When can my child go to school? A COVID-19 primer

Boston Globe – October 16, 2020

Westyn Branch-Elliman, MD (Infectious Diseases, BIDMC) answers questions for parents on schools and COVID-19.

With schools back in session for a month or so now, COVID-19 is starting to feel like a sinister game of whack-a-mole. Seems like every week I field a new dispatch from our town’s superintendent about a classroom — or a whole school! — shifting remote because of a case. How can we halt this? Or at least keep disruption to a minimum and not devolve into panic every time our child straggles home with a slightly runny nose? I have answers.

Enter two COVID-19 gurus: Westyn Branch-Elliman, MD, MMsc, an assistant professor of medicine and an infectious disease specialist affiliated with Harvard Medical School, VA Boston Healthcare System, and Beth Israel Deaconess Medical Center; and Elissa Perkins, MD, MPH, associate professor of emergency medicine, vice chair of emergency medicine research, and director of emergency department infectious disease management at Boston University School of Medicine/Boston Medical Center.

Clearly, they know what they’re talking about. Oh, and they’re parents — so they get the inconveniences and uncertainties surrounding school (and life!) right now. If you’re ready to throw your child’s laptop into a fiery inferno during remote days, you know how very important it is to responsibly keep school cases contained.Get HomeFront in your inboxThe Weekender is temporarily HomeFront, your guide to the best ways to stay entertained at home any day of the week.

With that in mind, here are some questions and key answers from two people you can trust.

I don’t have any known contacts for COVID, but I have new symptoms. I went to my doctor, they recommended a COVID-19 test, and I’m waiting for the results. Is it OK for me to send my children to school?

Everyone in your household should stay home and quarantine until the test result is available. If one person has test results pending, your entire household should quarantine while waiting for the results, even if it takes days. If the test is negative, then your children can return to school, provided they’re feeling well and do not have any symptoms.

I need a test, but I don’t know where to go! I need resources.

Getting a test quickly and efficiently is still a challenge! If you have a primary care doctor (or your child has a pediatrician), calling their office is a good place to start. In Massachusetts, the Department of Public Health has a listing of testing sites. It’s a useful resource if you need to find a place to get a test, and an interactive map can be found here. The interactive map includes a search function with a lot of options, so you can find sites that perform testing on children. You can also search for sites that provide free testing for people who don’t have insurance, sites that accept MassHealth, drive-thru testing sites, and sites that perform antibody testing.

My child really hates getting tested for strep. Will this test be just as bad?

This depends a lot on the specifics of the test. Many places are now offering anterior nares testing, which is a sample taken from the front of the nose. It’s about as invasive as nose-picking, and most people don’t find it too uncomfortable. Some places will collect a deeper swab, called a nasopharyngeal swab, and that’s more uncomfortable. If you’re worried, you should ask your child’s doctor how they collect the sample.

I’m planning to travel out of town this weekend, and I have to get a COVID-19 test before I go to the airport. I don’t have any symptoms. Do I need to keep my children home from school?

There’s a difference between a screening test and a diagnostic test. Screening tests are for asymptomatic people. Diagnostic tests are for people who have symptoms and who have a substantially higher probability of having the disease. We recommend quarantine for all households pending all diagnostic tests (because we suspect the test may be positive) but not for screening tests (because we suspect the test is negative). Also remember to follow state guidance about travel and post-travel testing and quarantining recommendations. Current recommendations can be found here.

Do people have to request one type of test or the other, either screening or diagnostic, or will the testing facility automatically know which to administer depending on circumstances?

Screening vs. diagnostic relates to the reason you’re getting the test. “Screening” tests are performed on people who don’t have symptoms, and diagnostic tests are performed on people who are sick (and sometimes people who have a known exposure).

Are both “PCR” tests? Or is a screening test the less precise antigen version?

