Limited testing for children creates a COVID ‘blind spot’

By Sarah Kliff and Margot Sanger-Katz

When Audrey Blute’s almost 2-year-old son, George, had a runny nose in July, she wanted to do what she felt was responsible: get him tested for coronavirus.

It wasn’t easy.

Blute, 34, planned to walk to one of Washington, D.C.’s free testing sites — until she learned they do not test children younger than 6. She called her pediatrician’s office, which also declined to test George.

As child care centers and schools reopen, parents are encountering another coronavirus testing bottleneck: Few sites will test children. Even in large cities with dozens of test sites, parents are driving long distances and calling multiple centers to track down one accepting children.

The age policies at testing sites reflect a range of concerns, including differences in health insurance, medical privacy rules, holes in test approval, and fears of squirmy or shrieking children.

The limited testing hampers schools’ ability to quickly isolate and trace coronavirus cases among students. It could also create a new burden on working parents, with some schools and child care centers requiring symptomatic children to test negative for coronavirus before rejoining class.

“There is no good reason not to do it in kids,” said Sean O’Leary, a Colorado pediatrician who sits on the American Academy of Pediatrics’ committee on infectious diseases. “It’s a matter of people not being comfortable with doing it.”

Many testing sites, including those run by cities and states, do not test any children, or they set age minimums that exclude young children. The age limits vary widely from place to place. Los Angeles offers public testing without any age minimum, while San Francisco, which initially saw only adults, recently began offering tests to children 13 and older. Dallas sets a cutoff at 5 years old.

The District of Columbia decided not to test young children at its public sites because children have nearly universal health coverage in the city, meaning they could be tested at a pediatrician’s office.

Parents like Blute, however, are finding that pediatricians’ offices appear to have limited testing capacities. George never got a test for his runny nose. Instead, Blute and her husband kept him isolated at home while they tried to work their full-time jobs.

“We were told to assume that everyone in the household has it, which didn’t seem like the best information — we’re both big believers in contributing to the data pool,” she said. “We think that’s really important.”

In Florida, the Division of Emergency Management announced last month that it would “prioritize” pediatric testing as students there begin to return to in-person school. Still, only a quarter of the 60 testing sites the agency supports will see children of all ages. The state’s 18 drive-through sites are limited to patients 5 and older, but did recently add priority lanes for symptomatic children.

“When we first started, and there was a lack of access to testing, this kind of triage might have made sense,” said Daniella Levine Cava, a county commissioner in Miami-Dade. “Clearly it doesn’t make sense in the current environment. We know that children contract the disease, we know that children spread the disease, and just because they are less likely to show symptoms, that doesn’t mean they pose any less of a risk to others.”

Pediatricians say the test itself is the same when administered to a child, although it can sometimes require additional supplies. Not all coronavirus tests have gone through safety testing in children, and sometimes providers use smaller swabs on toddlers.

Large pharmacy chains, which have set up thousands of testing sites across the country, have generally catered to adults. Walgreens does not see children at its drive-through clinics.

CVS Health has slowly dropped the age minimum at its 1,944 drive-through testing sites across the country. The pharmacies initially accepted only adult patients but dropped the age minimum to 16 in August, and are in the process of lowering it to 12 this month.

“Because we use self-administered swabs, we’ve been evolving our testing protocols as we learn more about what’s possible,” said William Durling, a CVS spokesman. “Twelve years old is the age that our team felt a child could likely swab themselves.”

Early in the pandemic, public health officials were not focused on children as an at-risk population, given how few ended up hospitalized for the virus. Some scientists even thought that children might be safe from coronavirus infection altogether.

But now, with schools underway, and with evidence of childhood infection more established, the testing infrastructure for children in many communities has major holes. Nir Menachemi, a professor of health policy and management at Indiana University, called it a blind spot that was interfering with school reopening plans and with efforts to understand how the virus was spreading.

“Having a blind spot makes you not able to respond from a public health perspective, either with the correct messaging or with the right policies to put into place to protect the people who are vulnerable,” he said.

When Christine Carter’s 5-year-old son, West, was experiencing a fever and vomiting, she worried it might be coronavirus. But her pediatrician’s office said it did those tests only on Tuesdays and Thursdays, and all appointments that week had already been booked.

“By the time I was going to be able to get him tested, he’d already have been a week into having it,” said Carter, who lives outside Baltimore. “It turned out to be an allergic reaction, but if I do really need to get him tested in the future, I fear the process will be really lengthy.”

In Chicago, Jen Cowhy’s pediatrician declined to test her 11-month-old daughter after a day care classmate tested positive. Cowhy, 31, called the city’s two pediatric hospitals, and both told her they would not test a child who had been exposed but was asymptomatic.

The limited testing sites for children reflect broader patterns in medical care delivery. Even when it comes to more long-standing health needs — like flu shots, checkups or an assessment of a sore wrist — many clinics, urgent care centers and drugstores that offer services to adults won’t accept children. So even if workers there can technically swab a child’s nose the same way they would swab an adult’s, they may not feel comfortable doing so.

Joe Little, the clinical supervisor for coronavirus testing at the AllCare Family Medicine and Urgent Care in Washington’s Dupont Circle neighborhood, said health workers without pediatric training sometimes worry that children will be resistant or emotional. But nurses at his clinic, one of the few places in the region testing young children, have had success administering nasal swab tests to people of all ages.

“They generally tolerate it pretty well,” said Little, who is trained as a nurse. “When we do it, the nurse will say: ‘We’re going to tickle your nose. Tickle, tickle.’ And then you’re doing it. And they’re like, ‘Oh, it didn’t hurt.’”

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