FAQs About Coronavirus (COVID-19) and CNPA Primary Care Practices

Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats and bats. Several coronaviruses routinely infect humans and are a cause of the common cold. The CDC is currently responding to an outbreak of a respiratory disease caused by a novel (new) coronavirus that was first detected in China and has now been detected in many locations internationally, including the United States. The virus has been named “SARS-CoV-2” and the disease it causes is named “coronavirus disease 2019” (abbreviated “COVID-19”).

Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date. You can learn more about who is most at risk for health problems if they have COVID-19 infection on CDC’s current Risk Assessment page.

Children’s National Hospital has some wonderful resources for families and children on Rise and Shine, which has a COVID-19 section. Find tips for talking to your children about the pandemic, for home activities and more. And, Kelly Register-Brown, M.D., child psychiatrist at Children’s National, created this wonderful factsheet for kids: A Kid's Guide to Coronavirus (PDF).

There are two types of tests for COVID-19: Tests to detect the virus and tests to detect if your child has the antibody to the virus. 

There are two types of tests to detect the virus:

• Reverse transcriptase polymerase chain reaction (RT PCR or PCR) tests
• Antigen tests (a.k.a. rapid test)

These tests differ in how they detect the SARS-CoV-2 virus which causes COVID-19, how quickly the results are available and their accuracy in detecting the virus.

COVID-19 antibody tests look for antibody proteins produced against COVID-19 by your immune system. COVID-19 antibody tests are not recommended for all children as their accuracy is not yet established.

Rapid COVID-19 antigen tests typically provide a result in 15 minutes and are accurate when the result is positive. However, negative COVID-19 rapid tests may need to be repeated by PCR test since rapid tests are not as sensitive in detecting the virus (e.g. more false negatives). If your child is sick, a positive rapid test can be helpful as you can begin your child’s isolation and notification of people your child may have interacted with who will also need to quarantine. If your child is asymptomatic, your provider may recommend additional testing by COVID-19 PCR which is better at detecting the virus.

COVID-19 PCR test results may take about two days. However these tests are more accurate for ruling out infection (fewer false negatives and false positives). We use the accurate PCR test at all CNPA locations.

COVID-19 PCR viral test samples may be collected by nasal swab, nasopharyngeal swab, oropharyngeal swab and even saliva. For CNPA offices offering testing, your provider will recommend the specimen collection type that will lead to the most successful collection based on your child’s age and other considerations. The sampling is brief with minimal discomfort experienced during collection.

CNPA locations offering COVID-19 tests include: 

• Bowie
• Foggy Bottom
• Greenbelt
• Quince Orchard
• Silver Spring

First, determine if your child was in close contact. The CDC defines close contact as: any individual who was within six feet of an infected person for at least 15 minutes within a 24 hour period starting from two days before illness onset. This definition applies whether the contact was wearing a mask or not.

If your child was in close contact with someone with COVID-19, the CDC recommends a COVID-19 PCR test, unless your child already had been confirmed as having COVID-19 in the prior 90 days.

Please follow the CDC’s advice and quarantine for 14 days since the last close contact with the COVID-19 positive person. Call your CNPA office for a telehealth appointment to see if your child may need testing for an exposure. Getting tested does not shorten the time your child must stay at home.

Please refer to the test locations section of our website. You can call the testing locations for more information. The D.C. Department of Health offers testing for anyone older than 3 years, even if they are asymptomatic. There are also locations in Montgomery County and Prince George’s County.

If you are not sure if your child should get tested, please call your CNPA provider for a telehealth appointment. Many CNPA offices are able to test a child at any age, including infants.

If your child had close contact with someone with COVID-19 within the last 14 days, your child should be tested for COVID-19 via your Department of Health contact tracing program/outdoor testing site or via your CNPA provider.

Call 911 or take your child to the emergency room at Children's National Hospital if your child has any severe symptoms which include shortness of breath, confusion, chest pain, a fever of 105° or higher, or other concerning symptoms.

