Philadelphia Continues to Encourage Testing, Masking, and Isolation of Schoolchildren for Covid-19

Parents following guidance could unnecessarily keep children home from school.

Most Americans have moved on from the pandemic, but yesterday the Philadelphia Department of Public Health announced the availability of free Covid-19 tests for schoolchildren in the country’s sixth-largest city. In addition, they repeatedly linked to “isolation, exposure, and testing guidance” that, while aligned with current CDC guidance, has basically been abandoned by the vast majority of parents and is inconsistent with Covid-19 guidance from public health agencies in our peer countries.

Philadelphia’s public health department continues to recommend parents test, mask, and quarantine schoolchildren.

Beneath a photo of a child (likely) suffering through (yet another) invasive nasal swab test, Philadelphia’s public health department told parents the following in English and Spanish:

Summer vacation isn’t over yet, but as we approach the hectic back-to-school rush, we want to put something other than school supplies on every parent’s radar – COVID-19 tests. They’re free through the Health Department’s Pediatric Partnerships team in time for the start of the school year.

While the nation’s Public Health Emergency ended in May, it’s important to take precautions and protect our kids from COVID-19, especially as indoor gatherings ramp up when the school year begins. COVID-19 is not over. That’s why every family should be equipped with tests at the ready if someone is exposed to COVID-19 or symptoms begin.  

There are a few issues here that I’d like to unpack:

1. The idea that schools should be treated as an exceptionally dangerous environment for Covid-19 transmission, which a number of studies have concluded is not true.

2. The thinking that children require some sort of special protection from Covid-19. While this is true for a small number of medically vulnerable children, almost all children have already met the virus. Those that haven’t — or are re-infected — will likely be asymptomatic or experience very mild disease.

3. The belief that Covid-19 will ever be “over.” We knew years ago that we are stuck with this virus for the rest of our lives.

4. Countries like Sweden and Norway no longer recommend testing of symptomatic adults, let alone symptomatic or exposed children. It is extreme to recommend healthy children who have merely been exposed to the virus be tested.

According to Philadelphia public health officials, an exposed child shouldn’t just receive one test, but should be forced to submit to serial testing:

Remember to test in threes! The virus can take some time after exposure to reach a level that turns a test positive, so test three times, every other day. During that time, it’s important to wear a well-fitting, high-quality mask or stay home to keep other people safe. If you receive positive test results, you’ll be able to take the right steps to protect yourself, your family and your community. 

It’s noteworthy that Philadelphia’s rapid test announcement is inconsistent with its own health department guidance and suggests exposed children “wear a well-fitting, high-quality mask or stay home to keep other people safe.” Given health department and CDC guidance both only recommend masking after exposure, it’s problematic to treat staying home from school as a viable alternative to masking. (To be clear, I personally don’t think exposed children should have to mask.) Of course, all of this is only an issue because CDC and Philadelphia bizarrely continue to recommend exposure testing, which, again, is not the case in many of our peer countries.

At a time when educators are trying to address dramatic learning loss from extended pandemic school closures — and Philadelphia children missed over a year of formal schooling — parents following the city’s guidance could potentially remove an exposed or asymptomatic child from school for over a week. While quarantined for exposure or isolated with an asymptomatic positive test, the child would not receive virtual instruction and would suffer even more disrupted learning and time spent in a potentially unsafe home environment.

Given rapid tests can sometimes lead to false positives, healthy children may unnecessarily miss several weeks of school over the course of the academic year. Indeed, school avoidant children — and this behavior has significantly increased during the pandemic — might even intentionally produce false positives to avoid attending class.

Philadelphia still recommends exposed children be tested for Covid-19 and isolate at home, even if asymptomatic.

As data analyst Kelley K. recently noted, this coming school year will be the fifth academic year living with Covid-19. It is unreasonable to disrupt yet another year with outdated testing, masking, and isolation guidance when the vast majority of children have already been infected, vaccinated, or both. While Philadelphia public health officials are likely just trying to follow CDC guidance, it’s a choice — and I would submit a bad choice — to prominently endorse exposure testing and asymptomatic isolation on the city’s Web site. Instead, sick children should simply be advised to stay home until they feel better. And, yes, we should make it easier for parents and guardians to care for their sick children.