By Guest Blogger Kacy A. Ramirez MD, Pediatric Infectious Disease Expert at Brenner Children’s

For more information on COVID-19, please visit or listen to the latest COVID-19 podcasts.

Questions from parents submitted to Triad Moms on Main:

Kacy A. Ramirez MD

As of May 22, we are in Phase II of COVID-19 ease of restrictions. That means that people at higher risk of becoming ill (age > 65 yrs or those with underlying medical conditions) with COVID-19 should stay at home.  For the rest of us parents/caregivers, we need to be thoughtful in how much non-essential exposure to COVID-19 we want to have for our family, our community, and ourselves. If we get infected with COVID-19, do we have other high-risk people in our home, at our job, or now within larger groups of people we are allowed to be around that could still get potentially sick from us too despite social distancing? If our child gets sick, what does that mean for them? And how much coronavirus is in our community anyway?

When gathering in large groups at essential facilities such as medical facilities, shopping centers, grocery stores, airport or transportation centers, we should practice social distancing as much as feasible, including limiting those leaving the house to essential family members only, and all persons above the age of two wearing a face mask. This idea is further supported by the fact that 80% of cases in the US were transmitted through a “super spreader”–ie one person was capable of transmitting infection to many others within a group setting. More recently, large church gatherings have been implicated in transmission.

As phase II restrictions allow us to partially or fully open more non-essential retail, personal care business, restaurants and places of worship; allows children to attend child care, day camps, overnight camps and pools; and allows gatherings of up to 10 people indoors or up to twenty-five people outdoors at the same time in a single confined indoor or outdoor space, we must also still continue to try as much as possible to maintain social distancing within these settings. Additionally, we know that transmission through respiratory droplets is directly proportional to our respiratory rates and singing, and should be considered as we allow ourselves to congregate. Ultimately, we should limit gatherings, events, and extracurricular activities to those that can maintain social distancing, support proper hand hygiene, and restrict attendance of those from higher transmission areas.

To date, NC has had about 32,000 cases of COVID-19, compared to about 170,000 cases in New YorkIn Forsyth county, there are about 1500 cases to date (5% of total cases reported in NC), and < 20 deaths have been reported. Currently, COVID-19 activity in North Carolina is increasing, only to further increase as we are increasing our testing capabilities. We are currently seeing about 50-60 cases per day. While most of our cases have been associated with outbreaks in nursing homes and the Tyson company, we are now seeing an increase in transmission within the community.

Nationwide, only 4.7% of all reported COVID-19 cases occur in children. Fewer children than adults with COVID-19 get a fever, cough, or shortness of breath, or are hospitalized (0.6-3%). Mortality rates are similar to that of adults (0.5%). However, severe illness has been reported in children, most often in infants less than a year, and a rare new inflammatory syndrome with features of Kawasaki disease called multisystem inflammatory syndrome in children (MIS-C) is being reported.

In NC, 6% of all COVID-19 cases have been reported in children, totaling 1500 cases to date. There has been one reported death. Also, there have only been two cases of MIS-C in North Carolina reported, and both children have survived.

North Carolina COVID-19 activity is mild-moderate on a national level, and is reaching its average expected activity levels at this time. These will only continue to increase as community transmission occurs and as restrictions are lifted. Children are still less likely to become ill or hospitalized. If they are, they are more likely to be less than 1 yr of age, and have underlying conditions. MIS-C is being reported in our state, but is still a very rare condition. Before we venture out to non-essential activities, we must ask ourselves if the risk of exposure to COVID is justifiable in our own particular lives, and have this discussion with our child’s pediatrician. Maintaining our social distancing practices within all of our interactions remains essential.


How safe is it to use public rest stops when traveling this summer?

Any place in which people are gathered more intimately, including at public rest stops, gas stations/convenience stores, etc., increases our risk of exposure to COVID-19. Thus, practicing social distancing and good hand hygiene, and wearing a mask during these stops is essential! Using hand sanitizer or washing hands well before and after these necessary trips in public places is also advised.

Importantly, before you begin non-essential travel or vacations within the US, look to the CDC for guidance, and follow local and state travel restrictions.

Here are some travel tips from the CDC:

  • Bring enough of your medicine to last you for the entire trip.
  • Pack enough alcohol-based hand sanitizer (at least 60% alcohol) and keep it within easy to reach.
  • Bring a cloth face covering to wear in public places.
  • Prepare food and water for your trip. Pack non-perishable food in case restaurants and stores are closed.


What are your thoughts on the safety of kids playing outdoor sports this summer?

