A ‘DIFFICULT DILEMMA’
As educators and parents closely monitor for illness, pediatricians urge back-toschool flu shots to prevent students’ symptoms being mistaken for COVID-19
As Connecticut students head back to school, public health officials say it is more important than ever for residents to get the flu shot. With educators and parents closely monitoring students for sore throats, fevers and coughs, flu symptoms could easily be mistaken for signs of COVID-19, leading to a “difficult dilemma” for schools as national manufacturers struggle to provide accurate, rapid COVID-19 tests.
Dr. Juan Salazar, physician-in-chief at Connecticut Children’s and an expert in infectious diseases and immunology, said each winter the hospital fills up with children who are sick with severe influenza. Some young patients end up in intensive care units, intubated.
“Influenza vaccination is something that needs to be taken seriously, and it is very important regardless of COVID,” he said. “Now this year in particular ... you want to decrease the number of kids with influenza because influenza can look like COVID. It’s going to create a very difficult dilemma as kids
are in school and go back home with fever and respiratory illness. It’s going to be very difficult to differentiate one versus the other, and it’s going to create a lot of anxiety.”
Gov. Ned Lamont voiced similar concerns during a press briefing Thursday.
“When it comes to what we’re thinking about in November, December, the traditional flu season, we worry a lot, especially if people are not getting their traditional flu vaccine, which I think is so important, especially this year,” he said. “Flu symptoms and COVID symptoms are very similar, and if there’s confusion in our emergency room, confusion in our hospitals ... we worry that the flu season could at least create a perception of COVID as increasing. If we don’t have the flu vaccine, we’re not going to be able to know the difference.”
While most family pediatricians have access to accurate, rapid tests for the flu, strep throat and respiratory syntactical virus, Salazar said there is still a nationwide lack of access to “sufficiently sensitive and accurate” rapid COVID-19 tests, and family doctors may get stuck in a “guessing game as to who has what.”
In early September, federal officials are expected to begin shipping 150 million coronavirus tests purchased from Abbott Laboratories to states to aid in the reopening of schools. While the test delivers results in about 15 minutes, like other rapid tests, it is less accurate than tests that are processed by a lab. In some cases, rapid results need to be confirmed by lab tests. The Abbott test also requires nasal swabbing by a health worker, and swab supply shortages have already impacted the U.S.’s COVID-19 testing efforts.
Lamont announced Thursday the rollout of a “rapid response testing team” that “will be able to get to a school really fast in case of a potential infection ... be it a school, be it a college, be it a child care facility.”
“We’re going to be partnering with our federally qualified health centers all over the state and hospital systems, bringing in this mobile unit,” he said. “We’re going to be working with local health officials to make sure we can get this right.”
Through partnerships with Jackson Labs and Hartford Healthcare, Connecticut Children’s offers several types of COVID-19 tests, but ideally, Salazar said pediatri
cians across the state would be able to tell parents before they leave the office whether their sick child has the flu, COVID-19, both, or another disease.
“It changes the dynamic of quarantine, it changes the dynamic of when can you go back to school, and it may allow schools to remain open,” he said. “If we stop influenza from the get-go, we’ll have less of a problem differentiating it [from] COVID-19.”
Massachusetts mandating flu shots
In light of the pandemic, Massachusetts recently announced flu shots will be required for all children 6 months or older who are attending child care, pre-school, K-12 schools and colleges and universities in the state. Health officials there said students must receive the vaccination by Dec. 31, unless either a medical or religious exemption is claimed. K-12 students who are home-schooled and higher education students who are completely off-campus and engaged only in online learning are also exempt, but elementary and secondary students in districts and schools that are using a remote education model are not. New Jersey is considering similar legislation.
The Connecticut Department of Education said all children in the state in day care and pre-K are already required to receive an annual flu shot by Dec. 31. The state continues to observe medical and religious exemptions for vaccines.
During a press briefing Monday, Lamont said the state Department of Public Health is looking into wider mandates and “we’ll be getting back to you on that soon.”
“Obviously, the public health officials are very clear with us, and this is from the Trump administration as well, that flu-like symptoms and COVID-like symptoms are very similar. If they hit at the same time, say late October, November, that could put a lot of pressure on the system,” he said. “So the degree to which we can reduce the number of people with, quote ‘flu-like symptoms,’ if they’ve taken a flu vaccine, would be very beneficial in terms of our health care system.”
Marney Reardon, coordinator of health services for Manchester Public Schools, said, “Although they are not mandated, we do promote the effectiveness and really the necessity to receive a flu shot. Even if they were to get the flu, the symptoms tend to be less with the flu shot.”
Reardon said the district and families are using checklists to
monitor children for what the Centers for Disease Control and Prevention has defined as “highrisk symptoms” including a fever over 100.4 degrees, lung congestion, coughing, shortness of breath and recent loss of taste or smell. All students exhibiting any of those symptoms would be immediately dismissed, Reardon said, “with a return to school protocol that includes 10 days of self-quarantine, 24 hours fever-free and improvement in symptoms.”
“The student also has the option to be COVID tested. If the test is negative, the student may return to school sooner than the 10 days, as long as they have not been in contact with anyone who has been positive for COVID-19,” she added. If a child tests positive, schools would begin contact tracing protocols and decide whether to keep children in the same cohort as the inflected child home or close the school for a few days.
Aimee Krauss, director of the West Hartford-Bloomfield Health District, said when the department reaches out to individuals for contact tracing, it will specifically ask if they received a flu shot, to help figure out whether any symptoms they are exhibiting may be related to COVID-19. The district is also offering its first drive-thru flu clinics for people ages 18 and over in late September and early October.
Krauss said if a child begins experiencing a fever at night, “We’re not encouraging [families] to give them an Advil and send them to school. They should be staying home. Part of the back-toschool plans is parents should be screening children before they go to school and get on the bus.”
With Connecticut ’s low COVID-19 infection rate, public health officials encouraged families not to delay annual immunization appointments. Salazar, the Connecticut Children’s physician, said he has not yet seen evidence of a flu shot shortage, and parents should be aware that going to the doctor’s office is “absolutely safer than going to the grocery store,” given their strict health and safety protocols.
“This is a window right now, it’s a very good window ... to head to your pediatrician and get the vaccines,” he said. “The CDC says October, but there’s no reason as to why pediatricians can’t begin vaccinating in September. .... Don’t wait until November.”