PCR testing identifies viral genetic material, whereas antigen testing identifies proteins that are made by the virus. Generally speaking, PCR testing is more sensitive, meaning it picks up more true cases of disease. The downside of PCR testing is that the test can be positive for a long time, even after someone isn’t infectious anymore. The assay used (whether it’s a PCR or an antigen test) is dependent on the facility where the test is being obtained. Both tests can be used for either screening or diagnosis, but PCR is usually preferred for the latter. Sometimes, when people discuss population-level screening for those without symptoms, they are thinking about using cheaper (and usually faster turnaround) antigen tests, which have lower sensitivity than PCR tests, but this isn’t universal.

My child’s friend tested positive for COVID-19, and her parents told us that we’re close contacts since they had a playdate the day before she had symptoms. We haven’t heard from the Board of Health contact tracers yet. Should I keep my child home from school?

There’s sometimes a delay in the Board of Health contact tracing. If your child interacted with someone (closer than 6 feet for more than 15 minutes) in the 48 hours before symptom onset and that person has a positive test for COVID-19, then your child is considered a “close contact.” Your child should get a test and stay home from school for a full 14-day quarantine, regardless of the results of your own child’s test. However, there’s no need for you to contact the Board of Health. The Board of Health receives positive COVID-19 test results directly from the laboratory and is responsible for reaching out to individuals who test positive and then conducting contact tracing.

My child has a sore throat and runny nose, but his senses of smell and taste are just fine. Do I need to keep him home from school? Yes. Your child should not go to school if they have any of the symptoms that can be caused by a COVID-19 infection, even if they don’t have all of the symptoms that can be caused by COVID-19. If your child does have symptoms, contact his or her pediatrician and arrange for COVID-19 testing.

What’s the difference between quarantine and isolation?

Quarantine is staying at home when you’ve been exposed to COVID-19. We do this because many people who get COVID-19 never develop symptoms, and because even people who do get sick can spread virus before their symptoms develop. The CDC recommends quarantining for 14 days after an exposure. Isolation is staying at home after you’ve been diagnosed with COVID-19.

Again, the goal of isolation is to prevent the spread of the virus to other people who haven’t been infected. Currently, the CDC recommends isolation for 10 days after a positive COVID-19 test in individuals who are healthy and don’t have severe disease. Isolation is shorter than quarantine because we’re not worried about the potential for a two- to five-day pre-symptomatic shedding period.

At what point can a positive kid be considered safe to resume normal activity?

If someone is diagnosed with COVID-19, isolation and precautions generally can be discontinued 10 days after symptom onset, once they’re fever-free for at least 24 hours without the use of fever-reducing medications, and with improvement of other symptoms. In some cases, the isolation period can be longer, so it’s always a good idea to check with your child’s doctor if you have questions.

My daughter tested positive for COVID-19. I know that I need to keep all my children home from school for a full quarantine (14 days). Nobody else has symptoms. Should I get my other kids tested?

Yes, everyone in your household should get a COVID-19 test, because the results will impact contact tracing (typically conducted by the local Board of Health) and additional testing. If your other children test negative, then your other children’s friends don’t need to be informed or receive testing, because they’re not close contacts of an infected person. But if one of your other children tests positive, then his or her close contacts need to undergo testing and possibly quarantine. Testing and quarantining is an important part of containing the spread of this disease.

I was diagnosed with COVID-19 and separated from my kids. That was 10 days ago, and I’m now healthy and returning home. When can my kids return to school?

Your children will need to quarantine for 14 days after their last possible exposure, dating to the time you stopped interacting with them. Now that you’re better, you won’t spread COVID-19 to them, but until they complete the quarantine period, it’s possible that they could spread COVID-19 to others.

We hear the word shedding a lot! Sounds yucky. What is that?

“Shedding” means that the virus is replicating in your body (meaning it’s making more copies of itself) and that the new viruses that grew in your body are being released into the environment (mostly through particles that leave your respiratory tract). Shedding can happen even if you don’t feel sick, or before you feel sick, which is why people with known exposures to COVID-19 should stay home and quarantine. The virus and the particles are tiny, so usually you don’t see or notice them at all — but that’s what makes it so challenging to control.