Frequently asked questions

COVID-19 vaccination questions

The following questions explore some common issues faced by families of children with chronic respiratory conditions.

What are the risks of COVID-19 to children with chronic respiratory conditions including CF?

To date we still see that COVID-19 infection in children is a mild illness. Children with chronic respiratory conditions including CF, asthma, PCD, tracheostomies and neuromuscular conditions not requiring ventilation support are at no increased risk of getting COVID-19 or having a more severe illness than their peers. That being said, as the virus is constantly changing, we don't know if this will be true for future strains, and so getting protected as early as possible with the vaccination is a good idea

Who is eligible for the COVID-19 vaccinations?

• Children aged 5-11 years old are now eligible for the COVID-19 vaccination
• Adolescents aged 16+ years and are now eligible for COVID-19 boosters 

For further information on vaccines for COVID-19, visit https://www.coronavirus.vic.gov.au/vaccine

Is the vaccine safe for people with lung diseases like CF?

Yes, all evidence so far is that the vaccine is definitely safe and effective in children in the 5-11 year old age group. This is true for people with chronic respiratory conditions such as CF as well.

Does my child still need to be vaccinated if they have been infected with COVID-19?

Yes is the answer. Current evidence suggests that the immune protection the body develops after a COVID-19 infection starts to wane after about 2 months. This means that 2 months following an infection, your child will no longer be protected. It may also not guarantee significant protection against other COVID-19 strains. Vaccinations result in more long lasting immunity. It is safe for your child to get vaccinated as soon as your child has recovered from the infection and no longer has symptoms.

How do I get my child vaccinated?

There are a number of avenues to explore:

• Local vaccination clinic/GP. The following link is helpful in finding centres catering for those aged 5 years and older with a break down by vaccine type: 'vaccine clinic finder'
• Online bookings for children and teenagers can also be found through the department of health website
• The RCH Immunisation centre is providing COVID-19 vaccines to patients known to the RCH. Further information can be found through their website

Please note that the respiratory department team are not in a position to book vaccination appointments in on behalf of families

For children aged 5 to 11 years, can I shorten the COVID-19 vaccine dosing interval from the standard 8 weeks?

The current standard dosing interval for the COVID-19 vaccine in children aged 5 to 11 years old is 8 weeks. For some children with a chronic illness, this interval can be shortened to 3 weeks. This includes children with a chronic respiratory condition (excluding those with mild or moderate asthma). A full list of conditions can be found in Table 1 through this link. 

For children who do qualify for a shortened interval, the decision should be made on a case-by-case basis and balance the pros and cons.

Pros

• Earlier vaccine cover: This may be an important factor for some families facing increased exposure risk for their child or vulnerable family members

Cons

• Modest increase in side effects (based on limited early evidence)
• Potential reduction in duration of vaccine protection (based on limited early evidence)

Further information can be found under “Recommended and variations on vaccination schedule” through this link.

As the decision is individual to your situation, you are welcome to discuss this further with your respiratory consultant/GP

My child is under 5. Can they get the COVID-19 vaccine?

We are aware some overseas countries are considering COVID-19 vaccinations for children aged younger than 5 years of age. At this stage, there is no move for that to occur in Australia. This position may change in future as more evidence emerges regarding the risks and benefits of the vaccine in this age group.

Should I isolate my child at home until they are vaccinated?

As previously mentioned, most children with underlying respiratory conditions are not at increased risk from COVID-19 compared to other viruses and so there is no need for additional precautions. Our advice would be to follow public health advice on social distancing. 

Information on safety around returning to school can be found in the below FAQ question "Should I let my child return to school?"

What should I do if I am worried that my child might have COVID-19?

Rates of community transition of SARS-CoV2 and we understand that many families of children with chronic respiratory conditions will be worried. The main points to hightlight are:

• Children experience milder symptoms of COVID-19 compared to adults even if unvaccinated
• Based on current evidence of children with chronic respiratory conditions, they are not at greater risk of more severe infection compared to their peers
• You should take the usual steps as you would for managing a regular viral infection but three are some points to consider which will be outlined below.

Diagnosing COVID-19

We recommend following the DHHS guidelines on approach to diagnosed COVID-19. As the guidelines continually change, we recommend looking at the following sources:

• If you're concerned your child might be experiencing symptoms of COVID-19, please visit www.dhhs.vic.gov.au/coronavirus or call the dedicated hotline on 1800 675 398 for advice
• Information on testing can be found through this DHHS link

Management of a child with an underlying chronic respiratory condition with COVID-19

A good resource is the RCH Kids Health Info Fact Sheet on COVID-19

For the majority of children with a chronic respiratory condition, our approach would be the same as with any other viral infection with a focus on:

Comfort care to:

• Manage fever and pain
• Encourage fluid intake

Observation of:

• Respiratory status (cough, work of breathing, respiratory rate)
• Hydration status (balance of fluids in and out)
• Seek help if condition worsens (see dot point 'seeking help' below)

Additional care points for specific groups:

• For children with CF and PCD, a prolonged wet cough may result and we recommend following our guidelines on managing an exacerbation
• For children experiencing an asthma exacerbation, please follow your asthma action plan
• For children on oxygen or ventilation, seek help if needing more support exceeding home care plans

Specialised COVID-19 treatment

For the majority of patients, there is no additional special treatment required for their COVID-19 infection. There are a small number of patients who may benefit from additional therapy.

