Navigating COVID-19 testing in the midst of cold season.

Chana Davis, PhD

Sep 30, 2020·8 min read

Last Friday, one of my three kids, a newly minted Kindergartener, developed a runny nose. Was it just a cold, or could it be COVID-19? This all-too-common occurrence kicked off our family’s first journey into COVID-19 testing.

To Test or Not to Test?

According to our provincial COVID-19 assessment guidelines, a runny nose alone isn’t enough to trigger testing or stay home from school.

To quote our BC’s Provincial Health Officer Dr. Bonnie Henry: “It’s a balancing act to make sure children are able to attend school as much as possible and minimizing the risk that they pose,”. This made sense to me, so I wasn’t initially too concerned.

Yet, things kept evolving. Saturday, one of my other kids, the twin sister of Ms Snotty Nose, told me at dinner that she had a bit of a tummy ache. My anxiety-meter went up a notch. Abdominal pain is a potential COVID-19 symptom. Was it the large ice cream cone that she had consumed a few hours earlier? I hoped so. Now both twins had one symptom, though neither one alone was a wire-tripper (test ASAP). As I tucked my girls in Saturday night, the one with the runny nose told me “Mommy, I feel sick”. Ugh. My anxiety went up another notch.

I started furiously googling the local COVID-19 testing guidelines, trying to figure out whether or not we qualified for testing, and how to do it. Moments later, I heard the dreaded sound: a tiny little cough. It was coming from the girls’ bedroom. Part of me was strangely relieved — there was no longer any doubt that we needed to get tested for COVID-19.

Sunday morning, my husband told the girls all about their upcoming test for “the coronavirus” and they eagerly practiced the procedure. Thankfully, our province recently launched a non-invasive COVID-19 test for kids that involves gurgling salty water.

As our nine year old boy sat watching his sisters, and feeling left out, we wrestled with more decisions. Should we test him, too? What about ourselves? We initially told him he didn’t need the test but he pushed back, announcing (for the first time) that his throat has been a bit sore lately. We were tempted to dismiss this claim as a strategy to be included in the adventure, but decided to play it safe, and get peace of mind. We were both symptom-free so opted not to get ourselves tested yet, but to stay away from others as a precaution.

The Waiting Game

By late morning, the three kids were tested and the waiting game began. We enjoyed a pancake breakfast, cancelled our plans for the day, and mapped out our anti-social day. We now faced more awkward decisions. Should we tell the neighbours — the other families that our kids often play with? We decided to share on a need-to-know basis rather than cold-calling everyone to announce the news. I told one mom down the street whose daughter was supposed to babysit later that day, but of course had to cancel. When a neighbour knocked on the door and asked our son to play, we told him that we couldn’t play until we got our test results back (and that it was a precautionary test, without a known exposure).

The Emotional Story

Throughout the day, my mind was all over the place. The emotional part of me couldn’t help playing out the worst-case scenario: one or more positive COVID-19 tests. Could my kids be one of the rare unlucky ones that has severe symptoms? Might there be long term effects? Could we have spread it to other people, including my mom who visits often? How would we cope with weeks of quarantine?

To make matters worse, I know I would blame myself. I have been the main driver of the decision to go back to school, and have even written and discussed on social media how I assessed the risk to be low, and well worth the benefits. Would I eat my words?

The Rational Story

The rational part of my brain was telling a different story. How likely is it that it’s COVID-19? What data can I use to wrap my head around this? Here’s a glimpse of the mental gymnastics I went through:

1. How common are colds / flus in my bubble?

A lot of people in our bubble, especially kids, have colds right now. If I had to guess, I’d say roughly 1 in 10 or 20 kids (let’s call it 1 in 15).

2. How common is COVID-19 in my community?

According to the latest COVID-19 data report, we are sitting at about 1 active COVID-19 case per 1,500 people in the city of Vancouver (441 new cases over 14 days, divided by 650,000 people, per regional map). The fact that this COVID-19 rate is 100 times lower than the cold /flu rate is a big relief.

The news gets better. In regions with extensive contact tracing system, such as here in BC, the actual exposure risk is probably lower than the raw population averages suggest. According to our BCCDC, only about 20% of cases are not part of known outbreaks, and most newly diagnosed cases are already in quarantine when tested (See Surveillance Report).