Children need to exercise and maintain a healthy lifestyle.  At this time, DHHS recommends limiting sports to activities which can practice social distancing or limit close contact, such as: golf, baseball, softball, cycling, swimming, diving, dance (when distanced from others), tennis, disc golf, horseback riding, track and field, figure skating, curling, running, and pickleball. For sports such as football, competitive cheer, lacrosse, basketball, soccer, wrestling, rugby, and hockey, it is recommended that activities are limited to athletic conditioning, drills, and practices in which dummy players, sleds, punching bags and similar equipment are used but athletes are not playing the actual sport itself. These activities can allow athletes to condition and prepare for sports when they are played in the future.


Are kids and teens transmitting the disease?

It is still too early to know the answer, and the evidence has been mixed. It was reported on May 26 that in 79% of COVID-19 cases, an adult in the household had a suspected or confirmed case of COVID-19 before the child. Children developed symptoms first in only about 8% of households. I would say that it is still likely that children transmit this infection.


How prevalent is Kawasaki disease and its tie to COVID-19? Is that something we need to worry about in the Triad?

You do need to be aware of MIS-C. It is, however, a rare condition and most children recover. Most cases (up to 100) have been reported in New York, where they have more cases of COVID. There have only been two reported cases in NC, and they both survived. Here is some information about this condition and how it presents. There is usually a history of COVID-19 illness or exposure about a month before your child becomes sick, although MIS-C patients can have active COVID infection at the time of presentation.


How many kids in the Triad have tested positive for COVID-19 and what is the breakdown of those who have had it and recovered, those who had to be hospitalized, and those who died from it?

In NC, 6% of all COVID-19 cases have been reported in children, totaling 1500 cases to date. Hospitalization rates for children likely mirror national rates of 0.6-3%. In NC, there has been one death of a child reported.


I’ve heard that it’s no longer true that COVID-19 can be passed by surface contact. How accurate is that?

COVID-19 is mostly spread by respiratory droplets released when people talk, cough, or sneeze. However, the virus may also spread to hands from contact with a contaminated surface and then to the nose or mouth, causing infection. Therefore, personal prevention practices (such as handwashing and staying home when sick) and environmental cleaning and disinfection are important principles.


Do you think it is safe for our kids to return to school in the fall?

The answer to this question is not easy. Many things must be considered to answer this question, including how likely children transmit the infection, the rate of community transmission in our area at the time, and how capable our school system is to safely conduct the process. If we can practice social distancing as much is practically feasible, then I think so, yes. School may look very different until a vaccine is available.


I would love to hear a doctor’s thoughts on whether or not teens should ride in cars together?

We are allowed to be in groups of up to 10 people together indoors, but it is still strongly recommended we socially distance, and wear a mask, particularly if we are within 6 feet of each other.  As always, we should avoid each other if we are sick/symptomatic, and we need to practice hand hygiene. Being in a car with friends, etc, may well increase the risk of COVID-19 as it is hard to be at least 6 ft apart.


When is it safe to have a play date? With just one family, or several at a time, obviously not feeling sick? Outside only? Masks or no masks? 

This is a tough one.  North Carolinians can now go to daycare, day camps, pools, and hold small get-togethers that do not have more than 10 people indoors or 25 people outdoors. Individuals are encouraged to follow the Three Ws to reduce the chance of spreading COVID-19.

  • Wear a cloth face covering.
  • Wash your hands for 20 seconds or use hand sanitizer.
  • Wait 6 feet apart from other people to keep your distance.

However, it’s hard for children to maintain a safe distance of 6 feet. And children don’t like masks, and can’t wear them if less than two years of age. Caregivers can sanitize their children’s hands, but children like to touch people and objects and their own mouths before we can effectively do that sometimes. So just realize, that for play groups with children, following these guidelines can be challenging, particularly indoors, and in younger children and infants, and know that they are then more likely to be exposed to the virus in these situations. Outside play with games that keep kids at a distance and washing hands frequently may be the best option. Assess what risk these activities would pose to your child and your household. Your pediatrician can help with this too.


What is their recommendation on the age of children who should be wearing masks if we need to take them into a grocery store with us?

Cloth face coverings can safely be worn by all people over the age of 2 years who are physically capable of doing so.


Is it safe to let your kids go swimming?

Yes, as long as we practice social distancing as much as possible.


Is it safe to allow close family to visit and hold a newborn baby if they are wearing a fabric mask? Or are only social distancing visits with a newborn safe at that time?

It is probably safest during the COVID outbreak to avoid newborn contact as much as possible by any non-household members.


Triad Moms on Main would like to thank Dr. Ramirez for taking the time to answer the questions that were submitted by our local families and readers. We hope that this information can guide our families to make informed decisions this summer as we continue to navigate these uncertain times. 

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