Evidence from the UK and internationally tells us that COVID-19 is generally milder in children than in adults: most infected children present with mild symptoms or are asymptomatic, and few very rarely develop severe or life threatening disease.
It is also important to consider that schools play a key role in promoting children’s health, social and mental wellbeing. They also provide the setting from which children can access health surveillance, support and advice as well as individual and group therapeutic programmes.
RCPCH advice on children who are clinically extremely vulnerable has been accepted by the UK Chief Medical Officers. In light of this, most children who were told to shield in March 2020 need to be taken off the shielding list and will be able to attend school and their normal activities as per UK Governments’ advice. For the smaller group of children who are still considered to be clinically extremely vulnerable, they also can return to school whilst shielding has been paused, however, if the UK Governments decide to recommence shielding then those on the list will need to shield and therefore stay at home.
Children will need to be actively removed from the list either by paediatricians or if only seen in primary care by their GPs. This has been agreed with the Royal College of GPs. A GP may ask for advice and guidance on specific patients, if this is the case they can be advised by following our guidance.
We are aware that families are understandably worried and confused in light of school re-opening. The College will continue to update current evidence on COVID-19 and children, and members are encouraged to use this when advising families.
Common cold and COVID-19 symptoms
As schools return we recognise paediatricians may receive queries from the families they see on what to do if and when a child develops this winter the usual coughs and colds. Below we describe the current evidence around indications for testing for children. This article may also be helpful to families and schools.
- As children return to schools after a prolonged break, we expect colds and similar viral infections to circulate. Parents will want to know which symptoms will warrant testing for COVID-19 (and remain away from school whilst awaiting results) and those which on probability do not justify testing (and can therefore stay in school). This will ensure that children are not unnecessarily kept away from schools and exposed to inappropriate testing.
- To help make that decision we have the following information:
- Evidence from the UK and internationally tells us that COVID-19 is generally milder in children than in adults: most infected children present with mild symptoms or are asymptomatic, and very few rarely develop severe or life-threatening disease.
- Similarly, hospital admission rates for children with evidence of COVID-19 infection are far lower than those of adults, with only 2% of all admissions occurring in children and young people below the age of 18 and 1.1% below the age of 5.1
- Fever and cough were the commonest symptoms for any child requiring hospital admission. Of 651 children admitted to hospital with COVID-19, 70% had fever and 39% had a cough.2 Less than 1 in 10 of these children were reported to have coryzal symptoms (runny noses) or sore throats.
- Most admissions occurred during the peak of the pandemic, when areas such as London had a COVID-19 prevalence of about 10%. The current prevalence rate is no higher than 0.2% in any region of the UK at present (8 September), so the risk of a child actually having COVID-19 presently is far lower.
- The evidence we have on transmission of COVID-19 in schools is also extremely reassuring. There is good data from the UK showing that children (especially primary school aged children and younger) are about half as likely to be infected with COVID-19 than adults.3 Children also appear to transmit COVID-19 less readily than adults; there have been very few reported COVID-19 outbreaks in nurseries or schools, either in countries like Denmark that reopened their schools early in the pandemic (15 April) and in Sweden and Iceland did not close their schools at all during the pandemic.4
- Equally reassuring for teachers, in those countries that have kept schools open, such as Sweden, teachers do not have higher rates of COVID-19 than the general population (and they have lower rates than professions such as supermarket workers and taxi drivers).5
From this available evidence we believe that children with simple cold symptoms such as coryzal symptoms (runny noses) or sore throats without fever who would normally have attended schools in other times should not be tested for COVID-19.
This is in agreement with current PHE guidance for deciding when to test. These symptoms are:
- new continuous cough
- fever/high temperature
- loss of, or change in, sense of smell or taste.
Following this guidance allows the identification of children most likely to be infected and help detect any emerging outbreak.
Some children with chronic respiratory illnesses (such as cystic fibrosis) may have more frequent coughs. If possible, local arrangements need to be in place to ensure they can also be routinely tested for COVID-19 when they develop a new persistent cough which fits PHE criteria at the same time as they have bacterial cough swabs.