If your child has been ill for more than 48 hours, you need help to access testing or you have additional questions, please schedule a telehealth appointment. Your provider may arrange for testing or possibly an in-office visit.

It is particularly important to call you CNPA office if your child has had a fever for more than three days and has vomiting, diarrhea, rash or seems ill. There is a rare illness associated with COVID-19 called multisystem inflammatory syndrome in children (MIS-C) that we may need to evaluate.

Please visit the Emergency Department only if you are experiencing an emergency. This will help limit the potential spread of the virus in our community and will help ensure that our Emergency Department is able to care for patients with the most critical needs first.

If your child has a mild illness and is coping well, please keep your child at home and monitor for any worsening symptoms. See the American Academy of Pediatrics Healthy Children site for recommendations on how to care for a variety of illnesses at home. 

If you have questions or if your child has signs such as a fever, cold symptoms or sore throat, please call us for advice. We will most likely schedule a telehealth visit for you with one of our providers and decide together if you need to be seen in the office.

If your child is sick with any possible COVID-19 symptoms and is in daycare, school or lives with a high-risk individual, then call your provider for a telehealth appointment to discuss testing options.

Many CNPA locations have started testing for COVID-19 in their offices. Please call your office for details about testing.

Your child had a COVID-19 test performed today. This test will be sent to Children's National Hospital to be processed. Until you receive the results of your child’s test, please quarantine your child and your family at home until we notify you of the test results. It typically takes two to three days to get a test result. 

• If your child’s COVID-19 test result is NEGATIVE, we will notify you via the patient portal or phone. Please verify that you are signed up for the patient portal before you leave the office when getting your child’s COVID-19 test.
• If your child’s COVID-19 test result is POSITIVE, we will call you to discuss the results and the next steps you should take.

If your child’s COVID-19 test result is positive, your child can be around others after:

• Ten days since symptoms first appeared and
• 24 hours have passed with no fever without the use of fever-reducing medications and
• Other symptoms of COVID-19 are improving.

* Loss of taste and smell may persist for weeks or months after recovery. These symptoms do not need to be gone before ending isolation.

Please note that these recommendations do not apply to persons with severe illness or with severely weakened immune systems (immunocompromised). If your child has severe COVID-19 illness or has a severely weakened immune system, your provider will discuss when your child can be around others again.

Most people do not require testing to decide when they can be around others. The COVID-19 PCR test is not recommended to be repeated for 90 days after the last positive PCR test result. Since the COVID-19 PCR test is so sensitive, it may be falsely positive (e.g. detect virus particles which are not infectious). However, your CNPA provider will discuss if it is necessary to do repeat testing before your child can be around others.

If another cause for your child’s symptoms was identified and your child's COVID-19 test was either not detected or was a negative result by the COVID-19 PCR test, please follow isolation and treatment guidance for your child’s diagnosed illness. In general, your child should be fever-free without fever-reducing medicines for 24 hours and symptoms should have improved before being around others.

If COVID-19 virus was NOT detected by your child’s COVID-19 PCR test, but no other cause was identified for your child’s symptoms, you should discuss with your provider if your child should remain in isolation for ten days (depending on exposure and symptoms) or if your child can stop home isolation sooner. 

Due to possible effects of COVID-19 on the heart, there are new recommendations for sports clearance. Your child will need an office visit after at least 14 days of being asymptomatic after their COVID-19 diagnosis for an exam to be cleared for return to sports, even if your child has been previously cleared.

We are currently available to see all children in the office for their regular check-ups. We encourage you to take advantage of this opportunity so that your child doesn’t fall behind in getting the care they need. If you prefer to start the check-up with a telehealth visit, we may be able to accommodate this preference. Please note an in-person visit is required to complete portions of the check-up that cannot be completed in the telehealth visit, such as the physical exam, hearing and vision screening and important vaccinations.

If you have concerns you would like to discuss with your provider, please ask for a telehealth visit. If you and your provider decide together that your child still needs an evaluation in person, you can schedule an in-person appointment.

