Parents send kids to school sick, citing as reasons their need to work, concerns about missing class and pandemic weariness

At least 58 districts have closed or used non-traditional instruction days in November due to illness, affecting more than 186,500 students. (Ky. School Boards Assn. map, adapted by Ky. Health News)

Schools in Kentucky and across the nation have been hit hard by a slew of respiratory viruses, and some parents are sending their children to school sick or sending them back to school while still infected.

They cite an inability to take more time off work, concern about their children missing in-class instruction and a weariness from dealing with the pandemic, Alex Janin reports for the Wall Street Journal.

In a typical year, Jackie Follansbee, a nurse in the Yakima School District in Yakima County, Washington, would send two to three children a week back home for returning to school sick, she told Janin. Now, it’s two to three “repeat offenders” a day, she says.

Respiratory illness has been so bad in Kentucky that so far in November, 58 Kentucky school districts have closed or used non-traditional instruction days due to illness, affecting more than 186,500 students, according to the Kentucky School Boards Association.

The Pike County Board of Education has amended its attendance policy to increase the number of parent notes that can be used for excused absences from school from five to 10, Kristi Strouth reports for the Appalachian News-Express. Students will continue to be allowed an unlimited doctor's notes to excuse their absences. 

Janin reports that schools across the country are sending notes to parents urging them to not send their children back to school until their child is fever-free for 24 hours without medication and symptoms are improving. And in some cases, nurses are calling families to remind them that symptoms of viral illnesses can last for a week or more.

In addition to an influx of respiratory syncytial virus, or RSV, Covid-19, and the common cold, Kentucky's latest influenza report shows that most of the 6,061 confirmed flu cases this year have been in children under the age of 10, followed by people between the ages of 11 and 20. 

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. And while most people recover in a week or two, it can be serious for infants and older adults. 

As of Nov. 19, about 16% of PCR tests for RSV in the U.S. were positive, more than double the 7.5% at the same time last year, according to voluntary lab reports to the Centers for Disease Control and Prevention.

As of the first week of November this year, the Wall Street Journal reports, U.S. children under the age of 18 were hospitalized for flu at the highest rate since 2009, according to CDC data.

Increased infection and the need for school-aged children to stay home until they are well is also affecting workplaces.

"A new round of viral infections — flu, RSV, covid-19 and the common cold — is colliding with staffing shortages at schools and day-care centers to create unprecedented challenges for parents and teachers," Abha Bhattarai reports for The Washington Post. "More than 100,000 Americans missed work last month because of child-care problems, an all-time high that’s surprisingly even greater than during the height of the pandemic, according to new data from the Bureau of Labor Statistics." 

Tried and true public-health measures help to decrease the spread of all of these viruses, including avoiding close contact with others when you are sick, covering your nose and mouth when you cough or sneeze, keeping your hands washed and staying  home when you are sick and don't have fever for 24 hours without medication.

Respiratory viruses are increasing among children, and are occurring earlier than usual; one can cause a debilitating condition

CDC graph shows share of outpatient visits for respiratory illnesses, by week of the year.

By Melissa Patrick

Kentucky Health News

With common respiratory viruses on the rise among children, doctors are concerned that the viruses are showing up earlier in this year, says Dr. Lindsay Ragsdale, chief medical officer at Kentucky Children's Hospital.

In addition to increases of rhinovirus and enterovirus, which cause the common cold, Ragsdale said the hospital is seeing upticks in Respiratory Syncytial Virus, or RSV, which normally shows up between November and February.

"This is very unusual, compared to [a] decade's worth of epidemiologic data," Ragsdale said. "We normally see a winter surge in kids, and now we're seeing it starting in July this year."

Norton Children's Hospital in Louisville is reporting similar unseasonable spikes in RSV, Aprile Rickert reports for WFPL, saying that the hospital has admitted 66 patients with the respiratory virus, more than double the 32 at this time last year.

These increases in respiratory viruses in children are happing all over the country, prompting the Centers for Disease Control and Prevention to issue a health advisory alerting clinicians that there has been a surge in pediatric patients with severe respiratory illness requiring hospitalization. The CDC notes a rise in three respiratory viruses: rhinovirus and enterovirus and a more severe version of enterovirus called D68 or EV-D68, which can cause a rare polio-like paralysis in children.

