Random virus testing pushed for schools
More data ‘a good thing,’ one expert says
Dr. Michael Silverman is an infectious diseases doctor and father of twins, five-anda-half-year-old boys, who recently returned home after playing with friends in their little bubble.
Why so sad? Silverman asked one of his sons. “Spider-Man died of COVID — that’s what one of his friends told him, and they were all sad. Like, this is so big for them,” said Silverman, chair of infectious diseases at Western University’s Schulich School of Medicine & Dentistry.
The London, Ont. doctor reassured his sons: “Spider-Man didn’t die and you aren’t going to die, you’re going to be OK.” Silverman said it’s time to dial down the fear factor. “What are we doing? We have to decrease the anxiety and fear in these kids, and the anxiety and fear in parents.”
“For the vast majority of children, parents shouldn’t fear, ‘if I send my kid to school this may be sending them to their death,’” he said.
Silverman believes it’s crucial children return to class, safely, but should daily fever checks, or random, routine testing of students, teachers and staff be part of back-toschool plans?
Saskatchewan announced this week that monitoring and testing in schools would increase to “proactively safeguard the wellness of students, teachers and staff.” Students with parental consent will have the option to participate in randomized testing. Testing will also be offered during routine inschool childhood vaccinations, and to targeted schools in communities that see a surge in infections.
Alberta’s top doctor, Deena Hinshaw, is asking Alberta’s 90,000 teachers and school staff to voluntarily be tested before school resumes and again throughout the year.
Virtually every provincial back-to-school plan calls for rapid testing of anyone showing symptoms, contact tracing and quarantining the exposed to contain the virus and prevent outbreaks.
But symptoms tend to be mild in children. Studies have found that as many as 28 per cent of confirmed COVID-19 cases in children were asymptomatic, and while schools don’t seem to play a significant role in transmission of COVID-19, “virus transmission in asymptomatic and pre-symptomatic children is possible,” according to the European Centre for Disease Prevention and Control.
Testing comes with its own challenges: Test someone in the early stages of infection and the test might come back “negative,” because there hasn’t been enough time for the person to develop enough viral load to be detectable, said University of Ottawa epidemiologist Raywat Deonandan. “So, a negative result doesn’t necessarily put the person in the clear.”
It’s also a “pretty big deal” to try to operationalize school-based testing at the local level, Canada’s chief public health officer, Dr. Theresa Tam, said recently. There are already long lineups for tests in some cities, and long waits for results, and if all the swabs and test reagent and nursing time is used to test people without symptoms we may not have enough to test the people who really need it — people who are sick, said Dr. Laura Sauvé.
Many people would have to be tested to find a positive, and the test itself is uncomfortable, even painful to children, said Sauvé, chair of the Canadian Paediatric Society’s infectious diseases committee. For younger kids, especially, “Once you have done one nasopharyngeal swab (a long, deep swab in the nose to the back of the throat) you won’t get another one very easily.”
“If we had no barriers to doing the test — an infinite amount of testing capacity, testing materials — and the test was easy to do and especially not painful, I would be more enthusiastic,” she said.
Work is being done on tests that are less painful, like saliva-based tests, but so far none have been approved for use in Canada.
Deonandan agrees there are logistical challenges to regular testing. “But it strikes me that more information is always a good thing,” he said. “Testing has always been, and continues to be, our best weapon against this disease until an effective vaccine is in our hands.”
Immediate testing of suspected cases, contact tracing and isolation go without saying, said Dr. Sandy Buchman, president of the Canadian Medical Association. “We have to be able to respond and be agile, quickly.”
Parents will be expected to screen kids daily for COVID-19 symptoms, including fever, cough and chills, symptoms that overlap with other respiratory bugs.
The problem is that a “fair number” of people have no fever when infected and are potentially contagious, said Montreal cardiologist and epidemiologist Dr. Chris Labos. “So, you may go to school, not have a fever, infect a bunch of people and then only get sick a day or two later. The temperature check isn’t going to prevent that.
“It’s much more helpful and probably a lot more productive, that the minute you have a case, can you then flip a switch, test everybody, get the results quickly and pull out all the positive cases to prevent an outbreak. Because there will be infections,” Labos said. The question becomes, can you prevent the infections from turning into outbreaks?
Silverman agrees that transmissions are a given. “And it’s important that when they happen we don’t say, ‘oh my god, what a mistake we made’ because there will be enormous pressure to close schools.
“We have to educate the public and have reasonable expectations, because if we have a zero tolerance to any kids getting infected, kids could be out of school for years and what’s that going to do to the future of this generation that’s growing up?”
YOU MAY GO TO SCHOOL, NOT HAVE A FEVER, INFECT A BUNCH OF PEOPLE AND THEN ONLY GET SICK.