Look out for the symptoms!
Your darling daughter suddenly has a fever.
What should you do? Stay calm, don’t panic.
Monitor your child for 72 hours and let her rest at home. If the fever is disturbing her, give her fever medications suitable for her age or those prescribed by your paediatrician. Ensure that it is the right dose. Some parents, in their anxiety, may re-use old paracetamol and give a dose meant for an older child – such mistakes are too common!
If your child has a Health Risk Warning (HRW) alert from MOH, you will need to do an ART and PCR test right away.
You do an ART self-test for your daughter at home and the dreaded T (test) line shows up red.
Even if your child does not have a HRW, the fact that she is symptomatic with a positive ART result also means that a PCR test is needed.
Going for a PCR test
You bring her for a PCR test at a paediatric swab centre (Thomson Paediatric Centre (Jurong East) is one of them!). After the swab, you are told to wait at home for confirmation. You head back in private transport (your own car or a private-hire car like Grab).
When you have a positive ART test, you’re not allowed to use public transport like buses (turn on your integrity and honour mode, please). Private-hire companies also have special bookings for ART-positive passengers and these heroes will send you home safely whilst staying protected themselves.
Treat your child just like any other time she had a mild viral fever. That’s what COVID-19 is to most kids – a typical viral upper respiratory tract infection.
Look out for COVID-19 symptoms
Symptoms of COVID-19 in children vary. It can range from no symptoms to severe pneumonia. Fortunately, most cases of childhood COVID infection are mild and indistinguishable from the common cold. Children often have fever, runny nose, cough, sore throat and abdominal pain associated with vomiting and/or diarrhea.
If there are any “red flag” symptoms, seek medical attention. These include shortness of breath, chest pain (especially when breathing in), paleness of the face, cold clammy skin with reduced consciousness and severe constant abdominal pain.
I typically provide a color-coded vitals chart for ART-positive patients. Vitals in the red – call 995; yellow – check with a healthcare provider, wake your child, recheck again in five minutes; green – all is good. If there is any labored breathing (as if your child just ran a marathon, breathing hard and fast, but she has only been lying down), please call 995. This is very unlikely in the first 24 hours of COVID-19 infection unless your child has an underlying medical problem.
A positive PCR test
After 12 to 18 hours of waiting, you refresh your Healthhub app and the dreaded positive for COVID-19 appears on your screen.
What do you do now? Stay calm. The results of your child’s positive PCR have already been sent to MOH’s other “hero” unit – the Case Management Task Group (CMTG). They work non-stop; they will be in touch with you to tell you the next steps to take.
Be patient, your child is still alright. Don’t forget – you can always call the life-saving 995 ambulance service if your child becomes very unwell.
Now it’s important to have a little perspective here. CMTG takes care of all COVID-19 cases island-wide so they may take some time for them to get to you. But fret not, they will get there. Focus on how your child is doing. Is she getting worse – breathing more labored, not feeding, fever going over 41 degrees Celsius, vomiting or not passing at least four diapers a day worth of urine? No? That’s great!
You can continue taking care of your child in the comfort of your own home. You don’t need to go anywhere right now!
A while later, you get a phone call. It’s CMTG, they will verify their identity and tell you that transport is on the way to send your child to a hospital for further evaluation. Pack your essentials, including your child’s favourite blanket. Bring some spare clothes, the things that you need for a few days, just in case an admission is on the horizon. The hospital will have the other daily items so just bring what you need. Don’t forget your chargers and other handy devices like laptops and iPads.
Home recovery for children
For children who are less than three months old, it’s routine to admit them for observation as they are younger. For children above three months old, the default is home recovery, if their home environment is suitable.
Special assessment will need to be done for children aged three months to three years, just to be extra safe. For this age group, MOH will arrange for them to have a face-to-face assessment. For kids over three years old, the default is to rest at home under the Home Recovery Programme.
The Home Recovery Programme is a multi-organisational effort, helmed by MOH partnering with KKH and NUH as well as private paediatricians. Private paediatricians include those from individual practices as well as group practices like Thomson Paediatric Centre. We reach out the parents of COVID-positive kids as assigned by MOH and assess children’s fitness for home recovery. Every child and family need to fulfil specific criteria before they are allowed to continue with home recovery.
If there are others at home who are not infected, check the MOH website for more details. The common confusion is about the swabs that caregivers need to do. As long as the caregiver is asymptomatic (i.e. no fever, cough, sore throat etc.), there is no need for daily ART, unless otherwise specified. Follow the recommended schedule, usually according to the HRW SMS that the adult will receive.
However, once a caregiver or family member has any symptoms that suggest an infection, a PCR test will need to be done. You can find your nearest Swab and Sent Home (SASH) or Public Health Preparedness Clinic (PHPC) by entering your postal code here: https://flu.gowhere.gov.sg/.
Recovery phase
While on home recovery, parents are given many resources, including telemedical consults, hotlines to call as well as easy and quick access to MOH. Once a child is confirmed to be COVID-positive, discharge is time-based and the child won’t need to have further swabs. MOH will issue a detailed discharge memo at the end of the 10-day recovery period.
Scientific evidence shows that most children feel fine and would have clinically recovered after 10 days. They are also very unlikely to transmit the infection after that period.
Dr Lim Yang Chern
Consultant Paediatrician, Thomson Paediatric Centre (Jurong East)
Address: 50 Jurong Gateway Road, #04-18 JEM, Singapore 608549
Phone: 6665 1000
Email: tpc_jurong@thomsonmedical.com
Disclaimer: Information on home recovery and hospital admission is accurate at the time of publishing. Subject to changes by MOH as Singapore’s COVID-19 situation evolves.
For more information about COVID-19, visit the MOH website.
Photos: iStock
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