The vast majority of children fully recover from EV-D68, but it can result in a rare complication called acute flaccid myelitis, or AFM. "Children with AFM may have weakness in one or more limbs, difficulty walking, and pain in the neck or back. Most require hospitalization, and about half are admitted to intensive care," write epidemiologists Katelyn Jetelina and Caitlin Rivers in Jetelina's newsletter, Your Local Epidemiologist. 

The CDC notes that outbreaks of AFM appear every two years, but it skipped 2020, likely due to efforts to prevent spread of Covid-19. But with the increase in the EV-D68 strain this year, the agency encourages clinicians to consider it as a possible cause of acute respiratory illness and to assess children for AFM.

The newsletter also included a CDC graph showing a rise in outpatient visits for respiratory illness, which includes symptoms of fever plus cough or sore throat, especially among those under age 4. "It’s normal to see an increase in cold and flu illness each year, but this is occurring ahead of the normal winter schedule," they write.

Lindsay Ragsdale, M.D.

Ragsdale said the increase in respiratory illness in children is likely because they haven't been getting normal immune system exposures because we have been social distancing and masking during the pandemic, so now exposures are happening in a different way.

Jetelina and Rivers agreed: "The drawback is that the population immunity normally maintained through regular cold and flu seasons eroded, leaving more people (especially kids) without recent immunity."

That said, Ragsdale stressed that most kids are pretty resilient and that the ones who need hospitalization often have an underlying lung disorder or have other health conditions that make them more fragile.

"So even though they've gotten these infections, the vast majority of them can stay home and just do symptomatic care," she said.

Another concern, she said, is that this early influx of respiratory illness will overlap with the incoming flu season and a possible Covid-19 surge this winter.

"That will cause some capacity challenges . . . for our Children's Hospital admissions," she said. "But we are working really hard to expand to new units and to make sure that we have room for every child that needs care. . . . I am worried that we're already seeing a high number of infections, but we're making plans."

Ragsdale encouraged families to seek medical care for their children with a respiratory illness if their child is dehydrated, is having trouble breathing or has prolonged fevers. Otherwise, she encouraged families to keep their child at home if they are sick, especially if they have a fever, to keep their hands washed and for the whole family to get their flu and Covid-19 vaccine.

"We do anticipate having a pretty significant flu season," she said. "We're glad to see the Covid numbers coming down, but again, we don't know what's going to happen this winter and vaccines are effective to prevent those infections."

Got a virus? You don't need an antibiotic but you might get one; Kentucky leads the nation in outpatient antibiotic prescriptions

Antibiotics don't cure illnesses caused by viruses, and can even cause "dire consequences" when used inappropriately, so it's important to take them only when necessary, says a news release from the state Cabinet for Health and Family Services.

"Antibiotics are the only drugs where use in one patient can impact the effectiveness in another patient," Andrea Flinchum, a registered nurse and coordinator for the Kentucky Department for Public Health’s Healthcare-Associated Infection Prevention program. "They are wonderful tools in fighting bacterial or fungal infections – but prescribing them for viruses or taking them for illnesses they do not treat, can cause bacteria to become resistant to these drugs."

Parents need to know that illnesses like the common cold, the flu, runny noses (even with yellow and green mucus), coughs, bronchitis, sore throats, most sinus infections and some ear infections are usually viral and antibiotics won't cure them, says the federal Centers for Disease Control and Prevention. In addition, antibiotics won't help your child feel better and won't keep others from catching your child's illness. Viral illnesses usually go away without treatment in a week or two.

The problem is that when your child takes an antibiotic when they don't need it it kills the good bacteria in your child's body, which can lead to complications, like diarrhea or yeast infections.

Overuse can also lead to bacteria developing resistance to a medication, making infections stronger and harder to kill. Sometimes these infections are so severe that they cannot be cured with antibiotics and thus require stronger treatments, and possibly hospitalization. The CDC estimates that each year 2 million Americans get an infection with antibiotic-resistant bacteria and every year 23,000 of those patients die.

The CDC estimates that more than half of the antibiotics given for upper respiratory infections and nearly a third of antibiotics used in hospitals are prescribed inappropriately. Kentucky has the highest prescribing rate for antibiotics in the outpatient setting in the U.S., Flinchum noted.

