapid negative and a letter including clearance to return to school immediately. Uh, yeah, not your call doc, not how we roll at our school but thanks for playing - gonna need a confirmatory PCR.

[tining, BSN, RN]

On 1/22/2021 at 10:30 AM, JenTheSchoolRN said:

I can confirm spread from a staff member to another staff member - but likely not due to work specifically, these staff members spend a lot of time together outside of work as friends. 

 

I sent a PSA to my staff stating that I see spread when someone has had a meal/drinks with someone that DOES NOT LIVE IN THEIR HOUSEHOLD.  This is when you are your most vulnerable - mask down, closer than 6 feet, longer than 15 minutes.  DUH!  I would consider this 95% of spread reason in my school.