The paediatricians we surveyed felt that the increase in outpatient paediatric infections could also be accounted for by increased testing. Many schools have been forced to close grades or classes for a period of time to allow for quarantine. Fortunately these children and teenagers have mostly had only mild symptoms and yet they present a source of infection to others in the community and therefore pose a risk.

Our impression is that schools are not high risk places. Most schools have excellent COVID protocols in place and follow them carefully. It seems rather that families are dropping their guards and taking unnecessary risks and that this results in infected children going to school so that increased numbers of COVID cases at school reflects what is going on in the community. Outbreaks at schools have more often been associated with children socialising at home or playing contact sport together than spending time together in a well ventilated classroom.

We all feel so guilty that our children have missed out on social and sporting occasions due to various levels of lockdown. We don’t want them to miss out on any more. When they have a COVID contact, we try to minimise it so that they can continue playing, ignoring the potential risk to others around them. Somehow we perceive the depth of our children’s losses as being unbearable for them. The perspective seems to be that making our children lose out is even worse than depriving ourselves.

A problem we frequently encounter is parents who send their children to school while waiting for a COVID PCR result. Sometimes the result is positive and the parents have to explain to the school how they knowingly sent a potential COVID case to school. Believe me, this is a very awkward conversation.

What about play dates?
Such a sweet thing is a play date. Do I think we should ban them? Most certainly not. But snotty or coughing kids must stay home. Try to keep play dates short and have them outside or in well-ventilated areas. Keep masks on when possible. It all requires extra effort and thinking – as if parenting wasn’t hard enough!

Here are a few more issues that we are seeing commonly come up in our GP practices:

Q: My child had a COVID contact last Saturday. Can he play soccer this Sunday? (Day 8. I will take him for a rapid COVID test the day before? He will wear a mask and sanitise before the match?)
A: Unfortunately not. He needs ten full days of quarantine.

Q: My child has a snotty nose. I’m sure it’s a normal winter cold. Can he go to school if the COVID rapid test is negative?
A: Nope. The rapid antigen test is not sensitive enough to rule out COVID; plus no child should go to school with any symptoms regardless of test result even if it was a PCR.

Q: After a COVID contact: Can my child have a COVID PCR test on Day 5 and then return back to school on Day 6 if it is negative?
A: This is not recommended. The Day 5 test was introduced by CDC for healthcare workers who needed to return back to work largely due to staff shortages. It is assumed the person is wearing appropriate PPE (including a medical mask) and that healthcare workers will be excellent at sanitising and social distancing. Save the money and keep your child at home for the full 10 days. It’s only worth testing if they become symptomatic.

Q: What are the symptoms of COVID in small children?
A: Mostly it’s like a cold or flu. The possible symptoms include: nasal congestion or runny nose, sore throat; ears can get sore too. Postnasal drip. Cough. VERY rarely they can get COVID pneumonia. They can also get diarrhoea and/or vomiting. Not every child gets every symptom. As you can see, COVID can present like other illnesses: the common cold, bronchitis, sinusitis, gastroenteritis. This is what makes it tricky. This is why sick children should stay at home. I generally do a COVID swab on all children who come to me with suggestive symptoms. I find most are negative, but every now and then one is positive. Usually someone in the household is also positive. We aren’t seeing a lot of small children picking COVID up at school.

Q: My husband tested positive today and the doctor said the chances of my two-year old and myself having it is good. Should we isolate away from each other? I have not shown any symptoms yet and my daughter had a runny nose from Friday, but she looks much better.
A: It’s very hard for parents to isolate themselves from their small children. I generally advise that children stay with their mother but if mom is too sick, then Dad or another caregiver has to get involved. Often the family unit ends up isolating together. If the other parent becomes COVID positive, the isolation is extended by another 10 days. It’s tempting to leave your children with their grandparents, but this is not advisable because there is a chance that your children could carry the virus and infect a grandparent. It’s often not possible to achieve ideal isolation in a family with small children. Just do your best.

It’s time to ramp up our COVID response with patience, kindness, self-control, and self-sacrifice. These are principles that get lost in our fast-paced world. COVID is teaching us to put others before ourselves, to wait it out and to act for the human good. These are the values we would like to pass onto our children too. As we say in South Africa – Sterkte – for the third wave!

Dr Karin van der Merwe is the Gauteng General Practitioners Collaboration.