Regional medical official explains when children should be tested for COVID-19

To the Editor:

The following is an open letter from Grey Bruce medical officer of health Dr. Ian Arra, to parents, grandparents and guardians of children in Grey-Bruce:

As a father of one, I sympathize with everyone’s concerns about having children go back to school during the COVID-19 (Coronavirus) pandemic, and with every parent’s concern about ensuring all unwell children receive the testing and care they need.

The Grey Bruce Health Unit has been actively engaged with both public and Catholic school boards and the private and rural schools throughout Grey and Bruce counties. For the most up-to-date information, visit our website or contact your school to see the return-to-school plan.

Feeling anxious, you may want to take your children to get tested for COVID-19, just to be sure they do not have it. I want to explain to all parents that if there are no symptoms, and no close link to a confirmed case (as decided by local public health), then there is no practical benefit to getting your children tested. There is, however, potential harm. Let me explain.
 

• Testing for COVID-19 can be a traumatic event for some children. Like any other clinical test, there is the potential for complications, including possible short-term and long-term anxiety.
• False reassurance is another harm. Testing those who have no symptoms only lets them know that on the day they got tested, they were not shedding the virus. It is very possible to test negative one day (while incubating the virus), and then develop symptoms and test positive in a day or so. A negative test result is not a bullet-proof way to say that you or your child is COVID-19 free; all it really says is that “the children were not shedding the virus a couple of days ago when they were tested.”
• Testing in people who have no symptoms can result in false-positives and potential harm. A false-positive may cause significant and unintended anxiety in families linked to the false-positive. Self-isolation, more testing, inability to attend work, and fear/anxiety are real outcomes of a false-positive. Imagine getting a call from public health letting you know that you and your family have been exposed to COVID-19, when, in fact, you were not? Now, imagine that this happens to a number of families as their children attend the same class or school. This is not acceptable in my mind, and could cause significant harm. To that end, as the Grey Bruce medical officer of health, it is important to share that there are no practical benefits of mass testing (or anxiety-driven testing) of asymptomatic individuals and that potential harms are significant. As a key step in becoming a medical doctor, I took an oath that governs my practice; the most crucial promise within that oath is “First, do no harm.”
• Testing people with no symptoms puts undue pressure on provincial testing capacity and delays the results for people who actually do have symptoms. Delays in receiving results can pose significant risk to facilities that may be battling true outbreaks.

Getting a COVID-19 test would be appropriate and strongly recommended only in the following two scenarios:
 

• Public health has let you know that you are a close contact to someone who has COVID-19, based on a thorough risk assessment completed only by public health. Deciding who is a close contact is a decision that can be made only by public health. This decision as to who is a close contact cannot be made by your health-care provider or school official(s).
• Your health-care provider has told you to get tested because you have COVID-19-related symptoms.

If neither of these situations exists, testing would NOT be suggested, and in fact, public health strongly recommends against it.

The increase in the provincial case count is definitely not a reason to get tested.

If there is a case in your child’s school or class, that, in and of itself, is not a reason to get tested. If there is potential that you were a close contact to a person with COVID-19, public health will call you.

If you do not get a call from public health, you DO NOT need to get tested. I fully appreciate that if you find out there was a case in your child’s school, your anxiety may be elevated. Rest assured that we will notify you if you or your child need testing, and will do everything in our power to keep the children and staff in that school safe.

We work together with school officials throughout the school year, to ensure that the safety and well-being of both your children and the staff in the schools remain paramount. We are also working with the health-care providers of Grey-Bruce to support them in ensuring timely testing and care are in place for our children.

I would like to emphasize the unparalleled amount of support the provincial and local political leaders have provided during this emergency. The provincial government’s efforts based on the chief medical officer of health's recommendations have been a vital foundation for our local public health response to maintain full control over the outbreak, and to best position our communities for safe and successful school re-opening.

Despite the efforts, yesterday evening, local physician leaders informed me that the assessment centres’ capacity was pushed to the limit. Based on our local data from the previous few days, more than 90 per cent of the individuals seeking testing had no symptoms.

Why is this important? Heartbreakingly, last night an overwhelmed mother from Grey-Bruce E-mailed, calling on me to support the local health-care system “to ensure there is easy and timely testing for our children.” The mother described her multiple attempts to have her unwell child tested at an assessment centre. All attempts failed.

Last night, when I wrote this letter, looking at my three-year-old daughter in her bed, the only picture I had is of a parent looking at her sick child going to sleep without the test and care that was needed.

As a parent and medical officer of health, I would never have my child tested without proper cause. I would only consent to testing if my child had symptoms, or was considered a close contact and directed by public health to do so.

I implore you to help our hospitals and health-care providers to ensure no other unwell child goes to sleep without the necessary care need.

Yours very truly,
Dr. Ian Arra, MD MSc FRCPC ACPM ABPM
Grey Bruce medical officer of health