Here’s a scenario that’s becoming all too common:
Your child had a runny nose last week, so you took the whole family for COVID-19 tests. You had to get time off work, wait in your car for hours at the drive-through clinic and nervously isolate at home. Thankfully, the tests all came back negative.
Now just a week on, you have a child complaining of a sore throat.
The thought of going through the testing rigmarole again is exhausting and you’re wondering if you can just keep the kids home from school and skip the test.
Many parents have asked for advice about how often to get their families tested over winter as it becomes clear just how much time we could be spending at COVID-19 clinics over the coming months.
Here’s a sample of the questions we received:
“Kids are back at school and I’m hearing of numerous kids coming down with cold symptoms (mine too this morning). Parents are doing the right thing and keeping kids at home, but no-one is taking their kid in for drive-thru COVID testing basically because they don’t want their kids to experience the discomfort of the test. What would you advise parents of kids in this situation?”
“I have a child in daycare and one in primary school. The little one constantly brings snotty noses and coughs home from kindy. Always has. I have now had two negative COVID tests in three weeks after twice experiencing mild symptoms, probably caught from my child. Is this now my reality until there is a vaccine? Getting everyone swabbed every couple of weeks and locking my family down until results come through? Or am I being excessive?”
Winter is the time of year when the common cold (which can be caused by a variety of viruses, including rhinovirus) does the rounds.
And despite physical distancing measures to slow the spread of coronavirus, more cold viruses are circulating in the community than this time last year. So it is highly likely that anytime you have a cough, sore throat or runny nose it will be rhinovirus, says Charlotte Hespe, chair of the Royal Australian College of General Practitioners (RACGP).
But rhinovirus and COVID-19 share a lot of the same symptoms and there is no way you — or a doctor — can spot the difference, only a lab test can.
So even though coronavirus testing is disruptive and unpleasant, experts are urging people to get the test and not self-diagnose.
Kids lead to adults
Current evidence suggests children are less likely than adults to contract COVID-19 and if they do, their symptoms are predominantly mild.
A study by the Murdoch Children’s Research Institute which used data from the Royal Children’s Hospital in Melbourne between March 21 and April 19 found 4 out of 433 paediatric patients tested positive for COVID-19 and none of these children were admitted to hospital.
Only one had a fever, and the others only had sore throats, headaches and runny noses, again reinforcing how fever is not a tell-tale sign of coronavirus.
Even though children are at low risk, taking them for a test every time they have the mildest of symptoms is actually about contact tracing back to their parents, the experts say.
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“The children are the canary in the mine, they are the first warning,” Dr Hespe says.
“Picking up COVID-19 in a daycare or school is not really about preventing the spread to the other children, it’s about the family member which that child has usually got it from.
“It’s the family member spread we are wanting to prevent.”
Ian Mackay, who specialises in virology, says it’s not out of the question that the current outbreaks in Melbourne could be traced back to children who were never tested.
“Even though we know kids aren’t major contributors to transmission, they might just be passing on mild stuff, taking it home, where we know it spreads really effectively, and causing some of these outbreaks that haven’t been sourced yet. Maybe not, but it’s one theory.”
What if it’s only a runny nose?
Here’s where the pragmatic approach might conflict with the public health advice.
The Government’s message is crystal clear — any symptom is worth a test.
But Asha Bowen, a paediatrician at Perth Children’s Hospital and an infectious disease researcher at Telethon Kids Institute, says a case of the sniffles doesn’t warrant a COVID-19 test.
“I recommend if kids have a fever, cough or sore throat then they should get COVID-19 tested,” she says.
“If they only have a runny nose then it is not required for a test to be done, but staying home is definitely recommended until the symptoms go away.”
Dr Hespe understands why some doctors are drawing the line somewhere, but doesn’t agree.
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Elimination of the virus hasn’t been achieved so we can’t afford to “wait and see” if more symptoms emerge or worsen, she says.
Every single symptom, even that barely-there sniffle must be tested until further notice according to Dr Hespe, who runs a GP clinic in Sydney.
“As a GP, I would apologise to every parent out there with small children because I remember what it was like, on average you had a respiratory tract infection at least every month.
“I know there’s going to be a lot of GPs who will try to minimise the inconvenience of having to get tested frequently, but that is not the RACGP approach. We need to keep safe vulnerable populations safe from this illness by stomping it.”
Dr Mackay also says the “no exceptions” approach is essential now.
