The symptoms for each virus are almost indistinguishable
My eldest kid has been back at school for nearly two weeks; my youngest has her very first day on Monday. As usual, the first few days of term are an absolute crucible for colds and flu.
“At this time of year children get colds and viral infections,” says Dr Sunil Bhopal, a paediatrician and epidemiologist at Newcastle University. “I spend the whole summer in paediatric A&E with hardly any children, and then in September we get an onslaught. It’s totally normal.”
But what’s not normal is that now, if a child has a runny nose or a sore throat, there is a risk it might be Covid-19. And, depending on the school, that child might be sent home — or, in some cases, their whole class might be. In my children’s school, if a child persistently sneezes, he/she has to self-isolate; in another school up the road, literally any sort of feeling-unwellness will get them sent home.
Education is absolutely vital and repeated disruptions will be damaging, especially to vulnerable children. But the risks to health are worth being aware of. So what can we know?
First, says Bhopal, the risks to children themselves are vanishingly low, and it seems to be — mercifully — the case that they do not spread the disease as much as grownups. That’s not certain yet but early signs from Sweden, Norway, Iceland and places that had no or shorter school closures suggest it.
Second, just as with adults, core symptoms are more diagnostic than things like runny noses and sneezing. There appears to be no clinically reliable way (short of testing) to distinguish paediatric Covid from colds and flu, but a cough, a fever or anosmia/loss of taste are a stronger signal. The Royal College of Paediatrics and Child Health (RCPCH), for which Bhopal is a spokesperson, advises that children should isolate and be tested if they have a core symptom, but that they should continue to go to school if they have a runny nose or sore throat.
It seems to me there are three key takeaways. First, government guidelines need to be clearer: schools should be explicitly told not to send kids home if they have cold symptoms but not the core Covid symptoms. As it is, if my kids’ school have one guideline and the one up the road another, then it will confuse parents, and scare them if their children are seemingly being sent into danger. The government needs to take responsibility and not force schools to make these choices.
Second, as Bhopal writes for the TES, it’s important to keep the number of children isolated to a reasonable minimum. Schools should not regularly be sending an entire year group of 200 children home because of a single positive Covid test.
Third, it really highlights the need for better testing. A child who is tested for Covid and has to wait five days for a result will miss a lot of school. The failures of the testing regime are causing real human damage.
None of this is perfect. There will be a lot of false positives: even going by core symptoms, fever is a core symptom, but children get fevers all the time, so a lot of children will still be off for no reason. Likewise there will be a lot of false negatives, because kids often don’t get the core symptoms. “As soon as there’s a better system in place we’ll change it,” says Bhopal. But for now, everyone agrees that the risks to children from being off school hugely outweigh the risks of going in, so we need to try to avoid keeping them home for colds and flus as far as possible.