My kid just threw up. Can she go to school? What about her vaccinated brother? Your one-stop COVID-19 cheat sheet for back-to-school
Your kindergartner has a runny nose. His vaccinated sister in Grade 8 feels fine. But there was also a recent COVID-19 case on the older kid's basketball team. So which of your kids can go to class? Who needs a nose swab? And where or how can they get tested?
At times, it can feel like you need a PhD to navigate the dizzying and ever-changing rules and protocols that come with being a parent in a pandemic. This year, the landscape is even more complex with some students vaccinated, extracurriculars back in the mix, and a surging Delta wave that promises to find the unvaccinated among us, many of whom are kids.
To save you from digging through your pile of COVID-19 handouts from your kid's school, or getting lost as you click through multiple public health websites, the Star has compiled a one-stop cheat sheet for Toronto parents rushing to get their kids off to school - and struggling to survive another pandemic school year with their sanity intact.
What symptoms will exclude your child from school or daycare?
Though runny noses are off the province's symptom list, using the new, streamlined screening tool is still a critical part of the rush-to-school morning routine. (A questionnaire is available on Toronto Public Health's (TPH) website, or you can use the province's online screening tool.) Experts say keeping students with COVID-like symptoms out of class will help prevent the virus from entering schools, reducing the risk of outbreaks and closures.
This year, students must stay home and self-isolate if they have one or more of the following symptoms: a fever greater than 37.8 C and/or chills; a cough; difficulty breathing; a decrease or loss of taste and/or smell; and gastrointestinal symptoms, such as nausea, vomiting or diarrhea.
Even those who are fully vaccinated or who tested positive within the last 90 days must stay home if they have one or more of these symptoms.
Health experts who spoke to the Star said parents can keep children home from school and get a COVID test for more minor symptoms, such as nasal congestion, sore throat and a runny nose. Doctors at Toronto-area hospitals who notify families of positive results say they do see COVID-positive children whose symptoms started with a runny nose or sore throat.
And some experts worry about removing runny noses from the screening lists this year, especially in light of the surging Delta variant. York Region has announced that its schools will continue screening for runny noses and sore throats, even though these symptoms have been removed from the province's symptom screening list.
In a statement to the Star, TPH's associate medical officer of health, Dr. Vinita Dubey, said that generally if a student is sick or has symptoms of illness they shouldn't go to school.
What symptoms will require a COVID-19 test?
Those same five symptoms - fever, cough, difficulty breathing, a loss of taste or smell and gastro" type complaints - trigger a COVID test.
While families can go to a local testing centre for a swab - the province's online symptom screening tool will direct you to the nearest locations using your postal code - Toronto schools and school-based daycares will have access to take-home kits this year. The new program aims to have kits in all schools by the end of this month, making that much-dreaded COVID test faster and easier for kids and families. (The program hopes to also equip all Toronto daycares with these testing kits but that rollout is expected to take longer.)
These take-home tests are PCR (polymerase chain reaction), not rapid-antigen tests, and can be completed at school or home.
What happens after you get test results?
If your child tests positive, inform the school and self-isolate at home. TPH will be in touch with more information. Household members who are not fully vaccinated should also stay home and get tested.
Students who test negative - and are not considered a close contact of someone who tested positive in the last 10 days - can return to school 24 hours after their symptoms start to improve. Those with nausea, vomiting and/or diarrhea must wait 48 hours before going back to class.
For students who choose not to get a COVID test, there are two options: self-isolate at home for 10 days, only returning to school on the 11th day if symptoms have started to improve; or receive a diagnosis from a medical professional indicating symptoms are non-COVID-related. In this case, a student can only return to class after their symptoms improve.
Some pediatricians have been reluctant to write alternative diagnosis" notes, however. Pediatrician Dr. Hirotaka Yamashiro, past chair of the pediatrics section of the Ontario Medical Association, said he's often asked by parents to write notes attesting their symptomatic kids don't have COVID but he always says no.
What is the doctor going to know that a (COVID) test wouldn't tell you? There's nothing the doctor can do, they don't have X-ray vision or something," he said. We can give you odds ... but that's not good enough, if you're talking about whether they're safe to go to daycare."
What happens when my child has a symptom on the screening list, but has also tested positive for COVID within the last 90 days?
Dubey said a COVID infection can provide some natural immunity, usually for at least 90 days"; after that point, some people have been reinfected, usually with a different variant/strain." So any new or worsening symptoms could still be a new COVID infection, and TPH recommends students in this situation be retested. Research shows it is possible a new positive result could be due to the PCR test picking up residual virus from the previous infection. But Dubey said public health officials will do an investigation to interpret results in this context."
What's happening this year with the sibling rule?
Last December, TPH introduced a rule that siblings of symptomatic children also have to be pulled from school or daycare until a COVID infection can be ruled out - a development that made every cough or fever all the more disruptive for families with two or more kids.
But this year, some kids will be vaccinated; others will have immunity from recent infections. So does the sibling rule still apply?
