Guideline changes may reduce number of children tested for COVID-19

By Sue Tiffin

“Thank goodness guidelines have changed, easier on families for sure,” said Dr. Norm Bottum after the provincial government updated screening protocols for children last week, amending a COVID-19 screening policy to focus on a shorter list of symptoms than before for kids attending childcare or school.

“Prior to [the Oct. 1] announcement, the self assessment tool listed about 17 symptoms and said if your child has one of these symptoms persisting for more than a few hours, and for whom the symptoms are new and not related to seasonal allergies or pre-existing medical conditions, [they] may stay home and/or return home if symptoms appear during the school day,” said Sinead Fegan, Trillium Lakelands District School Board communications. “Now, the updated Ministry of Health’s Ontario COVID-19 self-assessment tool for children in school has two sets of questions about symptoms that may yield different next steps depending on which symptoms are selected. The symptom list also no longer includes abdominal pain or pink eye.”

“Ensuring that children can attend school with minimal interruption is an important part of their healthy growth and development,” Dr. David Williams, chief medical officer of health for the province, said in a government press release on Oct. 1. “Based on a review of the current evidence and consulting with paediatric infectious diseases experts, we are updating the list of symptoms in the COVID-19 screening tool for schools and child care to ensure that our children receive the education and care that they need while minimizing the risk of COVID-19 transmission.”

The first set of screening questions asks about symptoms such as fever or persistent cough. Students with these symptoms are still advised to stay home, consult with a medical provider to receive an alternative diagnosis or receive a negative COVID-19 test. The second set of questions monitors symptoms such as a runny nose or headache. If children have one of those symptoms they are advised to stay home for 24 hours, returning to school if the symptom improves. Children with two or more of those symptoms are advised to stay home until they are able to see a doctor for an alternative diagnosis, or receive a negative COVID-19 test.  

“Parents/guardians must screen their child for symptoms every day before they come to school,” reads an Oct. 2 update to the Trillium Lakelands District School Board website. “Please disregard the School Attendance: A Resource for Families two-page handout TLDSB schools sent home last week, and moving forward, use the Ontario government’s COVID-19 Screening Tool for Children in School for daily screening.”

On Wednesday of last week, Bottum was at Haliburton’s COVID-19 assessment centre, which saw about 13 kids – some in a separate testing area in the Haliburton Highlands Health Services building, some through the drive-through testing site – for COVID-19 testing that day, at least 35 kids that week.

“The rules are now, that if the kids aren’t well they either have to isolate for two weeks or they have to be cleared with a COVID swab and be free of symptoms,” he said at that time. “A lot of parents are choosing to get their children swabbed so they can get back to school earlier. We’ve seen a lot of kids with two or three days with queasy stomachs or sniffles and then they feel better, but until they have that COVID swab they can’t go back.”
Bottum said the influx of kids had increased the busyness and numbers at the assessment centre, which increased hours to be open five days rather than three days a week last week in part because of the additional population coming in.

“I think that’s part of it, I think there’s maybe a few more adults that are having symptoms now,” said Bottum. “We don’t know if their kids are bringing it to them or their grandkids. That’s really one of the concerns isn’t it, if COVID ends up coming through kids and they share it with their family, it can spread pretty quickly. The thing with kids is that their symptoms tend to be fairly mild, so a runny nose could be COVID-19.”
The next day, the daily health assessment plan changed.
“We have had a number of children with only one symptom lasting only a day or two,” said Bottum. “Based on recommendations, we have to trust that these cases have a low probability of being COVID-19 cases. They still have to be well or significantly better to return to school.”

In Ontario, as of Oct. 6, 347 schools, just more than seven per cent of the province’s 4,828 public schools, are currently listed on the province’s data tracking website as having a reported case of COVID-19, with 611 cases being reported in total – 333 of those cases are students, 102 are staff and 176 individuals have not been identified as staff or student. Three schools have closed. In child care centres and homes, 187 cases have been reported in total, 110 of those related to kids, 77 related to staff. To date, 48 centres have been closed and 249 homes closed while currently 88 centres of 5,183 have a confirmed case and 20 centres are currently closed. As of Oct. 6, 55,483 tests done in the province were still in line at the lab to be investigated.

At the local testing centre, there are a couple of different testing options used – one a deep swab in the nose, the other that doesn’t go as far back.
“Both are irritating,” said Bottum. “But kids by-and-large are pretty good … parents I think have really spent a lot of time getting their kids prepared that it’s going to be uncomfortable, but we need to do this, and we need to do this before you can go back to school. Kids have been really impressive as to how they’ve been tolerating it.”
Bottum said both schools and medical professionals are working to get the tests done and get kids back to school.
“Most have had very minimal symptoms,” he said. “I’ve been on today and I haven’t seen any sick, sick kids, but they have had symptoms that could be consistent with a virus, which could be consistent with COVID-19 or any other virus.”

While the test is not necessarily a pleasant experience for kids, Bottum said getting it done and getting the results back – which is currently taking about four to five days – can be quicker for students and parents rather than isolating for two weeks.
“Some of these parents are just getting back to work, so having to take two weeks off after having just gone back to work is difficult,” he said. “I think they want to be able to get their children back to school for their sake, but also for the parent’s sake to return to work.”  

Bottum also soothed worries that attending the test centre for a test was putting people at risk of contracting COVID-19, with health-care providers changing PPE and disinfecting the room between each patient.
“The odds of that are basically zero,” he said.

For further information on COVID-19 cases in schools and child care centres as recorded by the Ontario government, visit https://www.ontario.ca/page/covid-19-cases-schools-and-hild-care-centres. Further information on school screening is available at https://covid-19.ontario.ca/school-screening/. Parents with questions have been asked by the school board to contact their child’s school.