The Challenges of Testing K-12 Kids in School

Families across the nation have been undergoing changes due to the pandemic that have cost jobs, income, basic needs, and the education of their children. Returning children to school without the confirmation of a majority of the country having received vaccines places them and their families at risk for being infected with and spreading the virus. Additional funds have been made available with the latest 2021 stimulus package approved by the U.S. government to encourage a return to school for K-12 grades and fund a variety of safety and health protocols for the COVID-19 prevention and testing. However, there are a number of challenges involved in both the virus symptoms that children experience and the testing itself. Identifying the differences between COVID-19 symptoms and infection in adults versus children is a method to attempt to meet the testing challenges that school systems face during the pandemic.

COVID-19 in Kids

A majority of the information that has been shared in the media and the medical community has related to the symptoms and infections of COVID-19 in adults. This data varies greatly when it comes to children. Reports both globally and in the U.S. for childhood cases of COVID-19 in children ages 0-17 years have been very low and hospitalization of children have been low. Due to varying symptoms and less testing, the CDC (Centers for Disease Control) has indicated that the real number of SARS-CoV-2 incidents in children are not known, however, those that have been reported have seen an increase since March, 2020. Research has shown that children are likely to have similar viral infection loads within their nasopharynx and have the ability to spread COVID-19 to others. It’s believed that the closing of a majority of the schools in the U.S. reduced the virus transmission in Spring and Summer of 2020. Comparison of COVID-19 infections due to the return of children in in-person school, child care, sports activities for youths, and other childhood activities may explain infections and transmissions of the virus. Studies are showing that children may experience many of the same symptoms as adults or just a few symptoms of COVID-19. In some cases, the symptoms have been less severe, with the most common being a higher fever and a cough. A recent review reported by the CDC indicated that around 16% of children that had COVID-19 are asymptomatic with additional evidence showing the possibility of half of the pediatric infections being asymptomatic. The challenge of diagnosing children is that the symptoms that they often have emulate those of other infectious as well as noninfectious conditions such as the flu, allergic rhinitis, and streptococcal pharyngitis. All of these situations contribute to the difficulty in making attempts to test children K-12 as they return to in-person school environments.

COVID-19 Symptoms in Children

While SARS-CoV-2 virus incubation in children is the same 2-14 day time period as adults, symptoms or signs of COVID-19 in kids can include some, all, or a combination of the following:

• Fever
• Headache
• Tiredness
• Cough
• Myalgia
• Sore throat
• Difficulty breathing or shortness of breath
• Rhinorrhea/nasal congestion
• A loss of smell or taste
• Reduced appetite or feeding
• Diarrhea
• Vomiting and/or nausea
• Abdominal pain

School COVID-19 Testing and Follow up Isolation

As school systems attempt to reopen for in-person class attendance, both children and teachers and staff must be protected against COVID-19 transmission. The challenges that each school system faces is to also attempt to comply with existing state, federal, tribal, territorial and local safety, privacy and health regulations that schools operate as a standard. School administrations are being asked to establish a strategy that operates within all of the regular policies and to include actions that need to be taken for testing and isolation procedures when an individual student or adult has been diagnosed with COVID-19. The current CDC (Centers for Disease Control) recommendations for testing include the antigen (viral) test for diagnosis of SARS-CoV-2 diagnoses. These tests are the same for both children and adults. The CDC has created a list of recommended guidelines that school systems, parents and caregivers can use for COVID-19 testing, isolation and quarantining of children. The prioritization of COVID-19 testing for K-12 children should be done if the child has any symptoms or signs of COVID-19 and:

• They have been within 6 ft (close contact) for fifteen minutes or more of anyone that has been laboratory/test confirmed of having COVID-19 or:
• Has an increase of likelihood of exposure to COVID-19 (lives in or with or traveled to an area/community that had a higher transmission rate as defined by the CDC’s Community Mitigation Framework and by the local public health department.

Has not experienced any symptoms but:

• They have been within 6 ft (close contact) for fifteen minutes or more of anyone that has been laboratory/test confirmed of having COVID-19.

While it is understood that any child with infectious disease symptoms should not attend school, the duration of time that they stay away is dependent upon the severity of the illness. For those that have a confirmed diagnosis of COVID-19, the CDC has established the recommendation for discontinuation of home isolation that include being able to be around others after:

• Ten days since symptoms first began to appear and:
• 24 hours with an absence of fever without the use of medications that reduce fever and:
• Improvement of other COVID-19 symptoms with the understanding that loss of smell and taste could continue for weeks or sometimes months after recovery and should not postpone isolation termination.