Yes! Now, more than ever, we want to ensure that all children have the full protection that immunizations provide.

You can check the 2020 Childhood Immunization Schedule to see if your child is up to date.

Yes! Please call your CNPA office to schedule an appointment. If you have multiple children, you may bring siblings to any child’s scheduled appointment to get a flu vaccine at most CNPA offices – please call to verify. Only children with appointments and children receiving flu vaccines are allowed in the clinic. Please do not bring other siblings to the appointment if they are not receiving medical care.

Yes! Given that both COVID-19 and the flu will be circulating this winter with similar symptoms, it will be very helpful to know that your child has received the flu vaccine.

Yes! We have changed our office to make sure well children are separate from sick children. Schedules have been altered to minimize or entirely eliminate your time in the waiting room and a shorter time in the office overall. All CNPA staff are required to wear appropriate PPE, extra cleaning and disinfecting is in place and additional other steps are taken. Read more about how we are protecting your family's health.

How you can help make your in-person visit safe:

• If you receive our "well child handout" prior to the visit, please read it before your visit. It is designed to address many of the issues that are age-specific such as safety, nutrition and development. We want to address all your questions and concerns.
• Please wear a non-vented mask (those presenting with vented masks will be required to wear an additional mask at all times while in the CNPA office). Masks are required for all children 2 years and older.
• Please keep masks on over your nose and mouth throughout your entire visit, even while waiting in an examination room.

To maintain optimal safety for everyone, please notify your CNPA office by phone before the appointment if you, your child or any family member has known or suspected COVID-19 infection. This includes any family member or patient with sore throat, headache, cough, fever, diarrhea, vomiting or loss of sense of smell and taste.

If you, your child or a family member has taken a COVID-19 test or are in quarantine due to known COVID-19 exposure within the last 14 days, please notify the CNPA office ahead of your appointment. 

If your child is COVID-19 positive, you may schedule a well visit for after a minimum of ten days or more after the onset of illness or the date of the positive test, if your child is asymptomatic. If your child is immunocompromised or was hospitalized due to COVID-19, the CDC recommends 20 days of isolation before going outside of the home.

For the safety of our community, we would like to limit the number of people in the office. If possible, we ask that only one healthy caregiver and only the child who has an appointment should come to the office.

Please call the CNPA office to arrange a telehealth visit if your child has signs of illness on the day of the visit. After that, if we decide together that your child needs to be seen, we will schedule an office visit at another time.

No. If the telehealth visit and the in-office visit occur on the same day, you will only be charged your usual co-pay for the in-office visit.

Yes. Telehealth is a convenient way to discuss a variety of concerns such as behavior concerns, developmental school concerns, asthma management and constipation follow-up.

We will give your child any needed forms at the appointment or we can send them via the Patient Portal. Excuse notes may be sent via portal or faxed directly to the school. We appreciate your understanding in this HIPAA matter that we are unable to email you directly.

Please call our office to ask for assistance in setting up your account if you don’t already have an account.

There is no one right answer to this question. It is important to take into account your individual family circumstances, how much risk your family is willing to take on and what infection control measures your daycare is taking. Group childcare tends to be more risky in terms of exposure to any illness than one on one, but having a babysitter or nanny is not a feasible option for many and socialization is also important for child development.

The CDC has developed a questionnaire to assist families in decisions on going to daycare or school.

It is critically important that your child is up-to-date on all immunizations before returning to daycare or school. Make sure your daycare is adhering to strict immunization requirements for all children.

It is also important to ask your daycare questions about their response to the pandemic.

• What are their cleaning plans?
• How many children will be assigned to each provider?
• Will there be room for social distancing?
• Will adults/parents be kept out of the facility as much as possible to limit exposure?
• What is the plan if a child, provider or family member tests positive for COVID-19?
• Will there be contact tracing?

