Does your kid have a sore throat? What being 'slightly sick' may mean once school starts

Your child wakes up in the morning and says she has a headache. Or a tummy ache. Or a sore throat. New policies to keep COVID-19 from spreading in daycares and camps mean minor symptoms like that can upend the lives of your entire family for days, requiring COVID-19 testing and for siblings to stay home, too.

So what does this mean for school, which has just begun in Quebec and is soon to start in other provinces?

Experts say public health officials are doing their best to keep everyone safe. That may mean a range of policies, from requiring parents to screen their kids for symptoms daily, to requiring a child to get a COVID-19 test for seemingly minor symptoms. And parents should expect those policies to change as the pandemic ebbs and flows in their community.

Camp experiences offer school preview

While school doesn't start until September, many parents got a preview of just how much things have changed when they sent their children to daycare or camp this summer. Among them was Joshua Ramisch, an Ottawa father of two boys, aged 9 and 12, who attended an outdoor day camp in August.

One morning, his younger son, Felix, woke up complaining about a headache and a tummy ache. Ramisch, thinking the symptoms were related to Felix's anxiety about trying to physically distance from other campers and having to get up unusually early, suggested he might feel better after some breakfast. Then he packed the boys off to camp. 

Once they arrived, Felix was asked about a long checklist of possible COVID-19 symptoms. When he mentioned his headache and stomach ache, his father was told that:

• Both Felix and his brother, who had no symptoms, had to go home. 
• Felix needed a COVID-19 test. 
• Other parents would be notified that a camper had to be withdrawn and get a COVID-19 test due to possible symptoms.

Ramisch said he was shocked.

"It was a surprise. It was heavy," he recalled. "I had to figure out how we were going to reconfigure the rest of the day."

CBC News talked to a number of parents in different cities in Canada about what happened after they reported symptoms of illness to their daycare or camp. 

While it was common across the country for camps and daycares to have lists of symptoms to screen for, they varied even within the same city — even between two different Ottawa camps where Ramisch sent Felix. Some institutions also differed in when a test was required in order for the child to return, depending on their symptoms. 

It was also common for daycares or camps in Canada to require siblings to stay home while the symptomatic child was being tested. Ontario provincial guidelines say camps should bar anyone who has had close contact with someone who has symptoms of COVID-19.

Ramisch's first tasks were dealing with older son Isaac's confusion and disappointment at having to miss camp and taking Felix for COVID-19 testing, despite the fact that his symptoms subsided shortly after leaving camp. After Felix was tested, the family had to stay in self-isolation until they got the results.

Fortunately, they didn't have to wait long to get a test and received a negative result at 11:30 p.m. the same night.

But it wasn't over. The camp's policy also said Felix had to be symptom-free for 24 hours, which meant he couldn't go back to camp the next day until a couple hours after his brother was dropped off.

The whole experience made Ramisch and his wife wonder what the school year would look like.

"It does raise way more questions than it answers," he said. "That adds to my anxiety about the return to school for sure."

He hopes schools will be up-front with parents about what will happen if one of their children shows symptoms and said he would like policies to clearly refer back to the decisions of public health authorities.

"That will probably also help inspire confidence," he said. "I defer to a doctor [more] than somebody who's a camp director or a school principal, at least on matters of health."

No 'best practices' exist

Most provinces have announced back-to-school plans that include policies similar to the ones camps and daycares have been following, such as daily screening for symptoms, but they vary from province to province.

For example, in Alberta, a child who says yes to any symptom on the list, including runny nose, sore throat, muscle or joint aches or headache, is asked to stay home.

In Prince Edward Island, parents have been told "no child will be going home because they have one symptom" unless it's something extreme like a fever. Many back-to-school policies in Canada are missing details about what happens if a child develops COVID-19 symptoms, including whether siblings would also have to go home.

Dr. Andrew Morris is an infectious disease specialist at the University of Toronto and the Sinai Health system who contributed to a report on medical experts' recommendations for a return to school.

He said the reason policies vary so much is because best practices for situations like this haven't been established yet. "Really, nobody knows what the right thing to do is."

Expect policies to change by region, over time 

However, Morris said policies should be made by public health authorities, not schools, and should be based on the local epidemiology.

"So if there's rampant COVID in your neighbourhood ... then maybe you handle it differently than if there's very little disease."

That also means that policies may — and should — change depending on the rate of spread of the disease in a community.

For example, given the low rate of spread in Canada right now, Morris doesn't think it makes sense to send siblings home if a child has symptoms, since it's unlikely those symptoms are related to COVID-19. (Of course, if they test positive, the whole household would need to self-isolate).

But if an outbreak happens in a given region or school, policies like sending all siblings home when just one child has a symptom may make sense, given the possibility of asymptomatic spread.

"That's why you need public health by region to be very clear about how they're handling these cases," he said. "And it needs to be nimble. It can't be one size fits all."

The Winnipeg School Division says parents in its district can expect school policies to be fluid. 

Chris Broughton, chair of the division's board of trustees notes that right now, parts of Manitoba are under more stringent restrictions, and "what school looks like in Winnipeg may not be what it looks like in Brandon or Swan River."

Likewise, procedures like symptom screening could look one way at the beginning of the school year, but a few months later "it could be completely different."

So far, the Winnipeg board isn't planning to send siblings home if a child shows symptoms but hasn't tested positive for COVID-19, and is deferring to public health when it comes to telling parents what to do.

"We won't be directing people to any kind of testing or anything along those lines," Broughton said. "Our staff aren't medically trained."

When a child has symptoms, Manitoba currently directs camps, daycares and schools to send families to its online COVID-19 screening tool, which prioritizes some symptoms over others when determining if a test is needed.

Is one symptom enough to stay home?

When it comes to the symptoms required to keep a child out of school and get them tested, Morris leans toward stricter policies.

"I think one thing we've learned pretty well, especially with kids, is that [COVID-19] has many different symptoms." In fact, he noted many kids have no symptoms at all.

He recommends making testing easy, ideally collecting test samples at the school to encourage it.

But he also warns against schools erring too much on the side of caution with overly strict isolation and quarantine policies when the prevalence of the disease is low. If applied too frequently, those rules could be challenging for schools to enforce and make parents reluctant to report all symptoms.

There's "an art to this," he said.

Shift in attitudes toward illness needed

Both Morris and Broughton say parents and families also need to step up by taking public health policies seriously to protect the community and keep schools open. Morris thinks governments could help by offering paid sick leave and parental leave for parents who have to care for sick children.

But they also say Canadians need to change their attitudes toward going to school or work with minor symptoms.

Morris noted that not taking the spread of illness seriously in schools has meant absenteeism rates of up to 15 per cent during a bad flu season. "This is probably a good time to get it right."

Broughton said that as a society, we need to shift how we look at being ill. 

"Like: 'I'm only a little bit ill, I'll take some symptom relief medications potentially and go to work anyway,' " he said. "That sort of mentality that we used to have is no longer going to be acceptable."

The upside, he added, is that kids are learning some important lessons.

"They will have gone through this education and learned properly right from the get-go how to prevent the spread of illness. And that may benefit all of us in the future."