For patients with the following circumstances, we recommend you contact our department to discuss options within 7 days of symptoms onset:

• Bronchiectasis (CF or PCD) with baseline FEV1 less than 60%
• Congenital tracheal stenosis
• Neuromuscular condition requiring respiratory support
• Tracheostomy requiring ventilation
• Severe asthmatics who have had a severe exacerbation requiring ICU or IV therapy, or 2+ hospital admissions for asthma, or children on biologic therapy to control symptoms
• Immunodeficiency
• Currently on oral steroids/IV steroid courses for longer than the past 1 month

Seeking help

If you are worried that a medical review is required:

• for non urgent care, you can visit your family doctor or contact the after-hours GP helpline on 1800 022 222
• for emergency care, visit the closet hospital emergency department or dial 000

For families known to the department, see 'Lines of communication with the respiratory department' for additional contact methods.

What is coronavirus, COVID-19?

The Royal Children’s Hospital (RCH) COVID-19 website provides paediatric specific information and advice around visiting the hospital. It includes a RCH video  which gives a practical overview of how to reduce risk of infection.

The  DHHS webpage provides up-to-date overview of the current situation and steps to take if you or your family are exposed to the virus.

How can I speak to my child about the virus?

For information about minimalizing infection risk, and guidance on how to talk to children about the virus, please see  'Coronavirus and children in Australia', published by The Raising Children Network.

For further information, scroll down below to FAQ question: ‘What can I do to manage my child’s worry and anxiety?’.

What can I do to protect my child from COVID-19?

• You can protect your family by:

  Getting a COVID vaccine if eligible

  •  Even if your child is too young to receive the vaccine, you can help protect them by having eligible close contacts vaccinated

• Following good infection control practices regularly as follows:

  • Wash hands frequently for at least 20 seconds
  • Avoid touching eyes, nose or mouth with unwashed hands
  • Avoid contact with sick people
  • Avoid touching things in public spaces as much as possible
  • Avoid shaking hands with other people

• Practice good cough etiquette by:

  • Covering your mouth and nose with a tissue when you cough or sneeze and throw away used tissues as soon as you can
  • Cough into your elbow or the crook of your arm to reduce the spread of germs
  • Wash your hands or use hand sanitiser if you cough or sneeze on them

• Abide by social distancing:

  • Follow the latest advice from the DHHS website
  • Avoid crowds and busy places
  • Avoid contacts such as hugs, kisses, handshakes, high fives
  • Try elbow connection instead!
  • Avoid people who are unwell with cold or flu like symptoms (coughing, sneezing, runny nose). Maintain a distance of at least one metre

• You can encourage other people around you to do the same.

  Should I let my child return to school?

  The global pandemic has indeed placed us in challenging times. The prospect of kids returning to on-site learning raises questions and concerns for every parent, particularly those of children with underlying health conditions such as lung diseases. The following advice applies to the majority of children under our care and has been formulated after careful consideration by respiratory specialists within the Department of Respiratory and Sleep Medicine.  

  • This information is also available for download via the following PDF download.

• We recommend that children return to school when schools reopen for these reasons:

  1. Children benefit from school for many reasons. Attending school is not only good for learning, it is good for emotional and social development.
  2. In many parts of the world schools have remained open during the pandemic
  3. The government has undertaken many changes in response to scientific advice that will make schooling as safe as possible (see figure)
  4. Children who get COVID-19 usually get very mild or no illness
  5. Children with respiratory illness who get COVID-19 also usually get very mild or no illness.
     
     
     

  In addition to this, schools have introduced twice weekly RAT testing for teachers and students.

  What can you do?

  • Ensure that all people in the household that are eligible for vaccination (everyone 5 years and older) gets vaccinated
  • For younger children (<5 years) who are currently ineligible for vaccination, do not wait for vaccination to return to school. There is a possibility that vaccines will not be available to younger children for some time and the recommendation for use are not yet clear.
  • If possible, teach your child to wear a mask at school
  • Ensure your child knows how to wash their hands and understands the school rules on social distancing
  • Do not send your child to school if they have any symptoms of any infection
  • If you have further questions about your individual child, please discuss these with your doctor
    
    

  What are HEPA purifiers/filters?

  A number of shared spaces including schools plan to use HEPA purifiers as a way to reduce the transmission risk of COVID-19. But what are they?

  • This information is also available for download via the following PDF download. 

  HEPA (high efficiency particulate air) purifiers contain filters that are made of a dense net of fibres. These purifiers force forcing air through the mesh-like filters which then capture participles including pollen, smoke, dust, moisture, bacteria and viruses. This is different to a water-based purifier that uses a water reservoir as its filter

  Use for COVID-19 transmission and bushfires?

