Increased demand for COVID-19 testing swamps NC pediatricians

The medical team at Goldsboro Pediatrics sees a steady stream of patients from 8 a.m. to 5:00 or 6:00 in the evening, their appointment schedules swelled by parents seeking COVID-19 tests for their children.  

Slots for the walk-in hour of 8:00 a.m. to 9:00 a.m. are usually filled by 8:30, said Dr. Teague Horton, a partner in the practice.  

Some children exposed to COVID-19 at school must be quarantined. They need to test negative for COVID-19 to shorten their quarantine from 10 days to seven days if they have no symptoms. 

 “The poor parents are like, ‘help me out so I can get my kid back into school,’” Horton said in a recent interview.  

Additionally, schools are excluding students who show symptoms of COVID-19 infection, such as fever, headache, congestion, or runny nose. Many symptoms are identical to other common illnesses, sending parents in search of tests to find out whether their children have COVID-19. 

“Every child who is in school or daycare, or who develops an illness – something with a fever, cough, runny nose, diarrhea – they need to have proof it’s not COVID to return to school or daycare,” said Dr. Ed Pickens, a UNC Health pediatrician who works in Durham. “We are doing a lot of testing of children so they can be cleared so they can return to school. It’s not easy to predict who is positive. Most illnesses have the same symptoms as COVID.” 

Schools opened this year during a surge in COVID-19 infections caused by the highly contagious Delta variant. As of Tuesday, the state Department of Health and Human Services reported COVID-19 clusters at more than 250 schools and childcare facilities. DHHS defines a “cluster” in a childcare or school as a minimum of five confirmed cases with positive test results within a 14-day period, with a plausible link between the cases.   

Earlier this month, the state Department of Health and Human Services noted the dramatic rise in COVID-19 cases in children. “Our case rates are highest for children 17 and younger,”  Secretary Mandy Cohen said at a September 9 news conference.  

Goldsboro resident Ashley Jones’ eight-year-old daughter came home from school a few weeks ago and told her grandmother than one of her classmates had COVID. Jones said she never heard anything from the school, but a few days later her daughter began coughing and developed at 103.6-degree fever.  

Jones was able to get an appointment for her daughter the next day at Goldsboro Pediatrics for a COVID-19 test, which was positive.  

This was after her daughter’s routine check-up had been pushed from August to December.  

“COVID has swamped the office,” she said. “You can’t even get regular health appointments.” 

COVID added a layer of stress to all the emotions that come with a new school year.  

“I was nervous sending her back this year,” Jones said. She sent her daughter to school with hand sanitizer and reminders to keep her mask on. “To send her there and for her to come home with COVID is very, very nerve wracking.” 

Dr. Christoph Diasio, president of the NC Pediatric Society, called COVID “a sneaky virus” because the early symptoms are so much like many common illnesses.  

Diasio said the offices of Sandhill Pediatrics where he practices are, like other pediatricians’ offices, juggling increased demand, nursing staff shortages, and the need to separate patients who might have COVID-19 from others. All this at a time when doctors are adjusting to new routines with the recent switch to Medicaid managed care.  

“We’re basically busier than we’ve ever been and everything is harder because of COVID,” Diasio said. “It’s higher patient volume, less supply, and administrative complexity.” 

Gov. Roy Cooper signed an Executive Order on Friday that gives parents more time to schedule medical appointments required for school, acknowledging the increased demand on pediatricians’ offices.  

“One of our top priorities as we continue to fight the COVID-19 pandemic is keeping children in classrooms, and offering extended time to complete these important health activities will help accomplish that goal,” Cohen said in a press release announcing the executive order. 

Usually, wellness checks and proof of immunization are required for children first entering public school within the first 30 days. Under the new order, parents have until Nov. 30 to show proof of an upcoming appointment.  

Though COVID-19 testing is a main reason for the rush on pediatric offices, the state also saw spikes just as school was starting in croup and RSV, or respiratory syncytial virus, illnesses usually seen in colder months.  

“The seasonal patterns for a lot of these infections are way off right now,” said Pickens, the UNC doctor.  

Last winter, there were few cases of flu and RSV, he said, possibly because school was online and people were wearing masks. “We don’t know what the coming winter is going to look like,” Pickens said.  

The Centers for Disease Control and Prevention recommends masking in schools for students and adults. A CDC study published this week found that schools that opened without mask requirements were 3.5 times more likely to have COVID-19 outbreaks than schools that required masks.  

“We have a really difficult situation right now, and we’re trying to plot the best way through,” Diasio said. “It’s all about ‘How do we keep kids in school.’” Vaccinate as many kids as possible. Continue to wear masks.” 

Getting more kids vaccinated “is something that would really help,” he said.  

People 12 and older are eligible to receive the Pfizer vaccine. On Tuesday, Pfizer and BioNTech submitted data to the FDA as a step toward requesting emergency use authorization so children 5-11 can get the shots.  

Increased COVID-19 cases in children can have devastating ripple effects because they can spread the virus to vulnerable family members.  

That’s what happened to Jones’ family in Goldsboro. She contracted the virus for the second time, even though she was vaccinated, as did her elderly parents who share a home with her and her daughter.

All have recovered, except for Jones’ mother, who has been hospitalized for a week.  

“It has scarred her lungs so bad, she’s still oxygen dependent,” Jones said. Her mother seems to improve, then there’s a setback.

“We believe in God that she’s coming home.”