"It is critical to use these life-saving drugs when truly necessary, while also using the right drug at the right dose and duration to protect the effectiveness of antibiotics," said Flinchum. "We encourage clinicians to improve prescribing habits and patients to ask their providers if antibiotics are truly needed for their care."

Tips for smart antibiotic use:

• Don't insist on an antibiotic if your health care provider diagnoses your child's illness as a virus.
• Remember, antibiotics only treat bacterial infections.
• Some ear infections DO NOT require antibiotics.
• Most sore throats DO NOT require an antibiotic, unless it's strep throat.
• Green colored mucus is NOT a sign that an antibiotic is needed.
• Take as prescribed, not doing so can cause antibiotic resistant infections.
• Don't save half-used bottles of antibiotics for future use.
• Don't share antibiotics.
• Prevent infections by keeping your hands washed.
• Get a flu vaccine.
• If taking an antibiotic, call your doctor if you don't see improvement within three days.

Cold or flu? Know the difference because flu can be dangerous

Image: www.cdc.gov

Cold or flu, how do you know? And what should you do about it? CBS News and the Lexington Herald-Leader offer some tips.

"We often use the terms cold and flu interchangeably. But they are completely distinct illnesses with their own set of symptoms. The differences can actually be picked up right away," Dr. Holly Phillips, CBS medical contributor, said on "CBS This Morning."

Cold symptoms come on gradually, she said, and include a sore throat, congestion, sneezing and a cough. Flu symptoms, however, come on suddenly and include fever, body aches, chills and fatigue.

It's important to know the difference because while colds can be annoying, "they tend not to be very serious," she said, but the flu can be dangerous.

"The flu causes more than 24,000 deaths a year and about 200,000 hospitalizations, sometimes more," Phillips told CBS.

Getting a flu shot is the most effective way to protect yourself and others from getting the flu, according to the federal Centers for Disease Control and Prevention.

The CDC recommends a flu shot for every American age 6 months and older. And because the majority of Americans who die from the flu are seniors who develop complications like pneumonia, it is especially important for those 60 and older to flu shot.

As for treatment, Phillips says that first and foremost, the cold and flu are both caused by viruses and should not be treated with antibiotics, which are only effective against bacterial diseases. She also notes that overuse of antibiotics leads to the development of dangerous antibiotic resistance.

The flu, however, can be treated with antiviral medicines such as Tamiflu and Relenza, which are available only with a prescription and must be taken within two days of the onset of illness. These drugs will shorten the course of the illness and the severity of the symptoms, she said. Doctors' offices now carry test kits that are 99 percent accurate to determine whether it is the flu or a cold.

Otherwise, over-the-counter medications are available to treat symptoms for both colds and flu, she said.

Unfortunately, people are contagious within 24 to 72 hours of being infected with the flu, often before they feel sick, and remain contagious for at least 24 hours after their fever is gone, Dr. Paul Pedersen, a family medicine physician, writes for the Herald-Leader. But, he says, it is still important to use common-sense practices to protect yourself and others,

In general, he writes: make sure to use a tissue or handkerchief or cough into your elbow rather than your hand; wash your hands frequently with soap and water, but carry hand sanitizer that is at least 60 percent alcohol for times when this is not possible; stay at home if you think you are getting sick, or isolate yourself from others at work if you can't stay home; avoid crowds as much as possible during cold and flu season; and avoid sharing plates, glasses, utensils or even keyboards during the cold and flu season.

Myths about colds abound; here's good advice: wash your hands to prevent infection, and if you get a cold, chicken soup can help

Cold and flu season is here, and the lack of a cure for the common cold has helped sustain much misinformation about it. Neda Frayha, an assistant dean at the University of Maryland School of Medicine, did a column for The Washington Post outlining five myths about the common cold:

1. Colds can be spread only if someone sneezes or coughs. Actually, direct contact with a cold sufferer "is even more likely to make you sick, whether or not they cough near you," Frayha writes. "Several major studies have shown that hand-to-hand touch is the most common way to spread rhinovirus, the family of viruses that causes most colds. One of these studies . . . also demonstrated the importance of hand hygiene — it recommended applying a liquid iodine solution to the fingers, though soap works well, too — in reducing the spread of the virus."