“There’s this whole spectrum of symptoms that include just having a sore throat or just having a runny nose in some cases,” he says.
“As much of a pain in the neck as it is, until authorities say otherwise, we’re trying to find the last few cases [so] we have to keep going and getting tested. Simple as that.”
Saying ‘it’s just a cold’ cost lives
On average, adults get two to four colds a year and children may get five to 10 per year, but state health departments have warned respiratory illnesses such as rhinovirus are more prevalent than this time last year.
“Bizarrely, [rhinovirus] seems to have survived our physical distancing and have just taken off as we’ve started to mingle again,” Dr Mackay says.
The high spread of rhinovirus means people will be more likely to assume any symptom is just the common cold which may put Australia at risk of more outbreaks, he says.
Dr Mackay says during winter in the northern hemisphere, the “it’s just a cold” mentality cost lives.
“Up north when COVID-19 started to emerge, the disease looked just like a cold, so it ran under the radar and spread without necessarily being noticed.
“That is an issue we’re going to have here now as although we’ve got hardly any flu, we’ve got a vast number of rhinovirus cases.”
Dr Hespe says theoretically winter might be worse for COVID-19 spread than summer, but the evidence largely suggests the virus is “not respectful of seasons”.
The Australian Government says testing kit supplies will continue to be closely monitored over winter and there is “sufficient” capacity to meet current demand.
Healius, which operates COVID-19 testing clinics all across Australia under pathology brands such as Laverty, QML and Dorevitch, says it will run testing facilities wherever the Government needs them and says last month it tripled capacity to more than 30,000 tests per day.
Not a pleasant experience
Dr Hespe says there’s been a lot of discussion among GPs about the need to send children for frequent COVID-19 tests as “nobody wants to put kids through it”.
“Kids don’t like being interfered with, full stop,” she said.
“But I really do appeal to that whole community responsibility.”
Dr Bowen says, as a mother, she understands the commotion and (sometimes tears) that are involved in getting kids swabbed.
“I know a visit to the clinic may be easier said than done for some kids — especially if they’re feeling sick, scared or tired.”
This is what she suggests to make the ordeal slightly less stressful:
- Let them know what it will be like (tell them the tickly swab in the back of their nose might make their eyes water)
- Reassure them you will be there with them the whole time
- Tell them it won’t take long
And once it’s done, “lots of high fives and treats for bravery are in order!” Dr Bowen said.
Obviously the best course of action is to get all children in a family tested if they have symptoms, but if you choose to only test one child each time, the experts agree that’s better than nothing.
“Having at least one of the family members who has symptoms tested is a good idea when not everyone is willing to get it done,” Dr Bowen says.
“If there was an older child that obviously has the same illness as the others, and you get a negative test, then I wouldn’t be going to get the others tested if it’s going to cause a whole lot of chaos,” Dr Hespe says.
Dr Mackay warns a single family commonly suffers from different viruses at the same time so this is not a fail-safe way to rule out COVID-19.
Why some might go for more tests than others
Australians are notorious for their high rates of presenteeism — showing up to work ill.
Some people think it’s noble to adopt a mentality of “just soldier on” but this year that has to be thrown out the window.
“This year is the year of congratulating people for going and getting a test on the first bit of symptom, congratulating people for staying home,” Dr Mackay says.
A peer-reviewed study of attitudes towards COVID-19 around the world undertaken by the University of Cambridge found the willingness of people to adopt protective behaviours (hand hygiene, staying home) depended on how risky they perceived the virus to be.
While the study did not examine people’s disposition to getting tested, it indicated that those in Australia with pro-social motives (the belief that it’s important to do things for the benefit of others) and personal connection to the virus (knowing someone who has had it) were the main reasons why people took more precautions.
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Mathew Marques is a lecturer in social psychology at La Trobe University and said the study proves the way people judge risk is complex, but says it’s not just about our outlook — people are also guided by each other.
“In Victoria, we are seeing people flooding testing centres. People take cues from what other people are doing,” he said.
“And when people observe others being more relaxed about testing, they may be more off guard.”
Mr Marques says the majority of people want to do what is safe for them and others, but it must be acknowledged that testing can be more difficult for some.
“I can go get tested because my wife can look after the kids so it doesn’t impact on my work.
“But if I’m a casual worker and can’t take time off, don’t have my licence … all those factors are going to play a part in how many tests I do.”