  Most people catch COVID-19 by inhaling it from shared air, and COVID particles can linger in the air in indoor spaces. HEPA purifiers can clear these potentially infectious aerosols. They have also been used in bushfire settings when windows are encouraged to remain closed. In these enclosed room settings, HEPA purifiers can work to capture the particulate matter released during bush fires.

  Shared spaces

  HEPA purifiers are therefore being implemented in shared spaces including schools. This is seen as an additional measure in reducing the risk of COVID-19 transmission until effective vaccine rates in the community are achieved.

  At home

  Some families have enquired about purchasing HEPA purifiers to use at home. At this stage we are not actively encouraging this. As a HEPA purifier is only effective in the room it is placed, there are limitations with how effective it is at home in mediating viral transmission. We do understand that mask wearing and social distancing is not practical at home. Instead, we encourage limiting spread within the home by having those eligible be vaccinated, getting tested if displaying symptoms and remaining vigilant with visitors to the home.

  Is it safe?

  When used correctly, HEPA filters are safe. As long as the filters are changed according to standard, there is minimal concern of HEPA filters recirculating caught particles or becoming a source for infection including pseudomonas. Due to the COVID-19 pandemic, there have been reports of users making homemade masks using HEPA filters intended for air purifiers. This is not recommended and can be unsafe. 

  Will wearing a mask prevent me from getting infected?

  We understand that SARS-COV2 is spread through aerosolised particles. Masks can help reduce this spread but not completely fool-proof. As such, wearing masks should be in addition to other measures including getting vaccinated if eligible, social distancing and hand hygiene. 

  As per DHHS recommendations, adults and children over the age of 12 must wear a face mask outside your home. 

  We recommend you reading the DHHS site on face masks available through this  link. It covers a range of questions including information on the types of masks to use and how to wear and care for your mask. Infants and children under the age of 12 are not required to wear a face covering. Due to the risk of choking it is not safe to use a mask on children under two years of age. 

  It remains our belief that the potential benefit of widespread use of masks is to reduce the risk of asymptomatic or minimally symptomatic adults spreading the virus rather than just protecting an individual from contracting the virus. Even before COVID-19, some respiratory patients such as our CF population routinely wore masks around the hospital to reduce the risk of cross-infection from CF germs. 

  Is it safe to attend a face-to-face outpatient clinic visit?

  Currently, outpatient appointments are predominantly being run via through telehealth appointments. Appointments will only be converted to face to face at the discretion of the clinician if clinically indicated. This is to minimalise the number of people attending the hospital, and protecting both staff and patients against contracting COVID-19.

  • You will be notified on your appointment letter if your appointment is to be conducted by telehealth or in person
  • If there is a planned change of appointment type, you will be contacted and informed of the change
    

  Our outpatient department is very experienced in working to prevent the spread of infection. Some additional measures taken include:

  • Families will be screened with a temperature check and questions prior to entering the outpatient department
  • Your attending clinician will be wearing personal protective equipment (PPE)
  • Clinic rooms will be cleaned after each patient visit
  • There will be limits on the number of people allowed into a clinic room

  For the latest information on how to attend the RCH hospital site and telehealth appointments please see https://www.rch.org.au/rch/Coronavirus_(COVID-19)/

  My child uses a nebuliser as part of their treatment. Are nebulisers safe to use? Will it increase my risk of contracting COVID?

  Many of our patients with chronic respiratory conditions use nebulisers as a method of administering their treatment. Some concern was raised following an outbreak of COVID within hotel quarantine which was linked to a guest who tested positive for coronavirus and was using a nebuliser.

  We want to clarify the following:

  • Nebulisers deliver treatment by aerosolising medication that is then breathed in by the user
  • Using a nebuliser is safe and does not increase the risk of the user contracting COVID
  • If the user is COVID negative, there is no increased risk of those around them to contracting COVID
  • If you or your child uses a nebuliser as part of routine care, please continue doing so
  • If your child is diagnosed with COVID and uses a nebuliser as part of their routine care, please contact your treating team to discuss options around potentially altering treatment plans to reduce COVID spread.

  What else can I do to help reduce the potential health impacts of COVID-19?

  Immunisations

  We highly recommend you have the 2021 influenza vaccine and be ready for the 2022 version when available. We recommend all members of the family get vaccinated. Given the altered pattern in virus spread, we recommend getting vaccinated even beyond the Winter period

  Immunizations can be coordinated through the RCH immunisation centre:

  • Immunisation Service team has taken extra precautions and implemented procedures to control risks of and exposure to transmission of COVID-19 and is still open to patients, families and the community for all scheduled vaccines. 
  • We encourage families to contact the centre in advance to schedule an appointment 
  • Information on how to access the Immunisation centre and book an appointment can be found here:  https://www.rch.org.au/immunisation/

  Alternatively, you can attend your local GP practice or pharmacy to organise vaccinations for other family members.

  For a list of those who are eligible for free influenza vaccine, visit the health.vic website.

  Tobacco smoke

  We highly recommend your child avoid being around people who smoke.

  If you smoke, it is highly recommended you take measures to quit. People who smoke are five times more likely to get the flu and twice as likely to get pneumonia.

  Reducing or stopping tobacco smoke exposure is one of the best ways to protect yourself and your family from viral infections including coronavirus.