You can get a cold from someone else's sneeze even if you aren't around. "Viruses can live on furniture, toys, phones and other common household or office surfaces for several hours," Fyarha writes. "A study in the American Journal of Epidemiology in 1982 showed that when young, healthy adults touched either coffee-cup handles or plastic tiles that had been contaminated with rhinovirus, and then touched their faces, half of them came down with a cold. Fewer of them became sick if they touched a plastic tile that had been sprayed with a disinfectant."

2. Hand-sanitizing gels are as effective as hand-washing to prevent the spread of the cold. "If given a choice between washing with soap and water or coating your hands in a dollop of sanitizer," Frayha writes, "the old-fashioned soap-and-water combination is the safer bet. Sanitizing gels don’t work well if your hands are visibly dirty. And they must contain at least 60 percent alcohol to reduce the spread of diseases such as the cold, but some varieties at your local pharmacy contain significantly less."

3. Air travel increases your risk of catching a cold. "There is no evidence that air travel makes us any sicker than our normal working environments on the ground," Frayha writes. "A large study published in the Journal of the American Medical Association in 2002 showed that traveling in a commercial aircraft with recirculated air did not increase the risk of catching a cold compared with flying in a plane that pumped in fresh air."

4. Colds cause fevers. Usually not in adults. "Fever is listed as a symptom of the common cold in television commercials for over-the-counter remedies . . . and in young children, fever is common in most upper respiratory infections," Frayha writes, but in adults, "fever — defined as a temperature of 100.4 degrees Fahrenheit or higher — is actually very rare in rhinovirus infections. It is much more common for a cold to cause a sore throat, a stuffy and/or runny nose, sneezing and cough, but with a normal body temperature. If you have these symptoms plus a fever, then you and your health-care provider should think about other possibilities, including strep throat, sinusitis, pneumonia or the flu. A true fever often means something else is going on in your body."

5. Home remedies such as chicken soup don’t work. "In 2000, researchers at the University of Nebraska studied homemade chicken soup and found that it had anti-inflammatory benefits, which can ease cold symptoms," Frayha writes. "Chicken soup exerted an anti-inflammatory effect — which could help a person feel better faster." She cautions, "There are dozens of home remedies that are said to help speed up recovery: ginseng, zinc, vitamin C, neti pots. There is little evidence to support them; some can even be harmful (for example, some zinc formulations can lead to permanent loss of smell)."

Doctors' offices full; many patients worry their common cold is one of the serious illnesses recently reported in the news

Doctor's offices are busier than usual this time of year not only because it's cold and flu season, but also because of an increased worry patients have that they might have one of the  more serious illnesses reported in the news like enterovirus D68 or Ebola, Elizabeth Renter reports for Fox News.

Dr. Sameer Maroof, a family physician at Doctors Express in Cary, N.C., told Renter that his office "had seen increase in the number of patients battling cold-like symptoms," and that some were"concerned that it could be a serious illness, such as the respiratory condition enterovirus D68."

So, what are the chances they have a serious illness? Most Americans get the common cold two or three times a year, Renter reports. While enterovirus D68, a respiratory virus with symptoms that range from mild to severe, has infected a little over 1,000 people since mid-August, with the number of infections expected to decline throughout the fall, according to the Centers for Disease Control and Prevention.

The problem is that these illnesses are closely related and have similar symptoms: runny nose, body aches, cough and respiratory problems. The flu also shares these symptoms, but add chills, fever and sore throat, Renter writes.

As for the flu, 5 to 20 percent of Americans get the seasonal flu each year, according to the CDC, but unlike the cold and enterovirus D68, the flu can be avoided because there is a flu vaccination available.

And the likelihood that you have Ebola is virtually nonexistent. The CDC has confirmed three cases of Ebola in the U.S. and you must have direct contact with the body fluid of someone with Ebola to contract it. The virus can cause diarrhea, vomiting, heavy perspiration and unexplained bruising.

So, if you have the symptoms of the common cold, it is likely you have the common cold, Renter writes. She said it's time to see the doctor if:
1. You are wheezing or having difficulty breathing.
2. You are part of an at-risk population like smokers or those with compromised immune systems.
3. You have persistent vomiting.
4. You have children with severe allergies or asthma.
5. You have symptoms lasting more than seven days.

"If patients are unsure whether their illness warrants a doctor’s visit, they should err on the side of caution," Maroof told Renter.

