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It has been about two months since many children returned to school. Most child care programs and activities in Alberta have also resumed. In preparation, my team and I developed guidelines to prevent widespread transmission of COVID-19.
This included a daily symptoms checklist for parents to use everyday to assess their children for any symptoms of COVID-19, and to take the proper actions, like keeping their children home and getting them tested for the virus, if necessary.
We developed the checklist with an abundance of caution, using the evidence we had at the time. I know it can be challenging to conduct this assessment everyday, and even more challenging to keep a child home from school and other activities. I thank parents and providers who have taken this responsibility seriously.
What we’ve seen since September
Just as we have done when developing all public health measures, we created the checklist knowing that we might revise our approach based on our experience and what we learn from other jurisdictions.
Over the past two months, we have seen few cases of transmission occurring in schools and licensed and approved child care programs in Alberta. While cases in school-aged children have risen since September, this pattern is identical to other age groups and reflects increased community transmission. Since September, only 6% of all COVID-19 cases in those aged 5 to 19 have been acquired at school. We are preventing the spread of the virus in schools and child care programs and protecting one another by working together.
Upon careful review of the evidence on COVID-19 symptoms for children under the age of 18, and based on what we have experienced in Alberta and our learnings from other provinces, we have revised the daily checklist for children and youth under the age of 18. This checklist also applies to those 18 and over who are students in high school. This checklist will be in effect starting November 2.
Removing runny nose and sore throat from the list
The biggest change is that we have removed runny nose and sore throat from the list of symptoms that require mandatory isolation for children. This means that any child who only has one of these symptoms will no longer be recommended for COVID-19 testing and does not need to be kept home for 10 days.
Instead, they should stay home for 24 hours and monitor their condition. If they are feeling better after 24 hours, they may return to school and/or activities. If they are feeling worse, or if additional symptoms appear, they should be tested for COVID-19 and stay home until all symptoms are resolved.
This change brings Alberta in line with B.C., Ontario and Quebec, which have all made similar changes. We have discussed the changes with colleagues in these provinces, and there has been no corresponding increase in COVID-19 transmission in schools and child care programs as a result.
We have also looked at our own evidence. Of all the children under 18 who have been tested for COVID-19 recently, less than 1% of those with only a runny nose or only a sore throat tested positive for COVID-19. For children who are not known to be close contacts of a COVID-19 case, having a common symptom like a runny nose or sore throat by itself does not signal a high risk of being infected.
New guidelines if a child has symptoms
In the new daily checklist, the core isolation symptoms are those that are more closely linked to COVID-19 infection.
If a child has ANY of the following core symptoms: cough, fever, shortness of breath and loss of taste or smell:
- They are to isolate for 10 days OR have a negative COVID-19 test result and feel better before going back to school.
Additionally, the action for children with other symptoms will depend on both the number of symptoms and the duration of symptoms.
If a child has ONE of the following symptoms: chills; sore throat or painful swallowing; runny nose or congestion; feeling unwell or fatigue; nausea, vomiting, diarrhea; unexplained loss of appetite; muscle or joint aches; headache; conjunctivitis (pink eye):
- They should stay home and monitor their symptom for 24 hours.
- If the symptom is improving after 24 hours, they can return to their child care program, school or other activities when they feel well enough to go. Testing is not recommended.
- If the symptom worsens after 24 hours (or if additional symptoms appear), they are to continue to stay home and testing is recommended but not required. The child can return to their child care program, activities and/or school when their symptoms have resolved AND it has been 24 hours or more since their symptoms started.
If the child has any TWO of the following: chills; sore throat or painful swallowing; runny nose or congestion; feeling unwell or fatigue; nausea, vomiting, diarrhea; unexplained loss of appetite; muscle or joint aches; headache; conjunctivitis (pink eye):
- They should stay home.
- Testing is recommended but not required.
- The child can attend school or their child care program and other public places when their symptoms have resolved AND it’s been 24 hours or more since their symptoms started.
As a parent myself, I know how challenging it can be to assess mild symptoms and make decisions about whether children are truly ill or not. It is also challenging, both for parents and children, to keep a child away from school and other activities for an extended time, especially when symptoms are mild. It’s also challenging for parents to have to stay home from work, if necessary, or arrange for alternative child care.
The changes to the checklist will help get children back into their child care program, the classroom and to activities as quickly and safely as possible.
Thank you for your continued efforts to keep your children and all Albertans safe. Please continue to look out for one another.
Dr. Deena Hinshaw
Dr. Deena Hinshaw was Alberta's Chief Medical Officer of Health from January 28, 2019 to November 14, 2022.