Furthermore, COVID-19 rates in kids tend to be lower than the population average, while rates in the 20–40s crew tend to be higher (See Surveillance Report)

Note: In cases where testing is not extensive (indicated by test positivity over 3%), or cases have been rapidly growing, the raw number can be an underestimate.

A more reasonable guess is probably closer to 1 in 3,000 kids have COVID-19. The exact number doesn’t really matter. The point is that it’s far more likely for most of us to be exposed to a cold or flu than to COVID-19.

3. What do our symptoms tell us about COVID-19 versus colds?

There is no one symptom, or set of symptoms, unique to COVID-19. Thus, symptoms offer very limited diagnostic value. Even fever, loss of taste and smell can happen with other viruses (this was the case for my brother).

That said, if your symptoms are common with colds, but rare with COVID-19 (like runny noses) this is cause for greater optimism.The reverse is true of symptoms that are more common with COVID-19 and less common with colds. This is why fevers are among the more worrisome symptoms.

It’s through this lens that the health leadership of British Columbia, recently removed runny noses from the official COVID-19 Symptom Checklist for schoolchildren. It’s not that they never occur with COVID-19, but rather that their predictive power, alone, is very weak, especially during cold season.

Given the extensive overlap of these symptoms with colds, and lack of the big kahuna — fever — my conclusion remained unchanged: statistically, it was far more likely that my kids had colds, not COVID-19.

My story: Our symptom list was quite a potpourri: runny nose (COVID-19 rare); cough (COVID-19 common); GI issues (COVID-19 common); sore throat* (COVID-19 moderate).* If you believe my son!

*See Appendix below for more on COVID-19 symptom frequency in children and adults.

4. Other key factors.

If you know you have been exposed to COVID-19, then the odds of a positive COVID-19 test skyrocket — the population average is no longer relevant. Similarly, if someone else in the house has a cold or other virus, this skews the odds of a cold in that direction.

Note: My back-of-the-envelope risk analysis assumes that colds and COVID-19 are equally contagious.

Guess the Test Results

As we got ready for bed, my husband and I played “guess the test results”. We are both scientists, having met in graduate school where we pursued our PhDs (mine in genetics, his in molecular evolution). I put the COVID-19 odds at about 2% and my husband put them at about 20%. As we discussed our divergent perspectives, I shared the insights I had gleaned from my machinations that day. He revised his guess downwards by a lot but still felt that 2% was a bit low. I felt that 2% might even be a bit high.

Drumroll Please…

We got our results by text message, almost exactly 24 hours after the tests were complete. They were negative and I walked the kids to school for recess with a bounce in my step, feeling grateful for our health, and our remarkable testing resources.

What an emotional ordeal. It’s going to be a long cold and flu season.

Closing Thoughts

One of the hardest things about pandemic life is the constant uncertainty. I hope that this glimpse into my family’s journey through COVID-19 testing helps you feel less alone, and perhaps a bit less stressed as you await your test results.

It’s natural to assume that every health issue is probably COVID-19, because this is on all of our minds. Yet, compared to colds, COVID-19 is very rare in most places. Simply thinking this through helped me sleep well as we awaited our test results.

At the same time, I want to be clear that getting tested for COVID-19 is the best course of action whenever you fit the public health guidelines. Even if your odds are slim, those rare cases add up at a population level. Getting tested is the right thing to do from a public health perspective (to protect others). It’s also likely to be a win for your family, offering peace of mind and less disruption than sending your kids to school, only to have them sent home.

Appendix

To learn more about COVID-19, check out your local public health websites. The British Columbia CDC has a great one, as does Health Canada.

COVID-19 symptom frequency:

Children:

“Reports have found fever (children 56% vs. adults 71%), cough (children 46% vs. adults 80%), and shortness of breath (children 13% vs. adults 43%) at a lower frequency in children. Gastrointestinal symptoms are often predominant in clinical presentation, including abdominal pain, diarrhea, nausea, and vomiting”. Source: Health Canada, Sept 39, 2020

Adults:

About Me

I’m a scientist and mother of three children. My son is beginning grade four, and my twin girls are starting kindergarten.

I completed my PhD in genetics at Stanford and spent the first decade of my career working in cancer research, drug development, and personalized medicine.

My new career chapter is dedicated to empowering others to make well-informed healthy choices, rooted in facts not fears. I’m also passionate about helping people to fall in love with the plants on their plates.

See more of my work, including articles, videos, podcasts, and healthy recipes at: https://FueledbyScience.com