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Natalie Enright Jerger's 4-year-old daughter woke up with a sore throat. She tested negative for COVID-19, but her symptoms kept her out of school for four days.

Chloë Ellingson/The Globe and Mail

Now that children with a cough have to wait for a COVID-19 test and stay home from school till they’re well, parents are dealing with a new fear: the common cold.

The cold is causing major disruptions, as even minor symptoms are requiring children to be sent home from schools and daycares, creating chaos for working parents, and propelling greater demand for COVID-19 tests. The trouble is many symptoms listed as part of routine COVID-19 screening are also common to colds, allergies and the flu – and COVID-19 symptom checklists vary from region to region.

In British Columbia, for instance, parents are asked to assess their children before school each morning for signs of fever, chills, cough or worsening chronic cough, shortness of breath, loss of smell or taste, diarrhea, nausea and vomiting. In Ontario, that daily health check includes the addition of sore throats, runny noses, pink eye and muscle aches.

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“That’s a long list of symptoms, and those symptoms overlap with very benign [issues],” said Toronto parent Natalie Enright Jerger. Keeping children with symptoms home “is absolutely the right thing to do,” she said, but “I’m very anxious about how much missed school there might be.”

Ms. Enright Jerger’s four-year-old daughter Evelyn attended only two days of senior kindergarten before she woke up with a sore throat, prompting her parents to keep her home. When she also developed a cough and runny nose, Ms. Enright Jerger’s partner took the child to get a COVID-19 test. The school informed them they could either keep her at home for 14 days or bring her back to school once her symptoms resolved if she tested negative for the coronavirus.

As the parents suspected, the child tested negative and was well enough to return after a four-day absence. But Ms. Enright Jerger is bracing for more sick days to come – which means more missed school, more interrupted work, and the prospect of waiting in hours-long testing lineups with a sick child, who may feel anxious about getting another nasal swab.

“I feel like it’s going to be a very dark winter with little kids,” said Matthew Slutsky, a Toronto father of two nursery school children, ages 2 and 3.

While Mr. Slutsky said he strongly supports efforts to stop the spread of COVID-19, he is confused about why schools have different requirements for when children can return, and why public-health authorities provide different lists of symptoms.

School policies in various jurisdictions are a hodgepodge. Some allow students with mild symptoms without fever to return after 24 hours if their symptoms improve. Some require either isolating for 14 days or receiving a negative COVID-19 test result. Others allow students to return if they have a negative result, but only if they don’t have a fever and have waited at least 24 hours after their symptoms started improving.

Moreover, Mr. Slutsky said he is confused about why public-health authorities provide different lists of symptoms and it’s also unclear when symptoms will result in children being sent home.

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“What is the definition of a runny nose? Because [when] you come in from cold weather, you’re going to have a runny nose,” he said.

Ran Goldman, a pediatrician in Vancouver and professor at the University of British Columbia, said it’s no wonder parents and teachers are confused, especially since many viruses cause common symptoms.

With both COVID-19 and influenza, children can experience fever. But with flu, symptoms tend to occur abruptly – “you’re almost like hitting a wall; you know you’re sick,” Dr. Goldman said. By contrast, from what doctors know so far, children with COVID-19 appear to become sicker and develop more symptoms gradually.

The flu is also more strongly associated with body aches, headaches, chills, shivering and loss of appetite, while these symptoms are uncommon with COVID-19, he said.

Unlike with COVID-19 or influenza, children with colds may not experience any fever at all, Dr. Goldman said. And while COVID-19 can cause shortness of breath and difficulty breathing, this is very uncommon with colds and allergies, he explained.

Part of the reason why lists for COVID-19 symptoms differ from one public-health source to another is there’s a tremendously large number of symptoms that individuals, including children, may exhibit, Dr. Goldman said. Creating a screening checklist that is both sensitive and specific to COVID-19 requires determining how likely it is that an infected person will have each symptom – something scientists and health authorities are still figuring out, he explained.

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The prevalence of COVID-19 in one’s community also plays a role in how various public-health officials determine the symptoms lists for their jurisdictions.

"If you’re in Nunavut where they haven’t had cases, your runny nose is almost guaranteed not COVID. If you’re in Ottawa and you have a runny nose, the chances that it’s COVID are higher,” Ottawa Medical Officer of Health Vera Etches said at an Ottawa Board of Health meeting on Monday evening.

She said there are lots of examples of people in Ottawa who just had fatigue, a sore throat or a headache but who tested positive for the virus.

On Sept. 11, B.C.'s Ministry of Health dropped several symptoms, including runny nose and sore throat, from its daily health check for students, stating there is “very low probability of these symptoms by themselves indicating COVID.”

Ontario Health Minister Christine Elliott said her province’s Chief Medical Officer of Health is in talks with Ministry of Education officials to determine whether runny noses should be removed from the list of COVID-19 symptoms.

“This is very new territory with COVID-19,” she told reporters on Tuesday, when asked whether Ontario would follow B.C.'s lead. “We don’t know everything it involves in terms of symptoms, so this will be an active conversation.”

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On Wednesday, Education Minister Stephen Lecce told reporters he is considering shortening the list of symptoms.

To some extent, it isn’t so important to differentiate whether a child is ill with a cold, flu or the coronavirus. Rather, the emphasis should be on ensuring sick children are comfortable as they recover, and that all precautions are taken to prevent the spread of illness, Dr. Goldman said.

“A sick child should not go to school, period,” he said. “So if the child has fever, it doesn’t always matter so much which virus they have. They should stay away from others.”

With a report from Laura Stone

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