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When schools reopened in Ottawa on Feb. 1, so many people logged on to public health’s online COVID-19 symptom quiz that the server crashed.

“It was bittersweet”, laughs Dr. Nisha Thampi, a pediatric infectious diseases specialist at CHEO.

“We don’t want families to be frustrated in doing the right thing. But that (crash) just speaks to the renewed energy in our community to do right by our children, and by our other families, and our neighbours.”

Daily screening, along with self-isolation and testing, are key components of efforts to keep COVID-19 out of schools, especially as more contagious variants of the virus take hold in Ontario.

It’s not always easy to sort through what constitutes doing the right thing in any of those key areas, though.

The rules keep changing and vary across the province. Messages from local and provincial authorities can conflict. It’s complicated, from what type of cough triggers a COVID-19 high alert to whether siblings without symptoms should stay home from school.

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And underlying all of those issues is the reality that it’s easier for some families than others to follow public health guidance.

For those with precarious employment it may mean a choice between doing the right thing by self-isolating at home or losing a job or the wages needed to pay the rent or buy groceries, says Thampi.

COVID-19 prevention guidelines are weakened in the absence of sick or other paid leave to help families comply with them, she points out.

Here’s a rundown of the latest rules:

Daily screening for symptoms

Staff and students are expected to screen themselves every day before school with a series of questions about symptoms of illness, travel history and close contacts. High school students must confirm they’ve passed the quiz — usually verbally to a teacher at school.

Ottawa Public Health has a self-screening tool online and so does the Ontario government.

The symptom categories are similar. Symptoms that are less associated with COVID-19 — a runny nose, nausea, vomiting and diarrhea, tiredness or muscle aches, sore throat and headaches — are grouped in one category. Students with one of those symptoms are advised to stay home for 24 hours, but if symptoms improve they can go back to school.

Students who have two of those symptoms, however, or one symptom from the no-go list — cough, fever, chills, shortness of breath or loss of taste or smell — are told to stay home and consult a doctor (Ontario screening tool) or immediately get a COVID test (Ottawa tool).

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Screening is far from an exact science.

Symptoms that are related to some other condition, for instance, don’t necessarily count.

If a student has a runny nose that is probably allergies, extreme fatigue that might be depression or a cough that seems like asthma, they don’t have to check off those symptoms when using the tool.

If parents are asked by a school or daycare for more information about a child’s symptoms that may be attributable to another condition, OPH provides a form they can fill out.

However, as Ottawa Public Health also notes, “having an underlying condition does not necessarily mean that your child does not also have COVID-19.”

And sorting symptoms into two categories is based on the best available evidence but means some COVID-19 cases will slip through.

Most children and youth with COVID-19 have no symptoms at all or only mild ones.

And there is a large variation in signs and symptoms of COVID-19 in children, note the medical experts who contributed to an Ontario school reopening report co-ordinated by SickKids hospital in Toronto.

“Predominant symptoms have included fever and cough in more than half the cases, followed by runny nose/nasal congestion, myalgia/fatigue and sore throat in 10–20 per cent of cases and gastrointestinal symptoms and headache in fewer than 10 per cent of cases,” says the report.

The self-screening test was stricter when schools opened in September. Any one symptom triggered a trip for a COVID-19 test, leading to hours-long lineups at overwhelmed assessment centres and days of waiting for appointments and results.

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The screening rules were relaxed on Oct. 1. The number of COVID-19 tests conducted on school-aged children immediately plummeted.

There is now a renewed debate over whether screening should be tightened again. The benefits of stricter screening in keeping COVID-19 out of schools have to be weighed against the disruption to kids and their families.

The SickKids report recommends a regional approach based on the level of community transmission of the virus.

In areas with “moderate to high” community transmission, the threshold for school exclusion and testing should be lower, such as single-symptom screening, said the report. Single-symptom school screening has already been adopted by the local public health units in the COVID-19 hot spots of Peel and Toronto.

Lower-risk areas may require a different approach.

In Renfrew County, for instance, which is currently in the “green” zone under the province’s colour-coded pandemic response guide, the public health unit does not support stricter screening.

“We need to balance the risk of transmission with the negative fallout for students and working parents from unnecessarily aggressive isolation procedures,” said a statement from the Renfrew County and District Health Unit.

“Schools, we have learned, are not significant drivers of infection and sending scores of kids with a runny nose home and isolating cases for up to 14 days is highly disruptive, so it has to be warranted.

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“In Renfrew County and District we sent over 600 kids and staff home to identify only seven additional (COVID-19) cases.”

There is also the logistical challenge of whether testing centres could meet the increased demand if screening is tightened.

Ontario Chief Medical Officer of Health Dr. David Williams has said he doesn’t want a return to the September testing logjams, which he describes as “very frustrating” for parents.

Who has to stay home and when

Anyone who fails the self-screening quiz must stay home and should get a COVID-19 test, says OPH.

Everyone in their household is also expected to self-isolate at home until the person with symptoms has a negative test result.

The rules are less clear in the case of people who do not have symptoms themselves but have been ordered to self-isolate because they have been in close contact with someone who has COVID-19. Close contacts must self-isolate for 14 days.

But do their asymptomatic household members have to self-isolate too?

The province says yes. Ottawa Public Health says no.

“The rest of the family do not need to be in isolation and do not need to be tested,” says OPH. As long as they have no symptoms, for instance, siblings can go to school and parents can go to work.

Ontario, in contrast, issued new guidelines in late January as part of its six-point plan to fight the spread of virus variants. “Households of all contacts and symptomatic individuals will be asked to stay home until the contact has received a negative test,” said the Ministry of Health in a statement.

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The different interpretations could affect thousands of families with school-aged children.

When someone at school contracts COVID-19, typically everyone in the class and cohort is identified as a close contact and sent home to isolate. Cohorts could include, for instance, students riding the same bus or attending the same before and after-school care.

On average, 20 high-risk contacts were identified for each school attendee who tested positive for COVID-19, according to a report by OPH that considered the time period of September, October and November. Schools opened gradually throughout September in Ottawa.

During that time, a total of 11,376 students and staff were identified as high-risk contacts, the report said.

The latest advice from OPH is that close contacts should be tested for COVID-19 on Day 7 of their 14-day isolation. The 14-day countdown starts from the day of exposure.

So if families follow the provincial guidelines, household members of a child sent home as a close contact could be in self-isolation for days while waiting for their child’s test result.

All about Testing

Ottawa public health officials say testing capacity has been ramped up. Same-day or next-day appointments are often available and results are usually ready in one or two days.

Students who pass the self-screening test but have a mild symptom can also be tested. In fact, OPH is encouraging it.

Here’s the message, in large bold type, on the OPH screening quiz: “please note it is possible that someone could test positive for COVID-19 even if they only have one symptom.

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“If you remain concerned that your child may have COVID-19 even though there is only one symptom, you may choose to have your child tested at an assessment centre.”

Testing is not mandatory for anyone. Students must follow public-health guidance on how long to self-isolate, but according to provincial guidelines are not required to show proof of a negative test to go back to school.

Parents are sometimes reluctant to have their child tested because they fear the procedure will be uncomfortable or it’s difficult for them to get to a test site. Others may conclude that a test is unnecessary if the child has to stay home and self-isolate anyway.

Public health authorities strongly encourage testing.

It’s another case of doing the right thing — for the community, in this case.

“Testing is critical to our public health response — knowing how much the virus is circulating in the community, preventing further spread and getting the virus under control will help prevent further transmission and future lockdowns,” says OPH.

jmiller@postmedia.com

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