Too sick for school? COVID complicates the answer

With the start of school comes the age-old question: When is my child too sick to go?

Now, COVID-19 makes the decision more complicated than ever. For example, in the past, doctors told parents that if children were fever-free for 24 hours, they were likely no longer contagious and could go back to school. But COVID throws that rule into question.

“Now, even the most minor symptom could be COVID,” said Kathryn Rudman, MD, a pediatrician with Briarpatch Pediatrics, in Yarmouthport, Sandwich and Nantucket. “We have this unforeseen virus that is way more contagious than anything we’ve seen. Someone who is relatively asymptomatic, or thinks they "just have allergies" but is positive for COVID, can even transmit the virus. That’s how contagious it is.”

And, any symptom – fever, sore throat, respiratory issues, vomiting, diarrhea – can be COVID, she said. Meanwhile, pediatricians are seeing traditional childhood complaints: colds, strep throat, foot and mouth disease and, soon, flu.

Children who have been wearing masks or have been isolated during the pandemic, haven’t had a chance to build up their immune systems, Dr. Rudman said.

Sending a contagious child to school can mean four or five other children end up in the pediatrician’s office, she said.

“Especially if they have vulnerable people at home, their parents are going to want to make sure they don’t have COVID or something that might be harmful to grandparents or the sibling that has an autoimmune disease.”

So, if a child feels sick, no matter the symptoms, the first step is testing for COVID, either via a polymerase chain reaction (PCR) test or rapid NAAT (nucleic acid amplification test), such as those seen in most pediatric offices and urgent care facilities, or a series of home tests, she said. “The home tests are more reliable the more you do,” she said. “So, if you do one on the first day of your illness, on the second day of your illness and on the third day of your illness, and they’re all negative, you’re probably not dealing with COVID.”

Questions to Ask

If it’s not COVID, parents can fall back on traditional questions to ask to determine when it’s OK to return to school:

• Is your child contagious? Ear infections, for example, are not contagious.
• Does your child feel well enough to fully participate in school? If a child feels too lousy to pay attention, what’s the point?
• Will your child need more than the teacher can provide? Teachers don’t usually have the bandwidth to comfort a child who feels under the weather.

If a child feels energetic, is eating, has no fever and is negative for COVID-19, they are probably OK to go back to school, Dr. Rudman said.

It’s important right now for parents to be “good humans” in making decisions about school attendance, she added. In other words, err on the side of safety.

“We have to recognize that there are other kids in the classroom who have chronic illness,” Dr. Rudman said. She suggests parents say to themselves: “OK, I definitely don’t want that person getting sick,” or, “I don’t want our family to be the reason that everyone at the birthday party is sick.’”

But she is sympathetic to working parents who struggle with balancing jobs and staying home with a sick child.

“I think employers need to be educated and hop on board with all the quarantine recommendations and the ramifications when kids are sick,” she said. “They need to be supportive of their employees and not make anyone feel like they’re doing the wrong thing when they’re trying to do the right thing.”

Of course, prevention is always the best tactic, she said. Again, traditional rules apply:

• “Hand washing, hand washing, hand washing, or hand sanitizer when you don’t have the ability to wash immediately,” Dr. Rudman said.
• Keep your hands away from your face. Cough into your elbow.
• Keep up to date on all vaccinations, including flu and the new bivalent COVID vaccine. “We’re definitely going to see a significant flu season and we’re going to see it earlier than we normally do,” Dr. Rudman said. “So, don’t wait for your check-up if it’s in November or December. Come in now for your flu shot.”
• Be concerned for others. “We’re all in this together,” she said. “And we can get out of a pandemic more quickly if we all work together.”