As with many difficult decisions during this pandemic, the daycare question is about risk tolerance. We not only have to consider "What is the risk of serious illness to my child in sending him or her to daycare?" (answer: probably fairly low as most children do very well if they get the COVID-19 infection). But, we also have to consider these questions: What is the risk of serious illness to a member of our household if my child or I were to be exposed to COVID-19 infection through daycare? Are there children or family members with high risk medical conditions such as diabetes, lung disease or heart problems? Do any older family members live with you?

We understand that these have been challenging times for families and that it has been very hard for people to remain physically distanced from their loved ones. Many people are starting to question when it may be okay to have grandparents visit their grandchildren or to travel themselves to visit family members. While social distancing and isolation are crucial to controlling the spread of COVID-19, we recognize that mental health and family relationships are also critical during this strange "new normal."

There is no single answer, but here are some things to consider when evaluating your family’s risk factors and risk tolerance. 

• Do the grandparents have high risk medical conditions? In general, the risk of getting very sick due to COVID-19 is higher in older people, but medical conditions such as lung disease, heart problems and diabetes can place people at higher risk for a more serious infection. 
• Consider how well each family member has been socially distancing — have any family members still been working outside the home on a regular basis?
• Some jobs may present a greater risk (for example, health care and grocery store workers) due to how much contact they have with other potentially sick people.

If you decide to visit with grandparents, some options for reducing risk could be:

• Spend the visit outdoors (studies show that transmission of COVID-19 is significantly decreased outdoors compared to a closed indoor space).
• Do not share utensils or a family style meal together.
• Consider driving instead of flying and minimize public rest area stops.
• Consider traveling to the grandparents instead of grandparents traveling to you if air travel is required for the visit.
• If possible, grandparents and other visiting family should be diligent about socially distancing for two weeks prior to the visit to reduce the risk of any member of the group acquiring and even unknowingly spreading COVID-19.
• Consider meeting somewhere geographically neutral if family members live in a high COVID-19 prevalence area.
• Consider pre-visit testing if this is available in your area. The COVID-19 PCR test can be used to identify asymptomatic COVID-19 infection. In contrast, the rapid antigen test is not recommended to identify asymptomatic COVID-19 infection.

From what we understand about COVID-19 infections, those most at risk of more serious illness are older and the very young (newborns to 1 year of age). We’ve developed some guidance around visitors in the newborn period based on mom’s COVID-19 testing results at delivery, if applicable:

If mom or baby test COVID-19 positive, visitors should only be considered once at least ten days have passed since mom or baby developed symptoms AND at least 72 hours have passed during which there has been no fever without anti-fever medications, and any respiratory symptoms are improving. If there are other members in the household, there should be a full two weeks of quarantine for all household contacts after symptom improvement of the infected individual to ensure that no other members of the household develop any symptoms.

If mom tests COVID-19 negative, visitors should still be quite limited. Those who you might consider allowing to visit are those who are in good health and who have adhered to strict social distancing for at least 14 days before coming to visit. It would be ideal to minimize potential exposure during travel (private vehicle with minimal rest stops versus shared bus/train/air). In case of potential COVID-19 exposure during hospitalization, visitors would ideally wait until your family has been at home for at least 14 days since being discharged from the hospital. However, families may also have family or friends come prior to delivery to help care for other children in your home. If visitors require air travel to visit, consider an arrival two weeks before they are needed and have them quarantine in a hotel or a rental home nearby, especially if traveling internationally or from a high COVID-19 prevalence area.

If you have additional questions unique to your family’s needs, we’d be happy to talk through them with you. You can also schedule a telehealth consultation visit for existing patients to discuss your questions. Some offices offer prenatal visits via telehealth for new patients.

As we continue to learn more about COVID-19, please note that the above guidance may change. Most importantly, remember that frequent hand washing, wearing a mask while in public, avoiding touching your face, social distancing and sanitizing high-touch surfaces remain critical to controlling viral spread.

For general questions about COVID-19, families can call 202-476-5169 to speak with staff from Children's National between 9 a.m. and 5 p.m., Monday through Friday. If you have questions about your child's personal health care needs, please contact your CNPA office for a telehealth appointment.