The COVID-19 & Schools


As schools return we recognise paediatricians may receive queries from the families they see on what to do if and when a child develops this winter the usual coughs and colds. Below we describe the current evidence around indications for testing for children. This article may also be helpful to families and schools.
As children return to schools after a prolonged break, we expect colds and similar viral infections to circulate. Parents will want to know which symptoms will warrant testing for COVID-19 (and remain away from school whilst awaiting results) and those which on probability do not justify testing (and can therefore stay in school). This will ensure that children are not unnecessarily kept away from schools and exposed to inappropriate testing.
To help make that decision we have the following information:
--Evidence from the UK and internationally tells us that COVID-19 is generally milder in children than in adults: most infected children present with mild symptoms or are asymptomatic, and very few rarely develop severe or life-threatening disease. 
Similarly, hospital admission rates for children with evidence of COVID-19 infection are far lower than those of adults, with only 2% of all admissions occurring in children and young people below the age of 18 and 1.1% below the age of 5.
--Fever and cough were the commonest symptoms for any child requiring hospital admission. Of 651 children admitted to hospital with COVID-19, 70% had fever and 39% had a cough. Less than 1 in 10 of these children were reported to have coryzal symptoms (runny noses) or sore throats. 
Most admissions occurred during the peak of the pandemic, when areas such as London had a COVID-19 prevalence of about 10%. The current prevalence rate is no higher than 0.2% in any region of the UK at present (8 September), so the risk of a child actually having COVID-19 presently is far lower. 
--The evidence we have on transmission of COVID-19 in schools is also extremely reassuring. There is good data from the UK showing that children (especially primary school aged children and younger) are about half as likely to be infected with COVID-19 than adults. Children also appear to transmit COVID-19 less readily than adults; there have been very few reported COVID-19 outbreaks in nurseries or schools, either in countries like Denmark that reopened their schools early in the pandemic (15 April) and in Sweden and Iceland did not close their schools at all during the pandemic.
--Equally reassuring for teachers, in those countries that have kept schools open, such as Sweden, teachers do not have higher rates of COVID-19 than the general population (and they have lower rates than professions such as supermarket workers and taxi drivers).5  
From this available evidence we believe that children with simple cold symptoms such as coryzal symptoms (runny noses) or sore throats without fever who would normally have attended schools in other times should not be tested for COVID-19.

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