In addition to testing, it is also important that parents keep children at home when they are unwell and children are actively encouraged to follow good hygiene measures.
The Department for Education’s plan is that all pupils, in all year groups, will return to school full-time from the beginning of the autumn term.
Other guidance in England (Department for Education)
- Guidance and advice hub (DfE)
- Guidance on full opening of schools
- Implementing protective measures in education and childcare settings
- What parents and carers need to know about schools and other education settings during the coronavirus outbreak (guidance until August 2020)
In Scotland, all children will return to school on 11 August 2020.
The Scottish Government have published a parents FAQs page on the reopening of schools and early learning and childcare on their parentclub website. This will continue to be updated as information becomes available.
Other guidance from Scottish Government:
- Shielding advice
- Preparing for the new school year
- Strategic framework for reopening schools, early learning and childcare provision
- Curriculum for Excellence in the Recovery Phase
- Support for continuity in learning
In Wales, schools were open throughout the COVID period for children of key workers and this was extended in June so that most children had some contact with schools before the summer holiday. In July, the Education Minister Kirsty Williams announced that all pupils will be able to return to school in September. This was based on advice from the Welsh Government’s Technical Advisory Group. In Wales, the school term starts on September 1 but there is some flexibility for schools to prioritise certain groups for the first two weeks of term.
- Back to school plans from September (Welsh Government guidance)
- Education and childcare: coronavirus (Welsh Government documents listed with regular updates)
- Schools increasing operations from 29 June: coronavirus (Welsh Government guidance for June 29 until end of term)
- Technical Advisory Group: advice on return to school
The start of term will be 24 August 2020 for Primary 7, Year 12 and Year 14 pupils and for vulnerable children across all year groups. All other pupils will return at normal autumn term start dates, which may vary depending on school. Department of Education has published the following guidance:
- Guidance on the new school day for mainstream
- Guidance for SEN schools
- Guidance for pre-school settings.
- Since 29 June any parent / carer can access childcare as facilities re-open and begin to build capacity. The Child Care Recovery Plan is available here.
Latest updates on this page
Updates in this version (18th September)
- Minor edits to Common Cold and COVID - 19 symptoms section
Updates in version 9 September
- Section on Common Cold and COVID-19 symptoms added.
Updates in version 17 August
- Northern Ireland: Updated link to Guidance on the new school day for mainstream
Updates in version 3 August 2020
- Updated advice regarding children who were shielding.
- Updated information on plans to reopen schools in England, Scotland, Wales and Northern Ireland.
- 1. Swann Olivia V, Holden Karl A, Turtle Lance, Pollock Louisa, Fairfield Cameron J, Drake Thomas M et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study BMJ 2020; 370 :m3249 ISARIC (International Severe Acute Respiratory and Emerging Infections Consortium) COVID-19 Report: 13 July 2020 media.tghn.org/medialibrary/2020/07/ISARIC_Data_Platform_COVID-19_Report_13JUL20.pdf
- 2. Swann Olivia V, Holden Karl A, Turtle Lance, Pollock Louisa, Fairfield Cameron J, Drake Thomas M et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study BMJ 2020; 370 :m3249
- 3. Viner RM, Mytton OT, Bonell C, Melendez-Torres CJ, Ward JL, Hudson L, Waddington C, Thomas J, Russell S, van der Klis F, Koiral A, Ladhani S, Panovska-Griffiths J, Davies NG, Booy R, Eggo R. Susceptibility to and transmission of COVID-19 amongst children and adolescents compared with adults: a systematic review and meta-analysis. www.medrxiv.org/content/10.1101/2020.05.20.20108126v2
- 4. ECDC. COVID-19 in children and the role of school settings in COVID-19 transmission. www.ecdc.europa.eu/sites/default/files/documents/COVID-19-schools-transmission-August%202020.pdf
- 5. Report in Swedish www.folkhalsomyndigheten.se/contentassets/5e248b82cc284971a1c5fd922e7770f8/forekomst-covid-19-olika-yrkesgrupper.pdf