Exercising when sick can delay recovery and can spread the infection; symptoms above and below neck are a key guideline

Feeling under the weather? Be careful about exercising; doing it when sick can do more harm than good.

mensfitness.com photo

“Depending on where a person experiences symptoms of illness can make or break his or her workout and recovery,”  Karin Richards, acting chair of the Philadelphia University of Sciences Department of Kinesiology, said in a news release.

“Those who experience above the neck symptoms such as stuffy noses and sneezing are generally fine to continue their exercise routine. However, those with symptoms below the neck such as a fever, nausea, and muscle aches are urged to stay in bed and recover.”

Flu is widespread in Kentucky, and one child's death has been attributed to it. Adult flu deaths do not have to be reported.

The flu virus can spread to others up to about six feet away, according to the federal Centers for Disease Control and Prevention. It is spread when infected people cough, sneeze or talk. It can also be spread by touching a surface or object that has flu virus on it and then touching your own mouth or nose. In other words, the flu is easily spread in fitness center environments and this is another reason to not exercise when you are sick.

Bed rest is advised for the flu. Here is a list of tips to help those with above-the-neck cold symptoms keep up their fitness goals:

• Lower the intensity of your workout. If you usually run, walk.
• Stretch.  Yoga and gentle stretching can make you feel better and relieve congestion and pressure associated with sinus issues.
• Workout only at home or outdoors until symptoms have gone away, so you don't infect others.
• Stay active year round as a way to stay healthy and avoid getting sick.

“There is a fine line between a minor cold and the flu, and it’s important for individuals to stay in tune with their bodies,” Richards said. “A person’s body is stressed when fighting the infection, so placing additional stress through intense exercise only suppresses the immune system even more.” She also recommends seeking the advice of your doctor if you have any questions regarding continuation or resumption of your exercise routine.

Back at school and already got the sniffles or other ailment? Here's a pediatrician's advice to battle back-to-school bugs

With school back in session, it probably won't be long before children are coming home with sniffles and sore throats. The average child gets six or more infections each year, reports Dr. Jacqueline Kaari, chair of the Department of Pediatrics at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, who also offers advice.

"Every parent has experienced it — the hectic morning maneuvering of getting the household fed, dressed and out the door is suddenly interrupted by an inconsolable child who has a sore throat, upset stomach, sniffles or something worse," she said. "When that happens, parents need to be able to quickly assess their child and determine if he or she is well enough to go to school or needs to stay home, or if it's time to call the pediatrician. Sometimes, parents will guess wrong, but if there's one rule of thumb, it should be to always err on the side of caution."

Kaari recommends the following guidelines for what do when it comes to:

Colds: Use child-strength, over-the-counter medicines and a cool mist humidifier to treat symptoms. Because they are caused by viruses, do not treat colds with antibiotics. Children can go to school if the symptoms won't impede them from participating in school activities.

Conjunctivitis (pinkeye): Go to the doctor for treatment, which is generally antibiotic eye drops. Children can usually go to school 24 to 48 hours after treatment starts.

Fever: Give acetaminophen (Tylenol) or ibuprofen (Advil) for low-grade fevers. Have the child drink lots of fluids and avoid fatty or fried foods, since fevers decrease stomach activity and make digestion more difficult. Keep children at home if the fever is above 100.4 degrees Fahrenheit. Call the doctor if a high fever lasts more than 24 hours or does not respond to medicine.

Flu: Have the child vaccinated. If he or she has not been vaccinated, keep the child home for several days and make sure he or she gets lots of rest and drinks lots of fluids.

Head lice: Kill with over-the-counter or prescription lotions and shampoos. Keep the child at home until all lice have been killed.

Ringworm: Look for small patches of skin that are scaly and red. They can also blister and ooze. Apply anti-fungal ointments or powders. Call the doctor if the infection is severe or does not go away.

Sore throat: If parents suspect strep throat, they should call the doctor. If drinking water relieves symptoms somewhat, the child likely has a viral infection that should go away in a few days.

Stomach ache: Children who have been vomiting should stay home from school. An hour after the child vomits, parents should start introducing small drinks of water. Clear liquids and bland food should be introduced throughout the day. If vomiting lasts more than 24 hours or if the child vomits blood or green or yellow bile, call the doctor.

Whooping cough (pertussis): Have the child vaccinated. If parents suspect whooping cough, characterized by a "whooping" sound when the child tries to breathe, call the doctor. (Read more)