Here's what parents need to know about COVID-19 as their children prepare to return to classrooms

As Manitoba families get ready to send their kids back to in-person school on Monday, some are worried about the risks that change might pose.

New cases are still surging in the province, as the highly infectious Omicron coronavirus variant causes a spike in hospitalizations and intensive care admissions among people with COVID-19.

The return to school is also set for just a few days after officials announced schools will no longer notify close contacts about cases. Instead, they'll focus on absenteeism due to COVID-19 as the province shifts its focus from stopping the illness from spreading to managing the risks it poses.

Here's what parents in Manitoba need to know about COVID-19 and their kids.

Will my kid be exposed to COVID-19?

In all likelihood, yes. At the rate Omicron is spreading, officials say, all Manitobans will probably be exposed to it in the next few weeks.

But it's not all bad news.

While the latest variant is highly contagious, it's "very, very rare" for it to make a child sick enough to be hospitalized, says pediatrician Dr. Jeff Burzynski, an emergency and intensive care physician at Winnipeg's Children's Hospital.

"Certainly, there are lots of kids that are becoming positive. There are very few, if any, that are being admitted to hospital with COVID symptoms or because of COVID," he said.

"I think parents really need to get the message that there [are] very few kids that we're seeing that had anything more than a typical viral illness in children that they've been seeing all of their kids' lives."

And parents aren't as helpless in the face of Omicron as they might feel. One of the best ways to protect kids is to get them fully vaccinated against the illness, says Dr. Fatima Kakkar, a pediatrician and infectious disease specialist at Montreal's Sainte-Justine hospital.

"At this point in the pandemic, children are likely going to see COVID — and either they see COVID vaccinated or unvaccinated," Kakkar told CBC's Information Radio host Marcy Markusa.

"What we're realizing is the effects are mitigated if they're vaccinated."

What will happen if they do get sick?

If your child's COVID-19 test comes back positive, don't panic. 

Omicron seems to be causing even less serious symptoms in kids than previous variants — and that's if they show symptoms at all, Burzynski says.

If they do have symptoms, he says, they'll likely include things such as a mild cough, runny nose or sore throat. In toddlers, Omicron may also cause croup, an inflammation of the upper airway. 

Those symptoms probably won't last long either, though parents can treat them by making sure kids stay hydrated and take Tylenol or Advil for a fever if needed.

And while more infections means we can expect more cases of serious illness than before, that doesn't mean Omicron is more likely to result in severe sickness than earlier variants, says Dr. Stephen Freedman, a professor of pediatrics and emergency medicine at the University of Calgary's Cumming School of Medicine.

"In fact, it probably is leading to more mild illness, more asymptomatic cases or mildly symptomatic cases," said Freedman, who's also a pediatric emergency medicine physician at the Alberta Children's Hospital.

Even multisystem inflammatory syndrome in children — a rare but serious condition that can be triggered by COVID-19 and cause inflammation in organs including the heart — hasn't been seen since previous waves, Burzynski says.

A spokesperson for Shared Health, which oversees health-care delivery in Manitoba, says the province has seen fewer than 20 instances of that condition, which happened largely during the second wave.

How do I know whether it's more serious?

If your child has a fever that lasts more than a couple of days while they have COVID-19, Burzynski says, that could require a trip to the doctor. The same goes for babies in their first three months with any fever at all.

And while rare, any signs of post-COVID multisystem inflammatory syndrome would likely appear about four to six weeks after infection. 

So if a child gets a persistent high fever around that time, along with a non-specific skin rash or red eyes or mouth, it's best to consult a doctor, Kakkar says.

How can I lessen my child's risk?

The best thing parents can do to protect their kids is to get them vaccinated when they're eligible — though right now, immunization rates among kids five to 11 are still far too low, Kakkar says. 

In Manitoba, just over half the kids in that age group had received their first dose as of Friday.

As for kids with conditions like asthma or chronic lung disease, parents can lessen the risk by making sure they're getting the proper treatment, Kakkar says.

"So, for example, if they have asthma, [make sure] that they're up to date with their inhalers, that they've seen their doctors," she said. 

Aren't there still kids ending up in hospital?

Yes, but that's in part because of the sheer number of Omicron cases.

Since the beginning of December — just before Omicron was first detected in Manitoba — less than 0.7 per cent of kids with COVID-19 were admitted to hospital, Dr. Brent Roussin, Manitoba's chief provincial public health officer, said this week.

More than two-thirds of those children were actually hospitalized for unrelated reasons — ones that were not worsened by their COVID-19 infection — and happened to test positive when they got there, Roussin says. 

Burzynski says that's in line with what he's seeing in the hospital, where during a typical emergency room shift he now sees "definitely over 50 per cent" of kids test positive for COVID-19 during routine swabbing.

But anywhere from one-third to half of those children make up what are known as incidental cases, where kids had come in for another reason — from a broken elbow to a mental health concern to appendicitis — without knowing they had the coronavirus. 

And as COVID-19 cases have skyrocketed in Manitoba, so has worry among parents — many of whom end up bringing their kids to the hospital because they don't know what else to do, Burzynski says.

"The kids are really not unwell in any way — like they've got maybe a little bit of a cough or a runny nose — but [the parents are] just obviously worried: 'Oh my god, what do I do with a COVID-positive kid now?'" Burzynski said.

"So that's where our job is as ER physicians, pediatricians to sort of spend that extra bit of time to sort of counsel the families."

Among Manitoba kids who have caught COVID-19 since December, rates of hospitalization were also slightly higher with younger kids, Roussin says: 0.58 per cent for those under five, 0.18 per cent for those five to 11 and 0.11 per cent for those 12 to 18.

Burzynski says that makes sense, too — not because younger kids are seeing more severe illness, but because doctors are much more cautious with them.

"We'll likely hang on to those kids in a higher number than we would an adolescent or somebody who's eight or nine or 10 years old," he said.

What if my kid gets sick before they're vaccinated?

First, make sure they're done self-isolating and feeling better.

If you don't, they could spread the illness — and the vaccine is unlikely to be very helpful while their immune system is already fighting an infection, the medical lead of Manitoba's vaccine task force said this week.

Dr. Joss Reimer also said anyone who was sick but didn't take a COVID-19 test should assume they had the illness and follow the same rules.

And while you don't need to drop everything and run to a vaccine clinic the day your kid feels better, Reimer says, waiting about an extra month after an infection to get another vaccine dose seems reasonable for most people.

So how do I know what's worth worrying about?

For Freedman, making a risk assessment for your family comes down to looking at the evidence that's available and identifying the themes most experts are touching on — and not just listening to the loudest, most extreme voices.

"You really don't want to be an outlier on any extreme," he said. "[Try] to follow where the general consensus of the vast majority of experts lies."

Todd Cunningham, a registered school and clinical child psychologist in Toronto, says it can be easy to focus on the negatives of something like sending your kids back to school.

But it's important to weigh the potential risk of them getting COVID-19 against the risks they face being stuck at home — from increased rates of depression and loneliness to health effects caused by too much screen time and not enough physical activity.

"It is really about … openly entering into that conversation, and not just having an immediate reaction to kind of how you're feeling," Cunningham said.

"Ask yourself, 'Why am I feeling that? Does that make sense? And does the decision make sense in the context of what seems to be known about COVID and what is required for our family?'"