That depends on the scenario. So the Star asked TPH to walk us through the sibling rules for different situations that might arise.
For these examples, we'll use an imaginary family with two kids: a kindergartner, Sally, and her 13-year-old brother, Sam.
Example 1: Sally develops COVID-19 symptoms. Does Sam also have to stay home from school if he ...
... doesn't have symptoms but is unvaccinated? Yes. Sam has to stay home until Sally gets a negative COVID test - and if she doesn't get tested, he can only go back to school after 10 days.
... doesn't have symptoms but he's only partially vaccinated? Yes. Sam has to stay home until Sally gets a negative COVID test - and if she doesn't get tested, he can only go back after 10 days.
... doesn't have symptoms but is fully vaccinated (more than two weeks post-second dose)? No. He can go to school.
... doesn't have symptoms but tested positive for COVID-19 within the last 90 days? No. Sam can go to school as long as he's been cleared following his last infection. (Typically, someone who tests positive is given instructions from public health explaining when they can come out of isolation.)
Example 2: Sally tests positive for COVID-19. Does Sam also have to stay home from school if he ...
... is asymptomatic and unvaccinated or partially vaccinated? Yes, he must self-isolate for at least 10 days and get tested.
... is asymptomatic and fully vaccinated? No, he can go to school - but since Sam is now a household contact of a confirmed COVID case, he is still recommended to go for testing, though he doesn't need to self-isolate while awaiting test results. The province's testing guidance says that asymptomatic close contacts of confirmed cases should still get PCR testing within 10 days of their last exposure to the positive case, regardless of vaccination status. (See below for more information on close contacts and symptoms they should monitor for).
... is asymptomatic and tested positive for COVID-19 within the last 90 days? No, he can go to school. Though if he develops new or worsening symptoms, he will have to stay home and get tested.
What about parents and other adults in the household?
TPH is pretty clear: If anyone in the household has COVID-19 symptoms, all children and adults who are not fully vaccinated must stay home and self-isolate until COVID has been ruled out."
And if another household member, whether a child or adult, develops symptoms while awaiting the original test results, that person must also stay home, self-isolate and get tested." Should a household member choose not to get tested for COVID, any household member not fully vaccinated must stay home and self-isolate for 10 days.
How are outbreaks being defined this year?
Like last year, a school outbreak is defined as two or more lab-confirmed COVID-19 cases in students, staff or other visitors where there's an epidemiological link within a two-week period - and where at least one infection could have been reasonably acquired" at school (including on the school bus or during before- or after-school care).
What is the threshold for dismissing an entire classroom or shutting down a school?
There is no threshold that would automatically trigger a classroom or school closure after a COVID case or outbreak, according to TPH. The decision will be based on individual investigation on the overall situation.
What are the rules for staff or students who are close contacts/high-risk exposures? Are they different if you're fully vaccinated? Should you look for different symptoms?
Toronto Public Health defines a close contact as: any person who was near a COVID-positive individual (within two metres) for 15 minutes or more, even if they were both wearing masks"; a person who had multiple close encounters with a COVID-positive individual over a 24-hour period (even if those encounters are less than 15 minutes); someone who hugged, or had close personal contact with, a COVID-positive individual; household members and anyone cared for by a COVID-positive individual in the same home.
If you've been identified as a close contact and are not fully vaccinated, you must self-isolate for 10 days, even if you test negative. Any close contact who develops symptoms - even if fully vaccinated or they were COVID-positive in the last 90 days - must isolate and get tested.
After being exposed, close contacts have to monitor for a broader list of symptoms. In addition to the five main symptoms described in the school screening tool, TPH says close contacts should also watch out for: fatigue (tiredness), sore muscles or joints; sore throat; runny or stuffy nose; abdominal pain; headache; pink eye; or a decrease or lack of appetite.
Close contacts with one of these additional symptoms - even if fully vaccinated - must stay home, self-isolate and get tested," said Dubey.
What happens to extracurriculars if there's a classroom or school outbreak?
A major change this year is that students can once again play in the school band, join a basketball team, or go on overnight field trips with their classmates. But this also means social contact among kids will proliferate - and a single COVID-19 infection has potential to spread further, faster.
Dubey said TPH will continue prioritizing contact tracing for school-aged kids this year, along with long-term-care homes and other high-risk congregate settings. Last year, principals were enlisted to help dismiss student cohorts" as quickly as possible after a COVID case was identified; TPH would then conduct an investigation to determine which cohorts needed to stay home and for how long, Dubey said.
A risk assessment includes determining if there was close contact, what was the level of the exposure, and for how long," she said.
Dubey said this system will again be in place this year though extracurricular activities will now be considered a cohort in addition to classrooms, buses and before and after-school programs.
She added that students who are fully vaccinated - or tested positive for COVID within the last 90 days and cleared - may not have to be excluded from dismissed cohorts, however.
Jennifer Yang is a Toronto-based health reporter for the Star. Follow her on Twitter: @jyangstar
Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie